ECE2009 Poster Presentations Endocrine tumours and neoplasia (53 abstracts)
The retrospective analysis of the pheochromocytoma diagnostic procedures in patients after laparoscopic adrenalectomy
Alicja Hubalewska-Dydejczyk 1 , Andrzej Budzynski 2 , Monika Buziak-Bereza 1 , Dorota Pach 1 , Ewa Stochmal 1 , Malgorzata Trofimiuk 1 , Elwira Przybylik-Mazurek 1 , Robert Chrzan 3 , Danuta Karcz 2 & Andrzej Urbanik 1
1Chair and Department of Endocrinology, Medical College, Jagiellonian University, Krakow, Poland; 2Endoscopic Surgery Department, Medical College, Jagiellonian University, Krakow, Poland; 3Chair of Radiology, Medical College, Jagiellonian University, Krakow, Poland.
The pheochromocytoma (PH) diagnosis is often very difficult, particularly in asymptomatic or oligosymptomatic patients. Every subject with adrenal tumor should be screened for PH, although many factors may interfere with biochemical evaluation. The false positive testing for PH may result in unnecessary surgical treatment.
Methods: Retrospective analysis of 45 patients after laparoscopic adrenalectomy due to suspicion of PH (based on biochemical testing) was performed. The subjects were divided into 2 groups according to the results of histopathological examination: group 1–27 PH positive patients (mean age 46.8±14.4 years), group 2–18 PH negative patients (mean age 55.7±13.7 years). Following parameters were analyzed: presence of PH related symptoms, urinary excretion of metanephrine (MN), normetanephrine (NMN), MN+NMN and pre-operative imaging (multiphase CT) results.
Mean value of NMN, NM and MNM+NM were statistically higher in group 1 (P value: 0.002, 0.001, <0.001 respectively). The highest sensitivity (81.5%) for PH diagnosis, as well as true negative predictive value, had MN+NMN. The highest true positive predictive value was stated for NM. The extimated cut-off levels for our laboratory: were: 713.6, 1598.6, 1396.1 for NM, NMN, NM+NMN, respectively.
Adrenal CT had the highest sensitivity for PH diagnosis (100% for cut off point of 59 HU in venous phase) and highest specificity (100% for cut-off point 48 HU for wash-out phase).
Results: The biochemical testing alone may be misleading particularly for only slightly elevated metanephrines excretion. Imaging results are the most sensitive tool for proper diagnosis of PH, and should be always considered while deciding on surgical treatment of patents suspected for pheochromocytoma.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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