Phaeochromocytoma and paraganglioma.

Use of current analytical techniques should lead to the successful diagnosis of most catecholamine-secreting tumours, and the experience and confidence which has evolved with the use of HPLC-ECD for plasma and urinary catecholamine estimation, as well as their greater diagnostic sensitivity and specificity, should soon render the older urinary assays based on catecholamine metabolites obsolete. Until then urinary metanephrine estimation will remain the diagnostic metabolite of choice. The diagnosis of small lesions and early recurrences will, however, continue to pose a great analytical challenge, and may call for the use of suppressive tests such as the pentolinium suppression test, venous catheterization, and MIBG scanning. The flow chart used for phaeochromocytoma diagnosis in our department is illustrated in Figure 12; and provides a strategy for the effective diagnosis of all but the most difficult lesions.