Preanalytical considerations and out-patient vs in-patient tests of plasma metanephrines to diagnose pheochromocytoma

Pommer, G. et al. (2022) Preanalytical considerations and out-patient vs in-patient tests of plasma metanephrines to diagnose pheochromocytoma. Journal of Clinical Endocrinology and Metabolism, 107(9), e3689-e3698. (doi: 10.1210/clinem/dgac390) (PMID:35767279)

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Abstract

Context: Sampling of blood in the supine position for diagnosis of pheochromocytoma and paraganglioma (PPGL) results in lower rates of false-positives for plasma normetanephrine than seated sampling. It is unclear how in-patient versus out-patient testing and other preanalytical factors impact false-positives. Objective: Identify preanalytical precautions to minimize false-positive results for plasma metanephrines. Design: Impacts of different blood sampling conditions on plasma metanephrines were evaluated, including out-patient versus in-patient testing, sampling of blood in semi- versus fully recumbent positions, use of cannulae versus direct venipuncture and differences in outside temperature. Setting: Ten tertiary referral centers Patients: 3147 patients tested for PPGL, including 278 with and 2869 without tumors. Interventions: None. Outcome measures: Plasma metanephrines and rates of false-positive results. Results: Out-patient rather than in-patient sampling resulted in 44% higher plasma concentrations and a 3.4-fold increase in false-positive results for normetanephrine. Low temperature, a semi-recumbent position and direct venipuncture also resulted in significantly higher plasma concentrations and rates of false-positive results for plasma normetanephrine than alternative sampling conditions, though with less impact than out-patient sampling. Higher concentrations and rates of false-positive results for plasma normetanephrine with low than warm temperatures were only apparent for out-patient sampling. Preanalytical factors were without impact on plasma metanephrines in patients with PPGL. Conclusions: Although in-patient blood sampling is largely impractical for screening patients with suspected PPGL, other pre-analytical precautions (e.g., cannulae, warm testing conditions) may be useful. In-patient sampling may be reserved for follow-up of patients with difficult to distinguish true- from false-positive results.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Davies, Professor Eleanor and Hampson, Ms Stephanie
Authors: Pommer, G., Pamporaki, C., Peitzsch, M., Remde, H., Deutschbein, T., Nölting, S., Müller, L. M., Braun, L., Gruber, S., Pecori, A., Hampson, S., Davies, E., Stell, A., Rossi, G. P., Lenzini, L., Ceccato, F., Timmers, H. J. L. M., Deinum, J., Amar, L., Blanchard, A., Baron, S., Fassnacht, M., Dobrowolski, P., Januszewicz, A., Zennaro, M.-C., Prejbisz, A., and Eisenhofer, G.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:Journal of Clinical Endocrinology and Metabolism
Publisher:Oxford University Press
ISSN:0021-972X
ISSN (Online):1945-7197
Published Online:29 June 2022
Copyright Holders:Copyright © 2022 The Authors
First Published:First published in Journal of Clinical Endocrinology and Metabolism 107(9): e3689-e3698
Publisher Policy:Reproduced in accordance with the publisher copyright policy
Data DOI:10.5281/zenodo.6624878

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