Jibiki K, Demura H, Naruse M, Demura R, Ito Y, Sakurai H, Abe Y, Naruse K, Nomura K, Odagiri E
Radioassay Center, Tokyo Women's Medical College, Japan.
Nihon Naibunpi Gakkai Zasshi. 1988 Aug 20;64(8):707-16. doi: 10.1507/endocrine1927.64.8_707.
Diagnosis of pheochromocytoma has been made by the determination of urinary noradrenaline and adrenaline excretion for 24 hours. The assay procedure and the collection of urine for 24 hrs. are intricate. In the present study, we have ascertained the clinical significance of urinary normetanephrine (NM) and metanephrine (M), chemically stable metabolites of catecholamines, in single voided urine for a diagnosis of pheochromocytoma. Urine and plasma samples were collected from 361 normal subjects, 59 patients with essential hypertension, 22 patients with chronic renal failure and 22 patients with pheochromocytoma. Urinary NM and M concentrations were determined by radioimmunoassay with prior hydrolysis by acidification with 1N HCl. Plasma NM and M concentrations in normal subjects were 71.8 +/- 30.7 pg/ml and 41.5 +/- 8.61 pg/ml, respectively. Plasma NM was increased in 8 and plasma M was increased in 20 of 21 patients with pheochromocytoma, although many of these overlapped with those patients with chronic renal failure (NM, 285.9 +/- 175.1 pg/ml; M, 206.3 +/- 186.7 pg/ml) and essential hypertension (NM, 107.7 +/- 90.7 pg/ml; M, 46.7 +/- 20.2 pg/ml). Urinary NM and M concentrations did not show specific diurnal variation and there was significant correlations between the values in single voided urine and those in the 24 hour urine. Urinary NM and M concentrations in normal controls were 197.5 +/- 46.7 ng/mg Cr. and 125.3 +/- 37.1 ng/mg Cr., respectively. Urinary NM concentration was increased in 14 and urinary M concentration was increased in all of 17 patients with pheochromocytoma. In addition, urinary M concentration was higher in most of the 17 patients with pheochromocytoma than that in the patients with chronic renal failure and essential hypertension. However, the values in three patients with Sipple's syndrome with a small adrenal tumor or recurrent cases overlapped with those in other diseases. Relationships between urinary concentrations of NM and/or M and tumor size showed positive correlations. Urinary NM and M concentrations showed significant decreases after surgical removal of the tumors. These results suggest that NM and/or M concentrations in single voided urine could be a sensitive and specific diagnostic tool for pheochromocytoma.
嗜铬细胞瘤的诊断是通过测定24小时尿去甲肾上腺素和肾上腺素排泄量来进行的。检测程序以及24小时尿液的收集过程都很复杂。在本研究中，我们确定了儿茶酚胺化学稳定代谢产物——尿中去甲变肾上腺素（NM）和变肾上腺素（M）在单次晨尿中对嗜铬细胞瘤诊断的临床意义。我们收集了361名正常受试者、59名原发性高血压患者、22名慢性肾衰竭患者和22名嗜铬细胞瘤患者的尿液和血浆样本。尿中NM和M浓度通过放射免疫分析法测定，测定前先用1N盐酸酸化进行水解。正常受试者血浆中NM和M浓度分别为71.8±30.7 pg/ml和41.5±8.61 pg/ml。21例嗜铬细胞瘤患者中有8例血浆NM升高，20例血浆M升高，尽管其中许多患者与慢性肾衰竭患者（NM，285.9±175.1 pg/ml；M，206.3±186.7 pg/ml）和原发性高血压患者（NM，107.7±90.7 pg/ml；M，46.7±20.2 pg/ml）的数值有重叠。尿中NM和M浓度未显示出特定的昼夜变化，单次晨尿中的数值与24小时尿中的数值之间存在显著相关性。正常对照组尿中NM和M浓度分别为197.5±46.7 ng/mg Cr.和125.3±37.1 ng/mg Cr.。17例嗜铬细胞瘤患者中有14例尿中NM浓度升高，17例患者尿中M浓度均升高。此外，17例嗜铬细胞瘤患者中大多数患者尿中M浓度高于慢性肾衰竭患者和原发性高血压患者。然而，3例患有小肾上腺肿瘤或复发病例的多发性内分泌腺瘤综合征患者的数值与其他疾病患者的数值有重叠。尿中NM和/或M浓度与肿瘤大小之间的关系呈正相关。手术切除肿瘤后，尿中NM和M浓度显著降低。这些结果表明，单次晨尿中NM和/或M浓度可能是嗜铬细胞瘤一种敏感且特异的诊断工具。
