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Diagnosis of Small Adrenal Pheochromocytomas by Adrenal Venous Sampling with Glucagon Stimulation Test

AUTHORS

Leilani B. Mercado-Asis 1 , * , Angelito G. Tingcungco 2 , David T. Bolong 3 , Rolando A. Lopez 4 , Eduardo Vicente Caguioa 2 , Milagros E. Yamamoto 2 , Joshua Marcos 3 , Arlene B. Mercado 5 , Manuel B. Zacarias 4

AUTHORS INFORMATION

1 Sections of Endocrinology and Metabolism, University of Santo Tomas, Manila, Philippines

2 Section of Vascular and Interventional Radiology, Department of Radiology, University of Santo Tomas, Manila, Philippines

3 Section of Urology, Department of Surgery, Faculty of Medicine and Surgery, University of Santo Tomas,, Philippines,

4 Division of Anatomic Pathology, Santo Tomas University Hospital, España, Manila, Philippines

5 Departments of Epidemiology and Biostatistics, Emilio Aguinaldo College, Manila, Philippines

How to Cite: Mercado-Asis L B, Tingcungco A G, Bolong D T, Lopez R A, Vicente Caguioa E, et al. Diagnosis of Small Adrenal Pheochromocytomas by Adrenal Venous Sampling with Glucagon Stimulation Test, Int J Endocrinol Metab. 2011 ; 9(2):e94650. doi: 10.5812/kowsar.1726913X.1951.

ARTICLE INFORMATION

International Journal of Endocrinology and Metabolism: 9 (2); e94650
Published Online: March 31, 2011
Article Type: Research Article
Received: May 29, 2019
Accepted: March 31, 2011
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Abstract

Background: Pheochromocytoma develops in 0.1–0.5% of the hypertensive population between the ages of 30–50 years and is classically characterized by either sustained or paroxysmal hypertension, flushing, sweating, palpitations, and severe anxiety.
Objectives: To demonstrate the safety and usefulness of bilateral adrenal venous sampling (BAVS) in patients with pheochromocytoma, but with negative imaging results
Patients and Methods: We used BAVS with glucagon stimulation (1 mg, IV bolus) and measured stimulated fractionated catecholamines (norepinephrine [NE] and epinephrine [EPI]).
Results: We performed BAVS with glucagon stimulation on 41 patients who presented with signs and symptoms highly suggestive of the presence of pheochromocytoma, and also had equivocal imaging results. Twenty patients were diagnosed with unilateral pheochromocytoma. The minimum predictive cut-off value for the EPI ratio of affected vs. unaffected sides in diagnosing a unilateral pheochromocytoma was 6.8 (sensitivity; 88.9%, specificity, 87.5%, P = 0.001). The minimum predictive cut-off value for the norepinephrine (NE) ratio of affected vs. unaffected sides was 3.8 (sensitivity; 90%, specificity; 81.2%, P = 0.001). The 2-min post glucagon-stimulated levels of affected versus unaffected adrenals were: EPI; 29,162 ± 8,756 vs. 1,136 ± 546 pg/ml (ratio = 25.7) and NE; 7,156 ± 1,399 vs. 760 ± 228 pg/ml (ratio = 9.4). The EPI:NE ratio on the affected side was significantly higher (4.1 vs. 1.5, P < 0.001). During the follow-up period, patients who did not require post-operative medication were those who had a shorter duration of hypertension (4.8 ± 3 vs. 10 ± 10.8 years).
Conclusions: BAVS with glucagon stimulation is a safe and useful approach for early diagnosis of pheochromocytoma.

Keywords

Adrenal Sampling Endocrine Hypertension Pheochromocytoma Neuroendocrine Tumor Catecholamine

© 2011, International Journal of Endocrinology and Metabolism. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

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