Thamara E Osinga1, Ido P Kema2, Michiel N Kerstens3, Wilhelmina H A de Jong4, Martijn van Faassen5, Robin P F Dullaart6, Thera P Links7, Anouk N A van der Horst-Schrivers8. 1. Department of Endocrinology (AA31), University of Groningen, University Medical Center Groningen, PO-box 30.001, 9700 RB Groningen, The Netherlands. Electronic address: t.osinga@umcg.nl. 2. Department of Laboratory Medicine (EA61), University of Groningen, University Medical Center Groningen, PO-box 30.001, 9700 RB Groningen, The Netherlands. Electronic address: i.p.kema@umcg.nl. 3. Department of Endocrinology (AA31), University of Groningen, University Medical Center Groningen, PO-box 30.001, 9700 RB Groningen, The Netherlands. Electronic address: m.n.kerstens@umcg.nl. 4. Department of Laboratory Medicine (EA61), University of Groningen, University Medical Center Groningen, PO-box 30.001, 9700 RB Groningen, The Netherlands. Electronic address: w.h.a.de.jong@umcg.nl. 5. Department of Laboratory Medicine (EA61), University of Groningen, University Medical Center Groningen, PO-box 30.001, 9700 RB Groningen, The Netherlands. Electronic address: h.j.r.van.faassen@umcg.nl. 6. Department of Endocrinology (AA31), University of Groningen, University Medical Center Groningen, PO-box 30.001, 9700 RB Groningen, The Netherlands. Electronic address: r.p.f.dullaart@umcg.nl. 7. Department of Endocrinology (AA31), University of Groningen, University Medical Center Groningen, PO-box 30.001, 9700 RB Groningen, The Netherlands. Electronic address: t.p.links@umcg.nl. 8. Department of Endocrinology (AA31), University of Groningen, University Medical Center Groningen, PO-box 30.001, 9700 RB Groningen, The Netherlands. Electronic address: a.n.a.van.der.horst@umcg.nl.
Abstract
BACKGROUND: Hypertension can be the predominant sign of pheochromocytoma (PCC) and sympathetic paraganglioma (sPGL) and screening for PCC/sPGL is often performed in patients who are already being treated with antihypertensive agents. There is very little information about the influence of antihypertensive drugs on plasma free metanephrines. The aim of this study was to determine whether commonly prescribed antihypertensive drugs can falsely elevate plasma free metanephrines concentrations measured by LC-MS/MS analysis. METHODS: In a prospective study we included patients with newly diagnosed hypertension, who started monotherapy with an antihypertensive agent (i.e. β-blocker, thiazide diuretic or angiotensin-converting enzyme (ACE) inhibitor). Plasma free metanephrine (MN) and normetanephrine (NMN) levels were measured before and one month after the start of the medication quantified by LC-MS/MS. RESULTS: Between 2009 and 2014, 39 patients were included (β-blocker n=13, thiazide diuretic n=14 and ACE inhibitor n=12). In the whole group, the median plasma free MN and NMN concentrations at baseline were 0.19 [0.17-0.26] nmol/L and 0.56 [0.38-0.95] nmol/L. One month after the start of antihypertensive treatment, the median plasma free MN and NMN concentrations were comparable; 0.20 [0-16-0.24] nmol/L and 0.63 [0.39-0.75] nmol/L, respectively (P=0.43 and P=0.39). Separate analysis for each of the three antihypertensive agents examined did not reveal any significant changes in the median plasma free MN and NMN concentrations. CONCLUSIONS: The measurement of plasma free MN and NMN with LC-MS/MS is not affected by use of β-blockers, diuretics and ACE inhibitors. Withdrawal of these drugs prior to the quantification of plasma metanephrines is therefore not necessary. Copyright Â
BACKGROUND:Hypertension can be the predominant sign of pheochromocytoma (PCC) and sympathetic paraganglioma (sPGL) and screening for PCC/sPGL is often performed in patients who are already being treated with antihypertensive agents. There is very little information about the influence of antihypertensive drugs on plasma free metanephrines. The aim of this study was to determine whether commonly prescribed antihypertensive drugs can falsely elevate plasma free metanephrines concentrations measured by LC-MS/MS analysis. METHODS: In a prospective study we included patients with newly diagnosed hypertension, who started monotherapy with an antihypertensive agent (i.e. β-blocker, thiazide diuretic or angiotensin-converting enzyme (ACE) inhibitor). Plasma free metanephrine (MN) and normetanephrine (NMN) levels were measured before and one month after the start of the medication quantified by LC-MS/MS. RESULTS: Between 2009 and 2014, 39 patients were included (β-blocker n=13, thiazide diuretic n=14 and ACE inhibitor n=12). In the whole group, the median plasma free MN and NMN concentrations at baseline were 0.19 [0.17-0.26] nmol/L and 0.56 [0.38-0.95] nmol/L. One month after the start of antihypertensive treatment, the median plasma free MN and NMN concentrations were comparable; 0.20 [0-16-0.24] nmol/L and 0.63 [0.39-0.75] nmol/L, respectively (P=0.43 and P=0.39). Separate analysis for each of the three antihypertensive agents examined did not reveal any significant changes in the median plasma free MN and NMN concentrations. CONCLUSIONS: The measurement of plasma free MN and NMN with LC-MS/MS is not affected by use of β-blockers, diuretics and ACE inhibitors. Withdrawal of these drugs prior to the quantification of plasma metanephrines is therefore not necessary. Copyright Â
Authors: Martijn van Faassen; Rainer Bischoff; Karin Eijkelenkamp; Wilhelmina H A de Jong; Claude P van der Ley; Ido P Kema Journal: Anal Chem Date: 2020-06-12 Impact factor: 6.986