diagnosis
Last reviewed 07/2021
A diagnosis of phaeochromocytoma can be confirmed from:
- biochemical
confirmation
- 24 hour urinary free catecholamines, VMA's
- high performance liquid chromatography for catecholamines - in plasma/urine
- radioimmunoassay
(RIA) for urinary/plasma metanephrines
- in adrenal incidentalomas
- 24-hour urinary fractionated metanephrines and catecholamines (1,2)
- fractionated catecholamines in the 24-hour urinary specimen linked to dopamine-secreting neoplasms
- when normal diagnosis can be excluded
- phaeochromocytoma
- plasma
normetanephrine
- the best single parameter- highest sensitivity and specificity (1)
- test of choice for the diagnosis or exclusion
- serum VMA and serum creatinine levels elevated
- serum CgA significantly higher
- chromogranin-
A (CgA) is secreted by chromaffin cells (3)
- chromogranin-
A (CgA) is secreted by chromaffin cells (3)
- plasma
normetanephrine
- in adrenal incidentalomas
-
tumor localization
- MRI
- computerized tomography (CT) of the abdomen
- detect lesions as small as 0.5 inches
- imaging phenotype - shows
characteristics of an adrenal mass on imaging (1)
- increased attenuation on CT
- prominent vascularity
- delayed washout of contrast medium
- confirmation
- increased uptake of a radiolabelled catecholamine precursor in the site of the tumour
- meta-iodobenzyl guanidine (MIBG, I-131 or 123) scintigraphy has been used to identify metastases, recurrent tumors and tumors in rare sites such as the pericardium and urinary bladder
- MIBG is an adrenergic tissue
localizing agent resembling norepinephrine
- MRI and MIBG scintigraphy are more sensitive than CT
Older investigations/tests that may be used in the diagnostic workup:
- clonidine suppression test
- pentolinium suppression test
- adrenal angiography
Reference:
- Unger N et al.Diagnostic value of various biochemical parameters for the diagnosis of pheochromocytoma in patients with adrenal mass. Eur J Endocrinol. 2006 Mar;154(3):409-17.
- Young MF. The Incidentally Discovered Adrenal Mass Young WF Jr N Engl J Med 2007; 356:601.
- Giovanella L et al. Diagnostic value of serum chromogranin-A combined with MIBG scintigraphy in patients with adrenal incidentalomas. Q J Nucl Med Mol Imaging. 2007 Jun 1.