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July 17, 2002

Imaging vs Biochemical Testing for Pheochromocytoma—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor

JAMA. 2002;288(3):314-315. doi:10.1001/jama.288.3.311

In Reply: Dr Neumann identifies an important limitation of studies comparing diagnostic tests when there is no criterion standard available for conclusive exclusion of disease. In such situations, how can we be sure of excluding disease and that our calculations of diagnostic sensitivity are not inflated? Indeed, as better diagnostic tests are developed, tests that were thought to be highly sensitive invariably are shown to have lesser sensitivity. We disagree with Neumann's suggestion, however, that screening for pheochromocytoma should include MRI, or even positron emission tomography. In our experience, most patients with seemingly "convincing" signs and symptoms do not have pheochromocytoma. In the absence of biochemical evidence of excess catecholamine, additional imaging studies are unlikely to yield further benefit.

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