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

Leilani B. Mercado-Asis; Angelito G. Tingcungco; David T. Bolong; Rolando A. Lopez; Eduardo Vicente Caguioa; Milagros E. Yamamoto; Joshua Marcos; Arlene B. Mercado; Manuel B. Zacarias

doi:10.5812/kowsar.1726913X.1951

International Journal of Endocrinology and Metabolism

Research Institute for Endocrine Sciences

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https://doi.org/10.5812/kowsar.1726913X.1951

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

Author(s):

Leilani B. Mercado-Asis^1,*,

Angelito G. Tingcungco²,

David T. Bolong³,

Rolando A. Lopez⁴,

Eduardo Vicente Caguioa²,

Milagros E. Yamamoto²,

Joshua Marcos³,

Arlene B. Mercado⁵,

Manuel B. Zacarias⁴

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

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

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

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

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

International Journal of Endocrinology and Metabolism:Vol. 9, issue 2; e94650

Published online:Mar 31, 2011

Article type:Research Article

Received:May 29, 2019

Accepted:Mar 31, 2011

How to Cite:Leilani B. Mercado-AsisAngelito G. TingcungcoDavid T. BolongRolando A. LopezEduardo Vicente CaguioaMilagros E. YamamotoJoshua MarcosArlene B. MercadoManuel B. Zacariaset al.Diagnosis of Small Adrenal Pheochromocytomas by Adrenal Venous Sampling with Glucagon Stimulation Test.Int J Endocrinol Metab.9(2):e94650.https://doi.org/10.5812/kowsar.1726913X.1951.

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

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Author(s):

Leilani B. Mercado-Asis:[PubMed][Scholar]
Angelito G. Tingcungco:[PubMed][Scholar]
David T. Bolong:[PubMed][Scholar]
Rolando A. Lopez:[PubMed][Scholar]
Eduardo Vicente Caguioa:[PubMed][Scholar]
Milagros E. Yamamoto:[PubMed][Scholar]
Joshua Marcos:[PubMed][Scholar]
Arlene B. Mercado:[PubMed][Scholar]
Manuel B. Zacarias:[PubMed][Scholar]