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In our case, although the tumor was smaller than 4 cm, adrenalectomy was performed because metanephrine, normetanephrine and vanillylmandelic acid levels in a 24-hour urine sample were increased.
The simplest and most reliable test for evaluating pheochromocytoma is measurement of plasma free metanephrines rather than traditional testing by quantitating urinary vanillylmandelic acid or catecholamines.
Among the younger patients, 2% had normal norepinephrine levels, 55% had normal epinephrine levels, and nearly 7% had normal urinary vanillylmandelic acid levels.
As glomus tumors may actively secrete catecholamines (Borba, De Castro, & Al-Mefty 2000), a 24-hour urine collection was ordered for vanillylmandelic acid, metanephrines, and total catecholamines.
Urine samples for homovanillic acid (HVA) and vanillylmandelic acid (VNIA) analysis are acidified to pH 2-4 to maintain analyte stability.
Urinary vanillylmandelic acid and catecholamines were within normal limits.
Tumor biomarkers, such as serum chromogranin A, 24-hour urine total metanephrines and 24-hour urine vanillylmandelic acid, correlated with reduction in target lesion size.