Investigations for phaeochromocytoma
How to order and read plasma free metanephrines (supine sampling, age-adjusted normetanephrine, the 3-times rule, the metabolite pattern), when to repeat or do a clonidine suppression test, and which scan to choose once biochemistry is positive.
Tier 2Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Biochemistry before imaging. Plasma free metanephrines (or 24-hour urine fractionated metanephrines) come first; scans follow a positive result.
- Metanephrines are made continuously inside the tumour, so they stay raised between paroxysms. Plasma catecholamines and urine VMA are obsolete.
- Normal plasma metanephrines (drawn properly) all but exclude a secreting tumour. The exceptions are small tumours, biochemically silent head and neck paragangliomas and some SDHx tumours.
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Sources
- Pheochromocytoma and paraganglioma: an Endocrine Society clinical practice guidelineJournal of Clinical Endocrinology and Metabolism (Lenders JW, et al.; 99:1915-42), 2014 (no update published at November 2026)
- Genetics, diagnosis, management and future directions of research of phaeochromocytoma and paraganglioma: a position statement and consensus of the Working Group on Endocrine Hypertension of the European Society of HypertensionJournal of Hypertension (Lenders JWM, et al.; 38:1443-56), 2020
- Biochemical diagnosis of chromaffin cell tumors in patients at high and low risk of disease: plasma versus urinary free or deconjugated O-methylated catecholamine metabolitesClinical Chemistry (Eisenhofer G, et al.; 64:1646-56), 2018
- Reference intervals for plasma free metanephrines with an age adjustment for normetanephrine for optimized laboratory testing of phaeochromocytomaAnnals of Clinical Biochemistry (Eisenhofer G, et al.; 50:62-9), 2013
- European Society of Endocrinology clinical practice guidelines on the management of adrenal incidentalomas, in collaboration with ENSATEuropean Journal of Endocrinology (Fassnacht M, et al.), 2023
- International consensus on initial screening and follow-up of asymptomatic SDHx mutation carriersNature Reviews Endocrinology (Amar L, et al.), 2021
- Biochemical diagnosis of pheochromocytoma: how to distinguish true- from false-positive test resultsJournal of Clinical Endocrinology and Metabolism (Eisenhofer G, et al.; 88:2656-66), 2003
- European Association of Nuclear Medicine practice guideline/Society of Nuclear Medicine and Molecular Imaging procedure standard 2019 for radionuclide imaging of phaeochromocytoma and paragangliomaEuropean Journal of Nuclear Medicine and Molecular Imaging (Taïeb D, et al.; 46:2112-37), 2019
- Pitfalls in the Diagnostic Evaluation of PheochromocytomasJournal of the Endocrine Society (Fagundes GFC, et al.; 8:bvae078), 2024
- RCPA Manual (catecholamines and metanephrines)AU/NZRoyal College of Pathologists of Australasia
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Turnstile bot check on sign-in and signed-out feedback