CATECHOL AMINE EXCRETION IN NORMAL PERSONS AND IN CASES OF PHAEOCHROMOCYTOMA

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Abstract
Urinary catechol amines have been estimated biologically in over 500 cases of hypertension. Sixteen of these patients had pheochromocytomas, of which 12 were of adrenal medullary origin and four of para-aortic origin. Estimation of free catechol amines is diagnostic provided that urine specimens are concentrated and both adrenaline and noradrenaline are determined. Under these conditions 96.3% of estimations in "normal" hypertensive subjects fall below 50 [mu]g. per 24 hours, and values above this are therefore considered diagnostic of pheochromocytoma. All cases of para-aortic tumor contained 100% noradrenaline in both urine and tumor, while nine of the 12 cases of medullary tumor contained some adrenaline in urine and tumor. This distinction in urinary adrenaline-noradrenaline pattern may provide pre-operative indication of the type of tumor, and hence its probable location. There is no significant correlation between tumor weight and amount of catechol amines in the tumor or excreted in the urine. The phentolamine test produces a significantly greater fall in blood-pressure in cases of pheochromocytoma than in hypertensive cases without tumors, but the deviation is so great that there is a high probability of erroneous diagnosis in a single case. There is a significant correlation between the excretion of total free catechol amines and 3-methoxy-4-hydroxyman-delic acid (VMA) in patients with hypertension but no pheochromocytoma, but not in patients with pheochromocytoma. The importance of these findings in relation to the accurate diagnosis of pheochromocytoma is discussed.

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