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Pitfall in HPLC Assay for Urinary Metanephrines: An Unusual Type of Interference Caused by Methenamine Intake

Departments of¹ Medical Oncology,² Chemical Endocrinology, ³ Endocrinology, and⁴ General Internal Medicine, University Medical Centre Nijmegen, Nijmegen, The Netherlands

^aaddress correspondence to this author at: University Medical Centre Nijmegen, Department of Medical Oncology, PO Box 9101, 6500 HB Nijmegen, The Netherlands; fax 31-24-354-0788, e-mail h.vanlaarhoven@onco.umcn.nl

The first 20% of the full text of this article appears below.

Evaluation of a clinically inapparent adrenal mass led to tests for pheochromocytoma (1) with findings of increased urinary metanephrine and normetanephrine but normal plasma metanephrines and catecholamines.

A 45-year-old woman presented with pulmonary embolism and thrombosis of the left arm. Her recent medical history included removal of the right breast because of cancer with postoperative locoregional radiotherapy and chemotherapy. She had a known spina bifida and an urostoma. She took pyridoxine, oxazepam, methenamine, paracetamol, furosemide, and tamoxifen on a regular basis. On physical examination she had a normal blood pressure, no Cushing signs, and no evidence of tumor recurrence.

After treatment with fractionated heparin and acenocoumarol the patient was further evaluated for the presence of tumor recurrence or distant metastases as an explanation for her thromboembolism. Mammography showed no signs of malignancy. The computed tomography (CT) scan of the thorax showed a pulmonary embolism but no evidence of metastases. The abdominal CT scan revealed a 2.5-cm hypodense mass in the right adrenal gland, most likely an adenoma. Because the differential diagnosis of adrenal masses with low attenuation on CT includes functional tumors, especially pheochromocytoma (2), the functionality of the adrenal mass was determined.

Cortisol was 0.09 and 0.07 µmol/L after a repeated 1-mg dexamethasone suppression test. The 24-h urinary excretion of cortisol was 37.9 nmol, which made the presence of glucocorticoid excess unlikely. Serum potassium was within reference values, and renin and aldosterone were not increased, which together . . . [Full Text of this Article]

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				A. Pfafflin, E. Schleicher, and K. Mussig 3-O-Methyldopamine (3-O-Methoxytyramine) Interferes with the Internal Standard 3,4-Dihydroxybenzylamine in a Plasma Catecholamine HPLC Method Clin. Chem., November 1, 2007; 53(11): 1976 - 1977. [Full Text] [PDF]