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Evaluation of the clonidine suppression test in the diagnosis of phaeochromocytoma

Journal of Human Hypertension volume 25, pages 451–456 (2011)Cite this article

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Abstract

The aim of this study is to review the experience of the clonidine suppression test in a regional endocrine centre and to compare the diagnostic sensitivity and specificity using various previous published criteria. The design used is retrospective study. The subjects include 56 patients in whom clonidine suppression tests had been performed from 1995 to 2000: 15 with phaeochromocytoma and 41 patients in whom the diagnosis was excluded using a combination of biochemical testing, abdominal computed tomography scanning and clinical follow-up. Plasma catecholamines were measured by high pressure liquid chromatography on basal samples and at hourly intervals for 3 h after the administration of clonidine 300 μg orally and the following diagnostic criteria were applied: plasma noradrenaline+adrenaline>2.96 nmol l–1 at 3 h post-clonidine or a baseline plasma adrenaline plus noradrenaline>11.82 nmol l–1; plasma noradrenaline>2.96 nmol l–1 at 3 h post-clonidine and plasma noradrenaline>2.96 nmol l–1 and <50% fall in noradrenaline at 3 h post-clonidine. The results obtained is that mean plasma noradrenaline plus adrenaline fell across the test in 40/41 patients in the non-phaeochromocytoma patients and was lowest at 3 h (basal 2.28±0.14 vs 1.36±0.11 nmol l–1, P<0.001). In the phaeochromocytoma group, clonidine had a variable effect on adrenaline plus noradrenaline levels with increases in 7/15. Using an abnormal result as a 3 h level of noradrenaline plus adrenaline>2.96 mmol l–1 gave a sensitivity of 93% and specificity of 95%. When a 3 h noradrenaline>2.96 mmol l–1 was used, sensitivity was 87% and specificity 95%. Using the former criteria, noradrenaline plus adrenaline>2.96 mmol l–1, 1/15 in the phaeochromocytoma group had a normal result after clonidine suppression testing. Two of 41 in the non-phaeochromocytoma group had a false-positive result. Under carefully controlled conditions, the clonidine suppression test is well tolerated, safe and accurate for use in the investigation of patients with suspected phaeochromocytoma.

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Acknowledgements

We are grateful to Sister D Saunderson and the nursing staff of Ward 7D, Royal Victoria Hospital for their expertise. During the course of this analysis, Dr Claire McHenry, Research Fellow, was in receipt of funding from the R&D office, Northern Ireland.

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Authors and Affiliations

  1. Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, Northern Ireland, UK

    C M McHenry, S J Hunter, M T McCormick & A B Atkinson

  2. Department of Endocrine Surgery, Royal Victoria Hospital, Belfast, Northern Ireland, UK

    C F Russell

  3. Department of Clinical Biochemistry, Royal Victoria Hospital, Belfast, Northern Ireland, UK

    M G Smye

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  1. C M McHenry
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  2. S J Hunter
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Correspondence to A B Atkinson.

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McHenry, C., Hunter, S., McCormick, M. et al. Evaluation of the clonidine suppression test in the diagnosis of phaeochromocytoma. J Hum Hypertens 25, 451–456 (2011). https://doi.org/10.1038/jhh.2010.78

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