Increased urinary excretion of 3-methoxytyramine in patients with head and neck paragangliomas.

Abstract

CONTEXT:

Patients with head-and-neck paragangliomas (HNPGL) are regularly screened for catecholamine excess. The clinical relevance of increased urinary secretion of 3-methoxytyramine is unclear in HNPGL.

OBJECTIVE:

The aim of the study was to assess the prevalence and the clinical, biochemical, and radiological presentation of patients with HNPGL with increased urinary excretion of 3-methoxytyramine.

PATIENTS AND METHODS:

A total of 136 consecutive patients with HNPGL were included and screened for catecholamine excess by measurement of 24-h urinary excretion of (nor)metanephrine, (nor)epinephrine, vanillylic mandelic acid, dopamine, and 3-methoxytyramine. In patients with catecholamine excess, abdominal/intrathoracic paragangliomas were excluded by (123)I-metaiodobenzylguanidine scintigraphy, magnetic resonance imaging, and/or computed tomography.

RESULTS:

Urinary 3-methoxytyramine excretion was increased in 31 of the 136 patients (23%). In 18 of these 31 patients, this was the only sign of biochemical activity of HNPGL. Dopamine excretion was higher in subjects with increased 3-methoxytyramine excretion (1.62 +/- 0.1 micromol/24 h vs. 2.5 +/- 0.3 micromol/24 h; P < 0.01). Of the 136 HNPGL patients, 21 (15%) had excessive excretion of at least one catecholamine and/or their metabolites when 3-methoxytyramine excretion was not taken into account. With the inclusion of patients with excessive 3-methoxytyramine excretion, 39 (29%) had excessive catecholamine excretion. Patients with 3-methoxytyramine excess had significantly more complaints of palpitations (P < 0.01), diaphoresis (P = 0.03), collapse (P < 0.05), and a higher pulse rate (P < 0.01). Increased excretion of 3-methoxytyramine was not associated with particular types of HNPGL or genotypes.

CONCLUSIONS:

A substantial number of HNPGL patients have biochemically active tumors, reflected in increased excretion of 3-methoxytyramine, associated with increased dopamine excretion. Some patients only display increased excretion of 3-methoxytyramine, but not of other catecholamines or their metabolites.

• Authors: N van Duinen, D Steenvoorden, I P Kema, J C Jansen, A H J T Vriends, J P Bayley, J W A Smit, J A Romijn, E P M Corssmit
• Journal: The Journal of clinical endocrinology and metabolism (J Clin Endocrinol Metab) Vol. 95 Issue 1 Pg. 209-14 (Jan 2010) ISSN: 1945-7197 [Electronic] United States
• PMID: 19897674 (Publication Type: Evaluation Study, Journal Article)

Chemical References

• Catecholamines
• 3-Iodobenzylguanidine
• 3-methoxytyramine
• Dopamine

Topics

• 3-Iodobenzylguanidine
• Catecholamines (urine)
• Cross-Sectional Studies
• Dopamine (analogs & derivatives, urine)
• Female
• Head and Neck Neoplasms (diagnostic imaging, epidemiology, urine)
• Humans
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Paraganglioma (diagnostic imaging, epidemiology, urine)
• Prevalence
• Radiography
• Radionuclide Imaging
• Up-Regulation