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Diagnosing phaeochromocytoma/paraganglioma in a patient presenting with critical illness: biochemistry versus imaging
Author(s) -
Amar Laurence,
Eisenhofer Graeme
Publication year - 2015
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/cen.12745
Subject(s) - metanephrines , medicine , pheochromocytoma , normetanephrine , paraganglioma , intensive care medicine , shock (circulatory) , vasoactive , radiology
Summary Phaeochromocytomas and paragangliomas ( PPGL s) are revealed by acute cardiovascular complications involving end‐organ damage in up to 20% of cases, a presentation associated with particularly high risk for mortality. Among such cases, PPGL s should be considered in patients with unexplained left ventricular failure, multi‐organ failure, hypertensive crises or shock. The diagnosis of PPGL commonly relies on measurements of metanephrines in plasma or urine. However, acute critical illness is usually associated with sympathoadrenal activation. Thus, levels of metanephrines in patients in an acute emergency or intensive care setting, whether treated or not with vasoactive drugs, usually cannot be used to reliably diagnose PPGL . Delays in provision of diagnostic test results, particularly when these require 24‐h urine collections, may also be incompatible for any need for rapid decisions on patient management or therapeutic interventions. The acute emergency situation therefore represents one exception to the rule where imaging studies to search for a PPGL may be undertaken without biochemical evidence of a catecholamine‐producing tumour.