Influence of various confounding variables and storage conditions on metanephrine and normetanephrine levels in plasma

• Published in: Clinical endocrinology (Oxford) Vol. 73; no. 2; pp. 153 - 160
• Main Authors: Deutschbein, Timo, Unger, Nicole, Jaeger, Andrea, Broecker-Preuss, Martina, Mann, Klaus, Petersenn, Stephan
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.08.2010; Blackwell; Wiley Subscription Services, Inc
• Subjects: Adolescent; Adrenal Gland Neoplasms - blood; Adrenal Gland Neoplasms - diagnosis; Adult; Biological and medical sciences; Blood Chemical Analysis - methods; Blood Chemical Analysis - statistics & numerical data; Blood Specimen Collection - methods; Blood Specimen Collection - statistics & numerical data; Confounding Factors (Epidemiology); Endocrinopathies; Exercise - physiology; Feeding Behavior - physiology; Female; Fundamental and applied biological sciences. Psychology; Humans; Male; Medical sciences; Menstrual Cycle - blood; Menstrual Cycle - metabolism; Menstrual Cycle - physiology; Metanephrine - blood; Metanephrine - metabolism; Middle Aged; Normetanephrine - blood; Normetanephrine - metabolism; Pheochromocytoma - blood; Pheochromocytoma - diagnosis; Vertebrates: endocrinology; Young Adult; Metadrenaline; Metanephrine; Storage; Normetanephrine; Conservation; Confounding factor; Endocrinology; Blood plasma
• ISSN: 0300-0664; 1365-2265; 1365-2265
• DOI: 10.1111/j.1365-2265.2009.03761.x

Summary Objective  Measurements of plasma free metanephrines have been advocated as first‐line tests for phaeochromocytoma. The aim of the study was to assess the impact of potential confounding variables. Design  Comparative study between 2008 and 2009. Subjects  Hundred and eighty healthy subjects. Measurements  The effects of age, BMI, gender, menstrual cycle (sampling every 2 days), time of day (sampling every 2 h), venepunture (0, 15, 30, 60, 90 and 120 min), physical exercise (0, 15 and 30 min), coffee (0 and 60 min), breakfast (0 and 60 min) and various body positions (standing and supine rest, each 0 and 120 min) were evaluated. In addition, whole blood and plasma samples were stored at 4 °C or at 22 °C for 0, 1, 3, 24 and 72 h. Plasma free metanephrines were measured using radioimmunoassay (LDN). Results  While metanephrine was significantly influenced by sex and age, BMI and sex were significant predictors of normetanephrine. Coffee (+20%) and food (+8%) elevated normetanephrine significantly (P < 0·05), while metanephrine remained stable. Physical exercise increased metanephrine (+82%) as well as normetanephrine (+84%) significantly (P < 0·005). Supine rest significantly decreased both metanephrine (−34%) and normetanephrine (−19%) when compared to standing rest (P < 0·01). Metanephrine and normetanephrine were not significantly influenced by time of day, menstrual cycle or venepuncture. When plasma samples were stored at 4 °C, metanephrine and normetanephrine were stable for 72 h. Conclusions  Physical exercise may lead to relevant changes in metanephrine and normetanephrine and should therefore be avoided prior to sampling. Although effects of age, sex and BMI were small, these variables should be considered when interpreting biochemical results. Blood should be taken in the supine position, and samples should be immediately centrifuged and stored at 4 °C to improve stability.