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August 1957

Chemical Determination of Urinary Catecholamines: An Aid in the Differential Diagnosis of Essential Hypertension and Pheochromocytoma

Author Affiliations
Los Angeles
From Bio-Science Laboratories.
AMA Arch Intern Med. 1957;100(2):196-200. doi:10.1001/archinte.1957.00260080022006

The classical description of patients with pheochromocytoma includes, as typical symptoms, paroxysmal hypertension, pallor, sweating, and tachycardia. It is now known that only a minority of patients exhibit such symptoms.1,2 The majority of cases manifest only a persistent hypertension and are difficult to differentiate from cases of essential hypertension. The proportion of pheochromocytomas among cases of hypertension, while small, is significant. Graham 3 encountered 8 cases, or 0.47%, of pheochromocytoma among 1700 unselected patients with hypertension subjected to bilateral lumbodorsal splanchnicectomy. If this percentage is correct, approximately 1 out of every 200 cases of hypertension involves a pheochromocytoma. It thus becomes important to have a highly specific method for the diagnosis of the latter disease.

The pharmacologic tests, such as the histamine, benzodioxane, and phentolamine (Regitine) tests, are known to yield both false-negative and false-positive tests.1,4,5 Since Engel and von Euler6 first pointed out in 1950 the

Helps, E. P. W.; Robinson, K. C., and Ross, E. J.:  Phentolamine in the Diagnosis and Management of Phæochromocytoma ,  Lancet 2:267-272 ( (Aug. 6) ) 1955.Crossref
Goldenberg, M.; Aranow, H., Jr.; Smith, A. A., and Faber, M.:  Pheochromocytoma and Essential Hypertensive Vascular Disease ,  Arch. Int. Med. 86:823-836 ( (Dec.) ) 1950.Crossref
Graham, J. B.:  Pheochromocytoma and Hypertension: Analysis of 207 Cases ,  Internat. Abstr. Surg. 92:105-121, 1951
 Surg. Gynec. & Obst. , (Feb.) , 1951.
West, G. B., and Taylor, N. R. W.:  Studies in Phæochromocytoma: HI. The Excretion of Noradrenaline in the Urine of Cases of Hypertension and Its Value in the Diagnosis of Phæochromocytoma ,  Glasgow M. J. 36:123-129 ( (April) ) 1955.
Goldenberg, M.; Serlin, I.; Edwards, T., and Rapport, M. M.:  Chemical Screening Methods for the Diagnosis of Pheochromocytoma: Nor Epinephrine and Epinephrine in Human Urine ,  Am. J. Med. 16:310-327 ( (March) ) 1954.Crossref
Engel, A., and von Euler, U. S.:  Diagnostic Value of Increased Urinary Output of Noradrenaline and Adrenaline in Phæochromocytoma ,  Lancet 2:387 ( (Sept. 23) ) 1950.Crossref
von Euler, U. S., and Hellner, S.:  Excretion of Noradrenaline, Adrenaline, and Hydroxytyramine in Urine ,  Acta physiol. scandinav. 22:161-167 ( (April) ) 1951.Crossref
Richardson, J. E.; Ross, J. H., and Turnbull, A. L.:  Reversal of Malignant Hypertension Due to Ectopic Phæochromocytoma ,  Lancet 2:275-278 ( (Aug. 6) ) 1955.Crossref
Lund, A.:  Adrenaline and Noradrenaline in Blood and Urine in Cases of Pheochromocytoma ,  Scandinav. J. Clin. & Lab. Invest. 4:263-265, 1952.
von Euler, U. S., and Floding, I.:  Fluorimetric Estimation of Noradrenaline and Adrenaline in Urine ,  Acta.physiol. scandinav. ( (Supp. 118) ) 33:57-62, 1955.
Lund, A.:  Fluorimetric Determination of Adrenaline in Blood: III. A New Sensitive and Specific Method ,  Acta pharmacol. et toxicol. 5: 231-247, 1949.
Lund, A.:  Simultaneous Fluorimetric Determinations of Adrenaline and Noradrenaline in Blood ,  Acta pharmacol. et toxicol. 6:137-146, 1950.
Ehrlén, I.:  Fluorimetric Determination of Adrenaline: II. ,  Farm. rev. 47:242-250, 1948.
Weil-Malherbe, H., and Bone, A. D.:  The Chemical Estimation of Adrenaline-like Substances in Blood ,  Biochem. J. 51:311-318 ( (June) ) 1952.
von Euler, C., von Euler, U. S., and Floding, I.:  Biologically Inactive Catechol Derivatives in Urine ,  Acta physiol. scandinav. ( (Supp. 118) ) 33: 32-38, 1955.
Weil-Malherbe, H.:  The Fluorimetric Estimation of Adrenaline, Noradrenaline and Hydroxytyramine in Urine ,  Biochem. J. 63, 4P ( (May) ) 1956.
Sobel, C., and Henry, R. J.:  Fluorimetric Determination of Catecholamines (Adrenaline and Noradrenaline) in Urine and Tissues ,  Am. J. Clin. Path. 27:240-245, 1957.
von Euler, U. S., and Hellner, S.:  Excretion of Noradrenaline and Adrenaline in Muscular Work ,  Acta physiol. scandinav. 26:183-191, 1952.
Moore, F. J.; Cramer, F. B., and Knowles, R. G.:  Statistics for Medical Students and Investigators in the Clinical and Biological Sciences , New York, The Blakiston Company, 1951, p. 23.