False Positive test Results for Pheochromocytoma from 2000 to 2008

Testing for pheochromocytoma becomes more frequent in clinical practice. False positive test results may cause patient anxiety and unnecessary imaging studies. The data on false positive results for pheochromocytoma in routine clinical practice are lacking. To examine the prevalence of false positive results and to reveal the clinical features and laboratory tests of patients with markedly elevated but false positive test results, a database of tests for pheochromocytoma at a large general hospital between 2000 and 2008 was reviewed. Of 1 896 patients tested, 417 (22.0%) had at least one abnormal test result and 66 (3.5%) had markedly elevated results. 24 patients with markedly elevated but false positive results received 65 imaging studies and 1 adrenalectomy. The causes of the misleading results included physiological variations (33%), laboratory errors (29%), and drug interference with measurement (21%). The false positive rate of a markedly elevated result was lowest for vanillylmandelic acid (9%) and highest for urine metanephrines (50%) (p = 0.03). Nearly half of all test results were normal and 79% of patients had at least one normal result. Therefore false positive test results for pheochromocytoma are rather common. Markedly elevated but false positive test results can potentially be avoided by judicious selection of patients and tests. Pretest risk, physiological variations of catecholamine levels, laboratory errors, and drug interference should be considered in interpreting abnormal test results.