{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T01:52:26Z","timestamp":1779933146238,"version":"3.53.1"},"reference-count":0,"publisher":"Oxford University Press (OUP)","issue":"3","content-domain":{"domain":["eje.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2019,9]]},"abstract":"<jats:sec>\n<jats:title>Objective<\/jats:title>\n<jats:p>Determine rate of high plasma normetanephrine or metanephrine (PNM-PMN) in a large sample of patients according to PNM-PMN posture and age-adjusted references.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Design<\/jats:title>\n<jats:p>Retrospective re-analysis of PNM-PMN from a Canadian reference laboratory (<jats:italic>n<\/jats:italic>\u2009=\u20095452), 2011\u20132015; most were in seated position (<jats:italic>n<\/jats:italic>\u2009=\u20095112) rather than supine (<jats:italic>n<\/jats:italic>\u2009=\u2009340). An international PPGL database demonstrated expected distribution of supine PNM-PMN in PPGL patients.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>All PNM-PMN from a tertiary referral laboratory were reviewed. Any PNM-PMN result greater than 2\u00d7 upper reference limit (URL) was considered likely true PPGL. Results 1\u20132\u00d7 URL were uncertain, requiring additional testing\/follow-up despite most being false positive given the rarity of PPGL. The rate of results in the 1\u20132\u00d7 URL category were calculated for each group according to collection posture and differing published URL: seated, supine or supine age adjusted.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>When collected and interpreted by seated URL, 19.6% of PNM required additional testing; only 4.6% being &gt;2\u00d7 URL. For patients over age 50 years, the abnormal rate was 24.9%. When collected supine, interpreted by supine age-adjusted URL, only 5.3% of PNM were mildly elevated. Possible false positives may be even lower when considering PMN or plasma methoxytyramine which were commonly high in true PPGL despite mild PNM elevations.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>In a general medical population, seated PNM has a high rate of abnormal results, far exceeding expected prevalence. Supine measurement with supine, age-adjusted interpretation is strongly preferred prior to costly or invasive PPGL investigations.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Summary<\/jats:title>\n<jats:p>Review of 5452 plasma normetanephrine measurements showed 20% to be high, likely false positives for most. Supine, age-adjusted measures were half as likely to be elevated.<\/jats:p>\n<\/jats:sec>","DOI":"10.1530\/eje-19-0176","type":"journal-article","created":{"date-parts":[[2019,7,10]],"date-time":"2019-07-10T14:07:37Z","timestamp":1562767657000},"page":"301-309","update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-1","source":"Crossref","is-referenced-by-count":33,"title":["A high rate of modestly elevated plasma normetanephrine in a population referred for suspected PPGL when measured in a seated position"],"prefix":"10.1093","volume":"181","author":[{"given":"Jessica","family":"Boyd","sequence":"first","affiliation":[{"name":"1Department of Clinical Pathology, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada"},{"name":"2Alberta Public Laboratory, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander A","family":"Leung","sequence":"additional","affiliation":[{"name":"3Department of Medicine\/Endocrinology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hossein SM","family":"Sadrzadeh","sequence":"additional","affiliation":[{"name":"1Department of Clinical Pathology, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada"},{"name":"2Alberta Public Laboratory, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Pamporaki","sequence":"additional","affiliation":[{"name":"4Department of Endocrinology, University Hospital, Carl Gustav Carus at TU Dresden, Dresden, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karel","family":"Pacak","sequence":"additional","affiliation":[{"name":"5Section of Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timo","family":"Deutschbein","sequence":"additional","affiliation":[{"name":"6Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital Wuerzburg, University of Wuerzburg, Wuerzburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Fliedner","sequence":"additional","affiliation":[{"name":"7Neuroendocrine Oncology and Metabolism, First Department of Medicine, University Medical Center Schleswig-Holstein, L\u00fcbeck, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory A","family":"Kline","sequence":"additional","affiliation":[{"name":"3Department of Medicine\/Endocrinology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","container-title":["European Journal of Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/eje.bioscientifica.com\/view\/journals\/eje\/181\/3\/EJE-19-0176.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/eje.bioscientifica.com\/view\/journals\/eje\/181\/3\/EJE-19-0176.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,14]],"date-time":"2023-02-14T16:13:19Z","timestamp":1676391199000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejendo\/article\/181\/3\/301\/6654161"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,9]]},"references-count":0,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.1530\/eje-19-0176","relation":{},"ISSN":["0804-4643","1479-683X"],"issn-type":[{"value":"0804-4643","type":"print"},{"value":"1479-683X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,9]]}}}