Przybylik-Mazurek Elwira, Buziak-Bereza Monika, Stochmal Ewa, Budzyński Andrzej, Białas Magdalena, Kostecka-Matyja Marta, Hubalewska-Dydejczyk Alicja
Katedra Endokrynologii UJ CM, Kraków.
Przegl Lek. 2010;67(12):1276-81.
Pheochromocytoma (PH) is a tumour of chromaffin cells of the sympathetic nervous system and its clinical symptoms are associated with excessive production and release of catecholamines. The main criterion for clinical diagnosis of PH is finding increased concentrations of catecholamines or their metabolites in serum and/or urine. The largest diagnostic and therapeutic problems are patients with slightly elevated levels of methoxycatecholamines in serum and/ or urine. Aim of this study was to determine the cut-off point for elevated methoxycatecholamine in the collection of daily urine, which would give the basis for determining the reasonable recommendations of the biochemical criteria for diagnosis of PH. Retrospectively we analysed the results of 45 patients sent to laparoscopic adrenalectomy to the Department of General Surgery II with the preoperative diagnosis of pheochromocytoma. The diagnosis of pheochromocytoma was based on the finding of elevated 24-hour urine methoxycatecholamines. Based on the results of the histopathological examination patients were divided into two groups. Group 1 included 27 patients (14 women and 13 men) with histopathologically confirmed pheochromocytoma of adrenal gland. Group 2 consisted of 18 patients (11 women and 7 men), in which histopathological examination did not confirm the presence of pheochromocytoma. Mean age of patients in group 1: 46.8 +/- 14.4 years, in group 2: 55.7 +/- 13.7 years. Hypertension was diagnosed in 77.8% of those with group 1 and 94.4% from group 2. Based on the analyzed results of the CT, we found that the average tumor size in group 1 (4.2 +/- 1.9 cm) was statistically higher than in group 2 (2.9 +/- 1.1 cm). The average concentration of normetanephrine (NMN) in 24-hour urine in group 1 was statistically significantly higher than in group 2 (2,686 +/- 870.4 vs. 2375.1 +/- 754 mg/24h), as well as the average concentration of metanephrine (MN) (2533.4 +/- 3269.3 +/- 491.6 vs. 371.5 mg/24 hrs), and the sum of both methoxycatecholamines (NMN + MN) (5219.3 +/- 5190.6 vs. 1241.8 +/- 1202.2). The highest sensitivity in diagnosing pheochromocytoma with the rate of 81.5% was obtained for the sum of normetanephrine and metanephrine in 24-hour urine, while the sensivity for levels of each methoxycatecholamine separately was similar (63%). The highest specificity in the exclusion of PH was shown for 24-hour urine metanephrine (94.4%). The highest positive predictive value was found for the level of metanephrine in 24-hour urine (94.4%). The diagnostic cutoff concentrations of NMN, MN and NMN + MN for the diagnosis of pheochromocytoma were set. For the 24-hour urine NMN- cut-off > 1500 ug/24 h, for MN > 700 ug/24h and for NMN + MN > 1350 ug/24h. Shown above cut-off levels of methoxycatecholamines urine concentration will allow to pose a more accurate preoperative diagnosis of PH.
嗜铬细胞瘤（PH）是一种起源于交感神经系统嗜铬细胞的肿瘤，其临床症状与儿茶酚胺的过度产生和释放有关。PH临床诊断的主要标准是血清和/或尿液中儿茶酚胺或其代谢产物浓度升高。血清和/或尿液中甲氧基儿茶酚胺水平轻度升高的患者面临最大的诊断和治疗难题。本研究的目的是确定24小时尿中甲氧基儿茶酚胺升高的临界值，为确定PH诊断的生化标准的合理建议提供依据。我们回顾性分析了45例术前诊断为嗜铬细胞瘤并送至普通外科二病区行腹腔镜肾上腺切除术患者的结果。嗜铬细胞瘤的诊断基于24小时尿中甲氧基儿茶酚胺升高的检测结果。根据组织病理学检查结果，将患者分为两组。第1组包括27例患者（14例女性和13例男性），组织病理学确诊为肾上腺嗜铬细胞瘤。第2组由18例患者（11例女性和7例男性）组成，组织病理学检查未证实存在嗜铬细胞瘤。第1组患者的平均年龄为46.8±14.4岁，第2组为55.7±13.7岁。第1组中77.8%的患者和第2组中94.4%的患者被诊断为高血压。根据CT分析结果，我们发现第1组的平均肿瘤大小（4.2±1.9 cm）在统计学上高于第2组（2.9±1.1 cm）。第1组24小时尿中去甲肾上腺素（NMN）的平均浓度在统计学上显著高于第2组（2686±870.4 vs. 2375.1±754 mg/24h），肾上腺素（MN）的平均浓度也是如此（2533.4±3269.3±491.6 vs. 371.5 mg/24 hrs），以及两种甲氧基儿茶酚胺之和（NMN+MN）（5219.3±5190.6 vs. 1241.8±1202.2）。24小时尿中去甲肾上腺素和肾上腺素之和诊断嗜铬细胞瘤的敏感性最高，为81.5%，而每种甲氧基儿茶酚胺单独水平的敏感性相似（63%）。24小时尿肾上腺素排除PH的特异性最高（94.4%）。24小时尿肾上腺素水平的阳性预测值最高（94.4%）。设定了诊断嗜铬细胞瘤的NMN、MN和NMN+MN的诊断临界浓度。24小时尿NMN的临界值>1500μg/24 h，MN>700μg/24h，NMN+MN>1350μg/24h。上述甲氧基儿茶酚胺尿浓度的临界值将有助于更准确地进行PH的术前诊断。
