Do not require urinary vanillymandelic acid and plasma and/or urinary catecholamines for diagnosis of pheochromocytoma-paraganglioma.

Type of practice

Laboratory tests



Topic Area

For the diagnosis of pheochromocytoma-paraganglioma require free plasma metanephrines and, if these are not available, fractionated urinary metanephrines. The remarkable sensitivity of plasma and urinary metanephrines allows the diagnosis to be excluded when they are not increased. Fundamental articles such as those by JW Lenders et al. conclude that the diagnostic sensitivity of urinary vanillymandelic acid is lower. Methoxytyramine in plasma (not urine) can be used in some dopamine-producing tumours and in monitoring metastatic disease and Chromogranin A in non-secreting pheochromocytoma-paraganglioma.


1. Lenders JW, Pacak K, Walther MM, et al. Biochemical diagnosis of pheochromocytoma: which test is best? JAMA 2002; 287:1427–34. DOI: 10.1001/jama.287.11.1427.
2. Lenders JW, Duh QY, Eisenhofer G, et al. Pheochromocytoma and paraganglioma: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2014; 99:1915–42. DOI: 10.1210/jc.2014-1498.
3. D’Aurizio F, Tozzoli R, Dorizzi RM et al. La diagnostica di laboratorio delle malattie del surrene. Raccomandazioni pratiche per feocromocitoma e paraganglioma. Riv Ital Med Lab 2014; 10:193– 203. DOI: 03 DOI 10.1007/s13631-014-0062-2m.
4. Boot CS. A Laboratory Medicine Perspective on the Investigation of phaeochromocytoma and paraganglioma. Diagnostics (Basel) 2023; 13:2940. DOI: 10.3390/diagnostics13182940.
5. Eisenhofer G, Pamporaki C, Lenders JWM. Biochemical Assessment of pheochromocytoma and paraganglioma. Endocr Rev 2023; 44:862-909. DOI: 10.1210/endrev/bnad011.



Attention. Please note that these items are provided only for information and are not intended as a substitute for consultation with a clinician. Patients with any specific questions about the items on this list or their individual situation should consult their clinician.