This work discusses the clinical performance of chromogranin A, free metanephrine and normetanephrine determination in plasma using a radioimmunoanalytical methods for the diagnosis of pheochromocytoma and paraganglioma. Blood samples were collected from 55 patients (46 pheochromocytomas, 9 paragangliomas). A sampling of biological materials was performed preoperatively and about one week, six months and one year after adrenal gland surgery. The comparative group without a diagnosis of pheochromocytoma/paraganglioma consisted of 36 pheochromocytoma/paraganglioma patients more than 4 months after adrenal gland surgery, and of 87 patients, 16 of them with multiple endocrine neoplasia, 9 with medullary and 5 with parafolicullar carcinoma of the thyroid gland. The rest were patients with various adrenal gland disorders. Chromogranin A, metanephrine and normetanephrine were determined in the EDTA-plasma using a radioimmunoassay kits Cisbio Bioassays, France and IBL International GmbH, Germany. Clinical sensitivity was 96 % for the combination of metanephrine and normetanephrine, and 93 % for chromogranin A. Clinical specificity was 100 % for the combination metanephrine and normetanephrine, and 96 % for chromogranin A. Falsely elevated levels of chromogranin A were observed in 1 patient with chronic renal insufficiency and 9 analyses were influenced by the administration of proton pump inhibitors. These results were excluded of CGA specificity. Both the combination of plasma free metanephrine, normetanephrine and chromogranin A as determined by radioimmunoassays, which are simple without the necessity of special laboratory material, are effective markers of pheochromocytoma or paraganglioma. Chromogranin A exerts association to malignity and all markers are associated with tumor mass.
- MeSH
- chromogranin A krev MeSH
- dospělí MeSH
- feochromocytom krev diagnóza MeSH
- lidé středního věku MeSH
- lidé MeSH
- metanefrin krev MeSH
- mladiství MeSH
- mladý dospělý MeSH
- nádorové biomarkery krev MeSH
- nádory nadledvin krev diagnóza MeSH
- normetanefrin krev MeSH
- radioimunoanalýza metody MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE: The aim of this study was to assess the diagnostic value of catecholamines and their O-methylated metabolites in vitreous humor samples in identifying antemortem cold exposure and fatal hypothermia in the forensic casework. METHODS: A total of 80 autopsy cases (40 hypothermia fatalities and 40 cases in which hypothermia as the main or contributory cause of death was excluded) were selected for this study. Catecholamines and their O-methylated metabolites were measured in urine and vitreous humor samples collected at autopsy. RESULTS: Urine catecholamine and their O-methylated metabolite concentrations were significantly higher in hypothermia-related deaths. On the other hand, measurements in vitreous humor samples did not reveal statistically significant differences between hypothermia-related deaths and controls. CONCLUSIONS: Globally considered, our findings seem to suggest that, contrary to urine catecholamines and their O-methylated metabolites, vitreous levels of these compounds appear to be of limited value in characterizing human antemortem stress reactions due to cold exposure and can hardly be used in the forensic setting to support the diagnosis of hypothermia.
- MeSH
- adrenalin metabolismus MeSH
- dopamin analogy a deriváty metabolismus MeSH
- dospělí MeSH
- hypotermie diagnóza metabolismus MeSH
- katecholaminy metabolismus MeSH
- lidé středního věku MeSH
- lidé MeSH
- metanefrin metabolismus MeSH
- mladý dospělý MeSH
- noradrenalin metabolismus MeSH
- normetanefrin metabolismus MeSH
- posmrtné změny MeSH
- senioři MeSH
- sklivec metabolismus MeSH
- soudní patologie MeSH
- studie případů a kontrol MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
This work discusses the clinical performance of deconjugated metanephrine (MN), normetanephrine (NMN) and 3-methoxytyramine (3MT) determined in the basal first morning urine using a chromatographic method with electrochemical detection for the clinical diagnosis of pheochromocytoma (PHEO) and paraganglioma (PGL). Urine samples were collected from 44 patients (36 with PHEO, 8 with PGL) aged 54+/-17 (20-78) years (22 females, 22 males). A sampling of biological materials was performed preoperatively and about one week, six months and one year after adrenal gland surgery. The control group consisted of 34 PHEO/PGL patients more than 4 months after adrenal gland surgery. All subjects in the control group were without a diagnosis of PHEO or PGL. Clinical sensitivity was 55 % for MN, 64 % for NMN, 80 % for combination of both MN and NMN, and only 23 % for 3TM. Clinical specificity calculated from the control group was 93 % for MN, 95 % for NMN, 95 % for the combination MN and NMN, and 97 % for 3TM. Cut-off values for deconjugated metanephrines in the basal urine were 310 (MN), 690 (NMN) and 250 microg/l (3MT). Chromatographic determination of deconjugated urinary metanephrines, which is simple without the necessity of special laboratory material, can serve for the screening of PHEO or PGL patients. Urine NMN and 3MT exerts an association to malignity, and all markers are associated with tumor mass. However, the principal laboratory diagnosis of PHEO or PGL must be based on plasma-free metanephrines and plasma chromogranin A with better performance in the laboratory diagnosis of PHEO or PGL.
- MeSH
- biologické markery moč MeSH
- dopamin analogy a deriváty moč MeSH
- dospělí MeSH
- feochromocytom diagnóza moč MeSH
- klinické laboratorní techniky metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- metanefrin moč MeSH
- mladý dospělý MeSH
- nádory nadledvin diagnóza moč MeSH
- normetanefrin moč MeSH
- paragangliom diagnóza moč MeSH
- senioři MeSH
- vysokoúčinná kapalinová chromatografie metody MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Feochromocytóm (FEO) a paraganglióm (PGL) sú neuroendokrinné tumory, ktoré vznikajú zo sympatických a parasympatických paraganglií. FEO sa najčastejšie prejavuje trvalou alebo záchvatovitou hypertenziou, bolesťami hlavy, potením, palpitáciami a úzkostnými stavmi. Diagnostika sa zakladá na typickom klinickom obraze a biochemickom potvrdení stanovením plazmatického normetanefrínu a metanefrínu, ktoré majú takmer 100% senzitivitu a sú vyšetrením voľby. Na lokalizáciu nádoru v bruchu a panve je metódou voľby počítačová tomografia (CT) alebo magnetická rezonancia (MRI). Definitívnou a kauzálnou liečbou je chirurgické odstránenie tumoru, a to preferenčne laparoskopicky. Hlavným cieľom predoperačnej liečby je normalizácia krvného tlaku, frekvencie srdca, obnova normovolémie a prevencia katecholamínovej „búrky“ a jej účinkov na kardiovaskulárny systém pri manipulácii s tumorom v priebehu operácie. Autori navrhujú pri hypertenznej kríze iniciálnu liečbu intravenóznym urapidilom, v prípade perzistujúcej tachykardie v kombinácii s perorálnym metoprololom podávaným s časovým posunom po dosiahnutí dostatočnej alfa blokády a/alebo s kalciovým blokátorom amlodipínom. Cieľom práce je upozorniť na úskalia v diagnostike feochromocytómu a ukázať možnosti súčasného predoperačného manažmentu, ktorý by mal zabrániť vážnym poškodeniam detí s FEO. Ošetrujúci lekár by mal rozpoznať a aktívne pátrať po týchto tumoroch, hlavne v kontexte známej genetickej predispozície (von Hippelovom-Lindauovom syndróme, mnohopočetnej endokrinnej neoplázii typu 2, pri neurofibromatóze typu 1 a paragangliómoch). Feochromocytóm nemusí vždy prebiehať pod typickým klinickým obrazom a preto je najdôležitejšou súčasťou jeho diagnostiky myslieť na túto možnosť a pri podozrení ju potvrdiť biochemicky.
Pheochromocytomas and paragangliomas (PHEO/PGL) are neuroendocrine tumors that arise from sympathetic and parasympathetic paraganglia. PHEO presents most frequently by permanent or paroxysmal hypertension, headache, sweating, palpitations and anxiety. Diagnosis is based on typical clinical presentation confirmed by biochemical measurement of plasma metanephrines and normetanephrines with the sensitivity almost up to 100% being the test of choice for the diagnosis of PHEO. The morphological test of choice is either computed tomography or magnetic resonance imaging, which have similar diagnostic sensitivities of the abdomen and pelvis. Definitive and causal treatment is by surgical resection and the procedure of choice for most PHEO is laparoscopic adrenalectomy. Main goal of preoperative management is normalization of blood pressure, heart rate, reinstitution of normovolemia and prevention of catecholamine „storm“ and its effects on cardiovascular system during manipulation with tumor in the course of operation. Authors suggest as initial treatment in hypertensive crisis intravenous urapidil and in case of persisting tachycardia the combination with metoprolol after adequate time delay to achieve satisfactory alpha blockade and/or calcium channel blocker amlodipine. The aim of the report is to draw attention to difficulties in diagnostics of PHEO and to outline current approaches to preoperative management to prevent severe adverse events of children suffering from this tumor. The pediatric provider should be able to recognize and screen for such tumors, particularly in the context of a known genetic predisposition (von Hippel-Lindau syndrome, MEN type 2, neurofibromatosis type 1, and paragangliomas). The clinical presentation of PHEO might be sometime atypical so most important part of correct diagnosis depends on having a clinical suspicion for it and then confirming the diagnosis biochemically.
- Klíčová slova
- hypertenzní krize, urapidil, palpitace,
- MeSH
- adrenalektomie MeSH
- alfa-1-adrenergní receptory - antagonisté terapeutické užití MeSH
- antihypertenziva terapeutické užití MeSH
- bolesti hlavy etiologie MeSH
- dítě MeSH
- feochromocytom * diagnóza chirurgie patofyziologie MeSH
- hypertenze * etiologie farmakoterapie MeSH
- katecholaminy metabolismus MeSH
- lidé MeSH
- metanefrin krev MeSH
- normetanefrin krev MeSH
- piperaziny aplikace a dávkování MeSH
- pocení MeSH
- předoperační péče MeSH
- úzkost etiologie MeSH
- von Hippelova-Lindauova nemoc komplikace MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
OBJECTIVES: Detection of free plasma metanephrines seems to be the most exact method for biochemical diagnosis of pheochromocytoma, but their diagnostic efficacy in the common low-risk clinical settings is debated. METHODS: A cross-sectional multicentre study including 1260 subjects assessed the diagnostic efficacy of free plasma metanephrine and normetanephrine in low-risk patients screened for resistant or markedly accelerated hypertension, paroxysmal hypertension, 'flushes' and, in a small proportion, for adrenal incidentaloma or genetic predisposition to pheochromocytoma. RESULTS: Pheochromocytoma was identified and verified by histology in 25 subjects (2%), with the diagnosis not confirmed by long-term follow-up or use of imaging techniques in the remaining 1235 individuals. The combined assay of free plasma metanephrines was a highly sensitive (100%) and specific (96.7%) measure, yielding a negative predictive value of 100%. CONCLUSION: The satisfactory diagnostic efficacy of free plasma metanephrines allows their use as a single screening test in cases of suspected pheochromocytoma in the population with a low pretest probability.
- MeSH
- feochromocytom diagnóza epidemiologie krev MeSH
- lidé středního věku MeSH
- lidé MeSH
- metanefrin krev MeSH
- nádory nadledvin diagnóza epidemiologie krev MeSH
- normetanefrin krev MeSH
- plocha pod křivkou MeSH
- plošný screening metody MeSH
- prediktivní hodnota testů MeSH
- průřezové studie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- multicentrická studie MeSH
- MeSH
- feochromocytom diagnóza MeSH
- hypertenze diagnóza patofyziologie MeSH
- interpretace statistických dat MeSH
- lidé MeSH
- metanefrin analýza krev metabolismus MeSH
- nádorové biomarkery analýza krev MeSH
- normetanefrin analýza krev metabolismus MeSH
- senzitivita a specificita MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- srovnávací studie MeSH
- MeSH
- alfa blokátory škodlivé účinky MeSH
- antidepresiva tricyklická škodlivé účinky MeSH
- biochemie MeSH
- clonidin MeSH
- dospělí MeSH
- falešně pozitivní reakce MeSH
- fenoxybenzamin škodlivé účinky MeSH
- feochromocytom diagnóza farmakoterapie krev moč MeSH
- lékové interakce MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory nadledvin diagnóza farmakoterapie krev moč MeSH
- noradrenalin krev moč MeSH
- normetanefrin krev moč MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- souhrny MeSH
- MeSH
- cirkadiánní rytmus MeSH
- katecholaminy moč MeSH
- lidé MeSH
- normetanefrin moč MeSH
- spánková deprivace MeSH
- Check Tag
- lidé MeSH
- MeSH
- lidé MeSH
- metanefrin fyziologie MeSH
- normetanefrin fyziologie MeSH
- spánková deprivace patofyziologie MeSH
- Check Tag
- lidé MeSH
