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Diagnosis

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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)

  • 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:

  1. 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.
  2. Young MF. The Incidentally Discovered Adrenal Mass Young WF Jr N Engl J Med 2007; 356:601.
  3. 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.

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