Plasma Metanephrines Yield Fewer False-Positive Results Than Urine Metanephrines in Patients With Obstructive Sleep Apnea.

Autor:	King TFJ; Department of Endocrinology, Changi General Hospital, Singapore 529889, Singapore.; Duke-National University of Singapore (NUS) Medical School, National University of Singapore, Singapore 169547, Singapore., Mok Y; Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore 529889, Singapore.; Department of Sleep Medicine, Surgery and Science, Changi General Hospital, Singapore 529889, Singapore., Dacay LM; Department of Endocrinology, Changi General Hospital, Singapore 529889, Singapore., Wong HS; Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore 529889, Singapore.; Department of Sleep Medicine, Surgery and Science, Changi General Hospital, Singapore 529889, Singapore., Hsu PP; Department of Otorhinolaryngology, Changi General Hospital, Singapore 529889, Singapore., Tan A; Department of Otorhinolaryngology, Changi General Hospital, Singapore 529889, Singapore., Wong KM; Department of Radiology, Changi General Hospital, Singapore 529889, Singapore., Saffari SE; Duke-National University of Singapore (NUS) Medical School, National University of Singapore, Singapore 169547, Singapore.; Department of Neurology, National Neuroscience Institute, Singapore 308433, Singapore., Lenders JWM; Department of Internal Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands., Puar TH; Department of Endocrinology, Changi General Hospital, Singapore 529889, Singapore.; Duke-National University of Singapore (NUS) Medical School, National University of Singapore, Singapore 169547, Singapore.
Jazyk:	angličtina
Zdroj:	The Journal of clinical endocrinology and metabolism [J Clin Endocrinol Metab] 2024 Feb 20; Vol. 109 (3), pp. 844-851.
DOI:	10.1210/clinem/dgad553
Abstrakt:	Context: Obstructive sleep apnea (OSA) is associated with increased nocturnal sympathetic activity. In OSA patients, elevations in metanephrines may lead to false-positive tests when evaluating for pheochromocytoma or paraganglioma (PPGL). Objective: To evaluate whether morning plasma metanephrines would lead to fewer false-positive results than 24-hour urinary metanephrines in OSA patients. Methods: Patients undergoing polysomnography for suspected OSA were recruited. Plasma free and 24-hour urinary metanephrines were measured by HPLC-MS/MS. Patients with elevated levels had repeat measurements, abdominal imaging, and follow-up to diagnose or exclude a PPGL. Results: Seventy-six patients completed polysomnography and biochemical testing; 68 (89.5%) patients had OSA, of whom 19 (27.9%) had elevated plasma and/or urinary metanephrines. On follow-up, one patient had a bladder paraganglioma, while PPGL was excluded in the remaining patients. OSA patients had more false-positive urinary metanephrines (17 of 67, 25.4%) than plasma metanephrines (2 of 67, 3.0%), P < .01, and this was more common in severe OSA (13 of 34, 38.2%), compared to moderate/mild OSA (4 of 33, 12.1%), P < .01. Both plasma and urinary metanephrines decreased after treatment with continuous positive airway pressure. On multivariable analysis, severe OSA, obesity, and family history of hypertension were positive predictors for false-positive urinary metanephrines in patients with suspected OSA. Conclusion: In OSA patients, plasma metanephrines are less likely to yield false-positive results for the diagnosis of PPGL than 24-hour urinary metanephrines. In patients with suspected OSA, obesity, or a family history of hypertension, plasma metanephrines may be the preferred first-line test to avoid unnecessary anxiety or follow-up. (© The Author(s) 2023. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu