Increased VMA found in?
Correct Answer: Pheochromocytoma
Description: ANSWER: (A) PheochromocytomaREF: Harrison's 18th ed ch: 343Pheochromocytomas and paragangliomas synthesize and store catecholamines, which include norepinephrine (noradrenaline), epinephrine (adrenaline), and dopamine.Elevated plasma and urinary levels of catecholamines and the methylated metabolites, metanephrines, are the cornerstone for the diagnosisCatecholamines and metanephrines can be measured by using different methods (e.g., high-performance liquid chromatography, enzyme-linked immunosorbent assay, and liquid chromatography/mass spectrometry). In a clinical context suspicious for pheochromocytoma, when values are increased three times the upper limit of normal, a pheochromocytoma is highly likely regardless of the assay used.Urinary tests for vanillylmandelic acid (VMA), metanephrines (total or fractionated), and catecholamines are widely available and are used commonly for initial testing. Among these tests, the fractionated metanephrines and catecholamines are the most sensitive.Plasma tests are more convenient and include measurements of catecholamines and metanephrines. Measurements of plasma metanephrine are the most sensitive and are less susceptible to false-positive elevations from stress, including venipuncture
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