Algorithm for the Diagnosis, Localization, and Management of Pheochromocytoma - Flowchart
Algorithm for the Diagnosis, Localization, and Management of Pheochromocytoma - Flowchart Pheochromocytoma Pheochromocytoma
«Flowchart»

Biochemical diagnosis

Plasma-free metanephrines

Biochemical diagnosis

Plasma-free metanephrines

Biochemical diagnosis

Plasma-free metanephrines

Negative

Negative

Negative

Positive

Positive

Positive

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Management

Observation, consider repeat testing if suspicion remains

Management

Observation, consider repeat testing if suspicion remains

Management

Observation, consider repeat testing if suspicion remains

End

End

End

Localization

MIBG

Localization

MIBG

Localization

MIBG

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Management

Preoperative conditioning

Management

Preoperative conditioning

Management

Preoperative conditioning

Management

Surgery

Management

Surgery

Management

Surgery

Localization

CT/MRI

Localization

CT/MRI

Localization

CT/MRI

Age <50 yr or suggestion of multifocality

Age <50 yr or suggestion of multifocality

Age <50 yr

Age >50 yr single site

Age >50 yr single site

Age >50 yr

Biochemical diagnosis

Repeat 24-hr urine metanephrines and catecholamines

Biochemical diagnosis

Repeat 24-hr urine metanephrines and catecholamines

Biochemical diagnosis

Repeat 24-hr urine metanephrines and catecholamines

Negative

Negative

Negative

Mild to moderate elevation

Mild to moderate elevation

Mild to moderate elevation

Positive

Positive

Positive

Biochemical diagnosis

Clonidine suppression test

Biochemical diagnosis

Clonidine suppression test

Biochemical diagnosis

Clonidine suppression test

Normetanephrine suppressed

Normetanephrine suppressed

Normetanephrine suppressed

Normetanephrine Not suppressed

Normetanephrine Not suppressed

Normetanephrine

Biochemical diagnosis

24-hr urine metanephrines and catecholamines

Biochemical diagnosis

24-hr urine metanephrines and catecholamines

Biochemical diagnosis

24-hr urine metanephrines and catecholamines

Positive

Positive

Positive

Negative/equivocal

Negative/equivocal

Negative/equivocal