嗜铬细胞瘤与去甲肾上腺素再摄取阻断相关的假阳性结果。

Endocrine-related cancer Pub Date : 2023-12-01 Print Date: 2024-01-01 DOI:10.1530/ERC-23-0063
Robin Schürfeld, Christina Pamporaki, Mirko Peitzsch, Nada Rayes, Osama Sabri, Silvio Rohm, Ronald Biemann, Benjamin Sandner, Anke Tönjes, Graeme Eisenhofer
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引用次数: 0

摘要

血浆肾上腺素和甲氧基酪胺的测量为嗜铬细胞瘤/副神经节瘤的诊断提供了一个敏感的测试。假阳性结果仍然是一个问题,特别是在服用去甲肾上腺素再摄取阻断药物的患者中。因此,在这项回顾性观察性研究中,我们测量了61名服用去甲肾上腺素再摄取阻滞剂(三环抗抑郁药或5 -羟色胺-去甲肾上腺素再摄取抑制剂)的患者和17名服用选择性5 -羟色胺再摄取抑制剂的患者的血浆肾上腺素和甲氧基酪胺,所有患者均无嗜铬细胞瘤/副神经节瘤。我们强调了一个单一的病例,血浆中去甲肾上腺素和甲氧基酪胺浓度升高与去甲肾上腺素再摄取阻断有关。数据比较了分别来自252和1804例有肿瘤和无肿瘤患者的结果。血浆去甲肾上腺素升高40% (p
本文章由计算机程序翻译,如有差异,请以英文原文为准。
False-positive results for pheochromocytoma associated with norepinephrine reuptake blockade.

Measurements of plasma metanephrines and methoxytyramine provide a sensitive test for diagnosis of pheochromocytoma/paraganglioma. False-positive results remain a problem, particularly in patients taking norepinephrine reuptake-blocking drugs. Therefore, in this retrospective observational study, we measured plasma metanephrines and methoxytyramine in 61 patients taking norepinephrine reuptake blockers (tricyclic antidepressants or serotonin-norepinephrine reuptake inhibitors) and 17 others taking selective serotonin reuptake inhibitors, all without pheochromocytoma/paraganglioma. We highlight a singular case with strongly elevated plasma normetanephrine and methoxytyramine concentrations associated with norepinephrine reuptake blockade. Data were compared to results from 252 and 1804 respective patients with and without tumors. Plasma normetanephrine was 40% higher (P < 0.0001) in patients on norepinephrine reuptake blockers and methoxytyramine was 127% higher (P = 0.0062) in patients taking tricyclic antidepressants compared to patients not taking uptake blockers and without tumors. The corresponding false-positive rates rose (P < 0.0001) from 4.8% to 23.0% for normetanephrine and from 0.9% to 28.6% for methoxytyramine. Selective serotonin reuptake inhibitors did not increase plasma concentrations of metabolites. In the highlighted case, plasma normetanephrine and methoxytyramine were elevated more than six times above upper reference limits. A pheochromocytoma/paraganglioma, however, was excluded by functional imaging. All biochemical test results normalized after discontinuation of norepinephrine reuptake blockers. These findings clarify that norepinephrine reuptake blockers usually result in mild elevations of normetanephrine and methoxytyramine that, nevertheless, significantly increase the number of false-positive results. There can, however, be exceptions where increases in normetanephrine and methoxytyramine reach pathological levels. Such exceptions may reflect failure of centrally mediated sympathoinhibition that normally occurs with the norepinephrine reuptake blockade.

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