Plasma free metanephrines in the diagnosis of pheochromocytoma: diagnostic accuracy and strategies for Japanese patients

Yuko Tanaka; Kazumasa Isobe; Enbo Ma; Tsuneo Imai; Toyone Kikumori; Tadashi Matsuda; Yuji Maeda; Akihiro Sakurai; Sanae Midorikawa; Yuji Hataya; Taiya Kato; Kei Kamide; Yukihiro Ikeda; Yosuke Okada; Masahiro Adachi; Toshihiko Yanase; Hideto Takahashi; Chie Yokoyama; Yusuke Arai; Koichi Hashimoto; Hitoshi Shimano; Hisato Hara; Yasushi Kawakami; Kazuhiro Takekoshi

doi:10.1507/endocrj.EJ13-0277

ORIGINALS

Plasma free metanephrines in the diagnosis of pheochromocytoma: diagnostic accuracy and strategies for Japanese patients

Yuko Tanaka, Kazumasa Isobe, Enbo Ma, Tsuneo Imai, Toyone Kikumori, Tadashi Matsuda, Yuji Maeda, Akihiro Sakurai, Sanae Midorikawa, Yuji Hataya, Taiya Kato, Kei Kamide, Yukihiro Ikeda, Yosuke Okada, Masahiro Adachi, Toshihiko Yanase, Hideto Takahashi, Chie Yokoyama, Yusuke Arai, Koichi Hashimoto, Hitoshi Shimano, Hisato Hara, Yasushi Kawakami, Kazuhiro Takekoshi

Author information

Yuko Tanaka
Department of Breast and Endocrine Surgery, University of Tsukuba, Tsukuba 305-8575, Japan
Kazumasa Isobe
Department of Laboratory Medicine, University of Tsukuba, Tsukuba 305-8575, Japan
Enbo Ma
Biostatistics Office, Tsukuba Critical Path Research and Education Integrated Leading (CREIL) Center, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan
Tsuneo Imai
Division of Breast and Endocrine Surgery, Department of Surgery, Aichi Medical University, Nagakute, Aichi 480-1195, Japan
Toyone Kikumori
Department of Breast and Endocrine Surgery, Nagoya University Hospital, Nagoya 466-8550, Japan
Tadashi Matsuda
Department of Urology and Andrology, Kansai Medical University, Hirakata, 573-1191, Japan
Yuji Maeda
Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Sciences, Kanazawa 920-8641, Japan
Akihiro Sakurai
Department of Medical Genetics, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan
Sanae Midorikawa
Department of Radiation Health Management, Fukushima Medical University, Fukushima 960-1295, Japan
Yuji Hataya
Department of Endocrinology, Kyoto City Hospital, Kyoto 604-8845, Japan
Taiya Kato
Department of Internal Medicine, Aichi Koseiren Toyota Kosei Hospital, Toyota 470-0396, Japan
Kei Kamide
Division of Health Sciences, Osaka University Graduate School of Medicine, Suita, 565-0871, Japan
Yukihiro Ikeda
Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan
Yosuke Okada
The First Department of Internal Medicine, School of Medicine University of Occupational and Environmental Health, Japan, Kitakyushu, 807-8555, Japan
Masahiro Adachi
Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
Toshihiko Yanase
Department of Endocrinology and Diabetes Mellitus, Faculty of Medicine, Fukuoka University, Fukuoka 814-0180, Japan
Hideto Takahashi
Biostatistics Office, Tsukuba Critical Path Research and Education Integrated Leading (CREIL) Center, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan
Chie Yokoyama
Division of Laboratory, University of Tsukuba Hospital, Tsukuba 305-8575, Japan
Yusuke Arai
Division of Laboratory, University of Tsukuba Hospital, Tsukuba 305-8575, Japan
Koichi Hashimoto
Tsukuba Critical Path Research and Education Integrated Leading Center (CREIL), Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan
Hitoshi Shimano
Department of Endocrinology and Metabolism, University of Tsukuba, Tsukuba 305-8575, Japan
Hisato Hara
Department of Breast and Endocrine Surgery, University of Tsukuba, Tsukuba 305-8575, Japan
Yasushi Kawakami
Department of Laboratory Medicine, University of Tsukuba, Tsukuba 305-8575, Japan
Kazuhiro Takekoshi
Faculty of Medicine, Division of Sports Science, University of Tsukuba, Tsukuba 305-8575, Japan

Keywords: Pheochromocytoma, Plasma free metanephrines (PFMs), Urinary metanephrines (uNMs), Area under curve (AUC), Diagnostic accuracy

JOURNAL FREE ACCESS

2014 Volume 61 Issue 7 Pages 667-673

DOI https://doi.org/10.1507/endocrj.EJ13-0277

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Abstract

Measuring the levels of the plasma free metanephrines (PFMs) represents a recently developed and promising test for the diagnosis of pheochromocytoma in the United States and Europe. As this test has not yet been evaluated in Japan, it is necessary to evaluate the diagnostic efficacy of measuring the levels of PFMs compared with the standard measurement of the urinary excretion of metanephrines (uMNs) whose reliability is well established to detect of pheochromocytoma. A total of 101 Japanese subjects clinically suspected of having pheochromocytoma in were included in this study. Subsequently, we prospectively measured the PFMs levels in all patients, compared with those of biochemical markers of the catecholamine secretion and metabolisms in the plasma and urine. All subjects with adrenal tumors underwent tumor excision. Data were available for 84 of the 101 patients, 47 of whom had histopathologically proven pheochromocytoma and 37 were finally diagnosed with non-pheochromocytoma. The results of comparisons in the accuracy of measurement for diagnosis of pheochromocytoma between PFMs and the urinary excretion of metanephrines (uMNs) were 0.980 VS 0.951 for AUC of receiver operatorating characteristic (ROC) curve, 0.957 VS 0.894 for sensitivity, and 0.973 VS 0.946 for specificity, respectively. Although the differences were small, the results of our study definitely demonstrated that measurement of PFMs was not inferior to standard urinary metanephrines (uMNs) measurement, which is established to be the most reliable biochemical method to detect pheochromocytoma. This study clearly shows measuring the PFMs levels to be a reliable and efficient method for diagnosing pheochromocytoma in Japanese patients, as demonstrated in previous reports.

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