Biochemical diagnosis


Graeme Eisenhofer, PhD
Professor & Chief, Division of Clinical Neurochemistry,
Institute of Clinical Chemistry & Laboratory Medicine and Department of Medicine
University Hospital, Dresden
Tel: 49 (0)351 458-4595

Eric Grouzmann, Pharm. D., Ph.D.
Privat-Docent, MER, FAMH Clinical Chemistry
Centre Hospitalier Universitaire Vaudois
Département des Laboratoires
Laboratoire des Catécholamines et Peptides
Hôpital Beaumont, Av de Beaumont 29
1011 Lausanne
Tel: 0041213144396
Natel: 079 556 79 68
Fax: 0041213147835

Prof dr. Ido P. Kema, PhD
Clinical Chemist
Head of Clinical Chemistry
Department of Laboratory Medicine
University Medical Centre Groningen
Internal address EA61
CMC-IV, 2nd floor, Y2.1135a
P.O. Box 30.001
9700 RB Groningen
The Netherlands

Steve Ball, MD
Senior Lecturer
Newcastle University & Newcastle Hospitals NHS Trust
Newcastle upon Tyne, NE1 3BZ
Tel: +44 (0)191-282-4636

Stefan Grebe MD, FRACP, DABCC
Chair Division of Clinical Biochemistry & Immunology & Departmental Vice-Chair Information Management & Supply-Chain
Department of Laboratory Medicine and Pathology
Hilton 730, Mayo Clinic,
200 1st Street SW, Rochester,
Minnesota 55905

Jacques W.M. Lenders, MD, PhD, FRCP
Department of Medicine, Division of Vascular Medicine
University Nijmegen Medical Centre, Nijmegen
Geert Grooteplein Zuid 8, 6525GA, Nijmegen, The Netherlands
Phone: +31 24 3618819
Fax: +31 24 3541734

Issues to be addressed by the working group on biochemical diagnosis of catecholamine-producing tumours

    Standardization/harmonization of analytical methods

  1. Available well characterized stable reference material in the appropriate biological matrix (SG, GE, IK, EG)
  2. For reference & calibration material for urine deconjugated metanephrines existing commercial material is almost exclusively in free form - there is a need for commercial material to reproduce the authentic mixtures of conjugated and free metanephrines (EG, GE)
  3. Sulfate conjugated material for calibrators for assays measuring directly sulfate conjugates without deconjugation step (EG)
  4. For immunoassays there is a need for availability of L-isomers of normetanephrine and metanephrine for standardization (EG, GE)
  5. Analytical interference precision issues (IK)
  6. Standardization/harmonization of reference intervals or thresholds for diagnosis (follows in part as a second step to the first step above)

  7. Thresholds for diagnosis (urine and plasma) ---- related to age, gender, clarity on appropriate populations for reference intervals (SB, JL)
  8. Sharing of population data for thresholds (SB)
  9. Need for agreement on supine versus seated sampling conditions for plasma metanephrines (JL,GE)
  10. For measurements of plasma MTY need for agreement on fasting versus non-fasting (JL, GE)
  11. For urine conditions of sampling – exercise, diet (GE)
  12. Sharing of SOPs for collections sample handling (GE)
  13. Clinical practice

  14. Sampling conditions (as in 8,9,10 above), but also interferences from medications (IK, SB)
  15. Urine free vs deconjugated metanephrines vs plasma free metanephrines and overnight sampling versus 24 hr sampling (IK, GE) – these are research-related issues
  16. Stabilization of urine (IK), especially for urine free metanephrines/catecholamines (GE), and possibly further plasma mets stabilization studies with impact on procedures for shipping/storing plasma (GE)
  17. Recognition of expert centers/laboratories – (JL) and patient access logistics (SB)
  18. Clinician education/awareness of impact of analytical techniques such as immunoassays vs LC-MS/MS (SB)
  19. Prognostic values of metabolite profiles (SB) and related to this interpretative assistance to clinicians from the laboratory such as disease likelihood, tumor location, tumor size, mutations, malignancy (GE)
  20. Clinical utility of methoxytyramine measurements in plasma and urine (GE)