Fractionated plasma free metanephrines in the diagnosis of pheochromocytoma

A negative plasma fractionated free metanephrine result is effective in ruling out pheochromocytoma (pooled negative LR 0.02), while a positive test result only moderately increases suspicion of disease (pooled positive LR 5.82 - 7.86)

A systematic review including 3 studies (one prospective, one retrospective, and one unknown) was abstracted in DARE. The gold standard was histology or (for negative test results) imaging and follow-up. All pheochromocytomas: The sensitivity ranged from 96% (specificity 85%) to 100% (specificity 100%) and the specificity from 85% (sensitivity 96%) to 100% (sensitivity 100%). The pooled positive LR was 7.86 (95% CI: 5.17, 11.94) and the pooled negative LR was 0.02 (95% CI 0.01, 0.04). Significant between-study heterogeneity was observed for the positive LRs (P=0.017). Sporadic pheochromocytomas. The sensitivity ranged from 97% (specificity 84%) to 100% (specificity 100%) and the specificity from 82% (sensitivity 99%) to 100% (sensitivity 100%). The pooled positive LR was 5.82 (95% CI: 4.81, 7.05) and the pooled negative LR ratio was 0.02 (95% CI 0.01, 0.07). No significant between-study heterogeneity was observed.

Comment: The quality of evidence is downgraded by sparse data and possibility of publication bias, and upgraded by strong association.

Ədəbiyyat

1. Sawka AM, Prebtani AP, Thabane L, Gafni A, Levine M, Young WF Jr. A systematic review of the literature examining the diagnostic efficacy of measurement of fractionated plasma free metanephrines in the biochemical diagnosis of pheochromocytoma. BMC Endocr Disord 2004 Jun 29;4(1):2.