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Licensed Unlicensed Requires Authentication Published by De Gruyter October 1, 2020

Plasma metanephrines and prospective prediction of tumor location, size and mutation type in patients with pheochromocytoma and paraganglioma

  • Graeme Eisenhofer ORCID logo EMAIL logo , Timo Deutschbein , Georgiana Constantinescu , Katharina Langton , Christina Pamporaki , Bruna Calsina , Maria Monteagudo , Mirko Peitzsch , Stephanie Fliedner , Henri J. L. M. Timmers , Nicole Bechmann , Maria Fankhauser , Svenja Nölting , Felix Beuschlein , Anthony Stell , Martin Fassnacht , Aleksander Prejbisz , Jacques W. M. Lenders and Mercedes Robledo



Plasma free metanephrines are commonly used for diagnosis of pheochromocytoma and paraganglioma (PPGLs), but can also provide other information. This multicenter study prospectively examined whether tumor size, location, and mutations could be predicted by these metabolites.


Predictions of tumor location, size, and mutation type, based on measurements of plasma normetanephrine, metanephrine, and methoxytyramine were made without knowledge of disease in 267 patients subsequently determined to have PPGLs.


Predictions of adrenal vs. extra-adrenal locations according to increased plasma concentrations of metanephrine and methoxytyramine were correct in 93 and 97% of the respective 136 and 33 patients in who these predictions were possible. Predicted mean tumor diameters correlated positively (p<0.0001) with measured diameters; predictions agreed well for pheochromocytomas but were overestimated for paragangliomas. Considering only patients with mutations, 51 of the 54 (94%) patients with NF1 or RET mutations were correctly predicted with those mutations according to increased plasma metanephrine, whereas no or minimal increase in metanephrine correctly predicted all 71 patients with either VHL or SDHx mutations; furthermore, among the latter group increases in methoxytyramine correctly predicted SDHx mutations in 93% of the 29 cases for this specific prediction.


Extents and patterns of increased plasma O-methylated catecholamine metabolites among patients with PPGLs allow predictions of tumor size, adrenal vs. extra-adrenal locations and general types of mutations. Predictions of tumor location are, however, only possible for patients with clearly increased plasma methoxytyramine or metanephrine. Where possible or clinically relevant the predictions are potentially useful for subsequent clinical decision-making.

Corresponding author: Graeme Eisenhofer, Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; and Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr.74, 01307 Dresden, Germany, Phone: +49 351 458 4595, Fax: +49 351 458 7346, E-mail:

Award Identifier / Grant number: CRC/TRR 205

Award Identifier / Grant number: 259735 (ENS@T-Cancer)

  1. Research funding: This work was supported by the European Union Seventh Framework Programme (FP7/2007–2013) under grant agreement 259735 (ENS@T-Cancer) and the Deutsche Forschungsgemeinschaft (CRC/TRR 205).

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: The study protocol was approved by the Ethics Committees of the participating centers.


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Supplementary Material

The online version of this article offers supplementary material (

Received: 2020-06-12
Accepted: 2020-09-14
Published Online: 2020-10-01
Published in Print: 2021-02-23

© 2020 Walter de Gruyter GmbH, Berlin/Boston

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