{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T01:59:49Z","timestamp":1761789589619,"version":"3.40.5"},"reference-count":27,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2019,9,5]],"date-time":"2019-09-05T00:00:00Z","timestamp":1567641600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Clinical Hypertension"],"published-print":{"date-parts":[[2019,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The diagnostic utility of different thresholds of elevated urinary fractionated metanephrine (UFM) for pheochromocytoma\u2010paraganglioma (PPGL) was evaluated in 10\u00a0164 community\u2010dwelling subjects (2012\u20102017). Levels were \u22651.5\u00d7 the upper normal limit (UNL) in 276 subjects (2.7%) and \u22652\u00d7UNL in 138 (1.4%). PPGL was subsequently diagnosed in 59 (mean age 51.9\u00a0\u00b1\u00a014.3, 64% female); 58 (98.3%) with UFM\u00a0\u2265\u00a02\u00d7UNL. Positive predictive values (PPV) were 42% for UFM\u00a0\u2265\u00a02\u00d7UNL, 55% for UFM\u00a0\u2265\u00a02.5\u00d7UNL, and 69% for UFM\u00a0\u2265\u00a03\u00d7UNL. The main reason for PPGL screening (52.5%) was adrenal incidentaloma. Mean (median) metanephrine\/normetanephrine levels were 6.7\u00a0\u00b1\u00a09\u00d7UNL (3\u00a0\u00d7\u00a0UNL) and 6.1\u00a0\u00b1\u00a08.9\u00d7UNL (2.5\u00a0\u00d7\u00a0UNL). Six patients (10.2%) had an extra\u2010adrenal tumor (one malignant paraganglioma); one had bilateral pheochromocytoma. Only one patient presented with the \u201cclassic triad\u201d (headache, palpitations, sweating). In conclusion, after excluding obvious reasons for false\u2010positive results, thorough diagnostic assessment for PPGL is justified in all subjects with UFM\u00a0\u2265\u00a0\u00d72UNL. The PPV of milder UFM elevations is very low.<\/jats:p>","DOI":"10.1111\/jch.13657","type":"journal-article","created":{"date-parts":[[2019,9,5]],"date-time":"2019-09-05T10:34:00Z","timestamp":1567679640000},"page":"1527-1533","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Pheochromocytoma: Positive predictive values of mildly elevated urinary fractionated metanephrines in a large cohort of community\u2010dwelling patients"],"prefix":"10.1111","volume":"21","author":[{"given":"Dania","family":"Hirsch","sequence":"first","affiliation":[{"name":"Institute of Endocrinology, Rabin Medical Center Beilinson Hospital Petach Tikva Israel"},{"name":"Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel"},{"name":"Maccabi Health Care Services Tel Aviv Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6969-4296","authenticated-orcid":false,"given":"Alon","family":"Grossman","sequence":"additional","affiliation":[{"name":"Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel"},{"name":"Maccabi Health Care Services Tel Aviv Israel"},{"name":"Department of Internal Medicine B, Rabin Medical Center Beilinson Hospital Petah Tikva Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Varda","family":"Nadler","sequence":"additional","affiliation":[{"name":"Maccabi Health Care Services\u2010Central Laboratory Rehovot Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandra","family":"Alboim","sequence":"additional","affiliation":[{"name":"Maccabi Health Care Services\u2010Central Laboratory Rehovot Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gloria","family":"Tsvetov","sequence":"additional","affiliation":[{"name":"Institute of Endocrinology, Rabin Medical Center Beilinson Hospital Petach Tikva Israel"},{"name":"Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel"},{"name":"Maccabi Health Care Services Tel Aviv Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,9,5]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2014-1498"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2004.03.006"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/HJH.0b013e32834a4ce9"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0032-1306294"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/jcp.46.8.734"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/jcp.46.3.280"},{"issue":"2","key":"e_1_2_7_8_1","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1093\/clinchem\/40.2.250","article-title":"Urinary and plasma catecholamines and urinary catecholamine metabolites in pheochromocytoma: diagnostic value in 19 cases","volume":"40","author":"Gerlo EA","year":"1994","journal-title":"Clin Chem"},{"issue":"12","key":"e_1_2_7_9_1","first-page":"535","article-title":"Pheochromocytoma with elevated metanephrines as the only biochemical finding","volume":"148","author":"Shawar L","year":"1996","journal-title":"J La State Med Soc"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0009-9120(00)00172-7"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/00004872-200106000-00006"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0029-1237699"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2002-030005"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2008.08.021"},{"issue":"6","key":"e_1_2_7_15_1","first-page":"354","article-title":"Prevalence of clinically unsuspected pheochromocytoma. 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