The measurement of urine catecholamine and metanephrine concentrations is important for biochemical screening and diagnosis of pheochromocytoma.The goal of this work was to develop a simple liquid chromatography-tande...The measurement of urine catecholamine and metanephrine concentrations is important for biochemical screening and diagnosis of pheochromocytoma.The goal of this work was to develop a simple liquid chromatography-tandem mass spectrometry(LC-MS/MS)method for determining catecholamines and metanephrines in urine to replace an existing liquid chromatographic method using electrochemical detection.Urine samples were prepared using Oasis weak-cation-exchange cartridges.The eluate was analyzed on an Agilent ZORBAX Eclipse Plus Phenyl-Hexyl column in 3 min.Adrenaline,noradrenaline,dopamine,metanephrine,normetanephrine,and their deuterated internal standards were monitored in positive electrospray ionization mode by multiple reaction monitoring(MRM).No evidence of ion suppression was observed.The assay was linear up to 5μmol/L for adrenaline,5μmol/L for noradrenaline,6.1μmol/L for dopamine,5.6μmol/L for metanephrine,and 34.6μmol/L for normetanephrine,with lower limits of quantification of 5,5,12,6 and 7nmol/L,respectively.The intra-day and inter-day precisions for all analytes ranged from 0.59%to 4.64%and1.98%to 4.80%,respectively.External quality assurance samples were assayed and showed excellent agreement with the target values.This simple method provides an improved assay for determining urine catecholamines and metanephrines.展开更多
Undiagnosed pheochromocytoma is a cause of hypertension intraoperatively. Hypertension from pheochromocytoma catecholamine secretion is potentially fatal and requires immediate treatment with cardiac afterload reducti...Undiagnosed pheochromocytoma is a cause of hypertension intraoperatively. Hypertension from pheochromocytoma catecholamine secretion is potentially fatal and requires immediate treatment with cardiac afterload reduction and preload augmentation for end-organ protection. Diagnosis and management in the acute period can be complex in the context of co-existing disease, other possible causes of hypertension, and the anesthetized patient who is unable to provide historical clues. This case report highlights the plausibility that pheochromocytomas may be more likely to present sub-clinically in elderly patients with severe vascular disease, so we suggest the potential utility of studying whether reduced vascular responsiveness is protective in any way to catecholamine load. Above all, as an increasing number of case reports of pheochromocytoma discovery intra-operatively emerge, many with catastrophic outcomes, the development value and feasibility of a rapid, on-site blood metanephrine test should be considered. Existing diagnostic methods of pheochromocytoma are relatively time-consuming and not useful in the acute situation.展开更多
Congenital Adrenal Hyperplasia is a group of autosomal recessive disorders resulting from deficiency of enzymes essential for the synthesis of cortisol.Disease of the adrenal cortex,but there may be involvement adreno...Congenital Adrenal Hyperplasia is a group of autosomal recessive disorders resulting from deficiency of enzymes essential for the synthesis of cortisol.Disease of the adrenal cortex,but there may be involvement adrenomedullary.Cortisol and epinephrine are directly related to the individual’s stress response.Lower values of epinephrine in children with congenital adrenal hyperplasia could be related to increased clinical complications and hospitalizations rate.We evaluated the serum values of metanephrines and normetanephrines in children and adolescents with classic congenital adrenal hyperplasia and primary hypothyroidism and possible correlations with disease and hospitalizations.Cross-sectional study involved 29 patients(10 simple virilizing and 19 salt-wasting),and control group of 28 patients with primary hypothyroidism(10 overt and 18 subclinical).There were no differences in age(p=0.24)and metanephrine(p=0.34)or normetanephrine values(p=0.85)between groups.Hospitalization rate was higher in the cases than in the controls(51 x 12).We conclude the serum values of metanephrine and normetanephrine in patients with congenital adrenal hyperplasia were within the normal values of reference,with no significant difference of group with primary hypothiroidism.The number of hospitalizations in the case was high in relation to the control,mainly in salt-wasting.展开更多
BACKGROUND Pancreatic paragangliomas(PPGL)are rare benign neuroendocrine neoplasms but malignancy can occur.PPGL are often misdiagnosed as pancreatic neuroendocrine tumor or pancreatic adenocarcinoma.CASE SUMMARY We r...BACKGROUND Pancreatic paragangliomas(PPGL)are rare benign neuroendocrine neoplasms but malignancy can occur.PPGL are often misdiagnosed as pancreatic neuroendocrine tumor or pancreatic adenocarcinoma.CASE SUMMARY We reviewed 47 case reports of PPGL published in PubMed to date.Fifteen patients(15/47)with PPGL underwent endoscopic ultrasound-guided fine needle aspiration(EUS-FNA).Only six(6/15)were correctly diagnosed as PPGL.All patients with PPGL underwent surgical resection except three(one patient surgery was aborted because of hypertensive crisis,two patients had metastasis or involvement of major vessels).Our patient remained on close surveillance as she was asymptomatic.CONCLUSION Accurate preoperative diagnosis of PPGL can be safely achieved by EUS-FNA with immunohistochemistry.Multidisciplinary team approach should be considered to bring the optimal results in the management of PPGL.展开更多
文摘The measurement of urine catecholamine and metanephrine concentrations is important for biochemical screening and diagnosis of pheochromocytoma.The goal of this work was to develop a simple liquid chromatography-tandem mass spectrometry(LC-MS/MS)method for determining catecholamines and metanephrines in urine to replace an existing liquid chromatographic method using electrochemical detection.Urine samples were prepared using Oasis weak-cation-exchange cartridges.The eluate was analyzed on an Agilent ZORBAX Eclipse Plus Phenyl-Hexyl column in 3 min.Adrenaline,noradrenaline,dopamine,metanephrine,normetanephrine,and their deuterated internal standards were monitored in positive electrospray ionization mode by multiple reaction monitoring(MRM).No evidence of ion suppression was observed.The assay was linear up to 5μmol/L for adrenaline,5μmol/L for noradrenaline,6.1μmol/L for dopamine,5.6μmol/L for metanephrine,and 34.6μmol/L for normetanephrine,with lower limits of quantification of 5,5,12,6 and 7nmol/L,respectively.The intra-day and inter-day precisions for all analytes ranged from 0.59%to 4.64%and1.98%to 4.80%,respectively.External quality assurance samples were assayed and showed excellent agreement with the target values.This simple method provides an improved assay for determining urine catecholamines and metanephrines.
文摘Undiagnosed pheochromocytoma is a cause of hypertension intraoperatively. Hypertension from pheochromocytoma catecholamine secretion is potentially fatal and requires immediate treatment with cardiac afterload reduction and preload augmentation for end-organ protection. Diagnosis and management in the acute period can be complex in the context of co-existing disease, other possible causes of hypertension, and the anesthetized patient who is unable to provide historical clues. This case report highlights the plausibility that pheochromocytomas may be more likely to present sub-clinically in elderly patients with severe vascular disease, so we suggest the potential utility of studying whether reduced vascular responsiveness is protective in any way to catecholamine load. Above all, as an increasing number of case reports of pheochromocytoma discovery intra-operatively emerge, many with catastrophic outcomes, the development value and feasibility of a rapid, on-site blood metanephrine test should be considered. Existing diagnostic methods of pheochromocytoma are relatively time-consuming and not useful in the acute situation.
文摘Congenital Adrenal Hyperplasia is a group of autosomal recessive disorders resulting from deficiency of enzymes essential for the synthesis of cortisol.Disease of the adrenal cortex,but there may be involvement adrenomedullary.Cortisol and epinephrine are directly related to the individual’s stress response.Lower values of epinephrine in children with congenital adrenal hyperplasia could be related to increased clinical complications and hospitalizations rate.We evaluated the serum values of metanephrines and normetanephrines in children and adolescents with classic congenital adrenal hyperplasia and primary hypothyroidism and possible correlations with disease and hospitalizations.Cross-sectional study involved 29 patients(10 simple virilizing and 19 salt-wasting),and control group of 28 patients with primary hypothyroidism(10 overt and 18 subclinical).There were no differences in age(p=0.24)and metanephrine(p=0.34)or normetanephrine values(p=0.85)between groups.Hospitalization rate was higher in the cases than in the controls(51 x 12).We conclude the serum values of metanephrine and normetanephrine in patients with congenital adrenal hyperplasia were within the normal values of reference,with no significant difference of group with primary hypothiroidism.The number of hospitalizations in the case was high in relation to the control,mainly in salt-wasting.
文摘BACKGROUND Pancreatic paragangliomas(PPGL)are rare benign neuroendocrine neoplasms but malignancy can occur.PPGL are often misdiagnosed as pancreatic neuroendocrine tumor or pancreatic adenocarcinoma.CASE SUMMARY We reviewed 47 case reports of PPGL published in PubMed to date.Fifteen patients(15/47)with PPGL underwent endoscopic ultrasound-guided fine needle aspiration(EUS-FNA).Only six(6/15)were correctly diagnosed as PPGL.All patients with PPGL underwent surgical resection except three(one patient surgery was aborted because of hypertensive crisis,two patients had metastasis or involvement of major vessels).Our patient remained on close surveillance as she was asymptomatic.CONCLUSION Accurate preoperative diagnosis of PPGL can be safely achieved by EUS-FNA with immunohistochemistry.Multidisciplinary team approach should be considered to bring the optimal results in the management of PPGL.
