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To the Editor: Dr Lenders and colleagues¹ concluded that measurement of plasma free metanephrines has a 99% sensitivity for pheochromocytoma, and thus a negative test result virtually excludes this diagnosis. The main problem of this study is that there was no criterion standard to rule out pheochromocytoma in at least 98 of the 644 patients in the "pheochromocytoma excluded" group, and several other patients only had computed tomography. By contrast, we found that magnetic resonance imaging (MRI) has a high sensitivity of 97% for this diagnosis.²

Although Lenders et al argue that plasma free metanephrines are highly sensitive and specific for pheochromocytoma, it should be noted that the ranges of all biochemical tests, including plasma free metanephrines, show overlap between the confirmed and excluded pheochromocytoma groups. The authors report 3 patients with pheochromocytoma and normal plasma free metanephrine levels. This underscores the point that no existing method can absolutely exclude . . . [Full Text of this Article]

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Biochemical Diagnosis of Pheochromocytoma: Which Test Is Best?
Jacques W. M. Lenders, Karel Pacak, McClellan M. Walther, W. Marston Linehan, Massimo Mannelli, Peter Friberg, Harry R. Keiser, David S. Goldstein, and Graeme Eisenhofer
JAMA. 2002;287(11):1427-1434.
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Biochemical Diagnosis of Pheochromocytoma--Is it Time to Switch to Plasma-Free Metanephrines?
Eisenhofer
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