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Diagnosis of Pheochromocytoma

J. Richard Crout, MD
JAMA. 1966;198(1):90. doi:10.1001/jama.1966.03110140140045.
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To the Editor:—  The careful analysis of 26 cases of pheochromocytoma by Moorhead et al (196:1107, 1966) is a scholarly contribution. Nonetheless, I must disagree with the recommendation that histamine and phentolamine tests be done as primary screening procedures for this tumor. The authors' own data (Table 5) reveal that these tests are less accurate than are urinary assays of catecholamines and metabolites, a finding repeatedly documented in the literature. Pharmacological tests are also uncomfortable to the patient, sometimes hazardous, and not inexpensive (approximately $10 for one ampule of phentolamine and a bottle of saline, plus 20 to 30 minutes of professional time). Furthermore, phentolamine tests in particular yield a high incidence of falsely positive results.In our laboratory the methoxycatecholamine determination (normetanephrine plus metanephrine) is used for routine screening purposes because of its simplicity and reliability (Amer Heart J61:375, 1961). This assay has provided a positive


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