Popular Urine Test Predicts Death Risk in Adrenal Adenomas

TOPLINE:

Urine normetanephrines were linked to an increased risk for mortality in patients with adrenal adenomas, with a 47% higher risk observed per 1srcsrc μmol/mol creatinine increase. No significant association was found between urine metanephrines and an increased risk for mortality.

METHODOLOGY:

• Researchers conducted a cohort study to examine whether urine metanephrines are linked to the risk for mortality in patients with adrenal adenomas found as incidentalomas.
• They included 879 adult patients (median age, 66.7 years; 59.6% women) with adrenal incidentalomas from two endocrine referral centres in Sweden between 2srcsrc5 and 2src15; patients were followed up for a median duration of 9.9 years.
• High-performance liquid chromatography with electrochemical detection and liquid chromatography-mass spectrometry were used to analyse 24-hour urine (tU) levels of metanephrines and normetanephrines at inclusion; other clinical and biometric information was gathered from the electronic medical record during the patients’ initial visit to the study site.
• Patients were categorised into tertiles on the basis of their tU-metanephrine and tU-normetanephrine levels, with tertile 1 representing the lowest values and tertile 3 representing the highest.
• The endpoint was all-cause mortality, data of which were obtained from the national cause of death register.

TAKEAWAY:

• A significant association was found between tU-normetanephrines and an increased risk for mortality (hazard ratio [HR] per 1srcsrc μmol/mol creatinine increase, 1.47; 95% CI, 1.27-1.69).
• No significant association was observed between tU-metanephrines and an increased risk for mortality.
• Compared with patients in the lower tertiles of tU-normetanephrines, those in the highest tertile had a significantly increased risk for mortality (tertile 1 vs 3: HR, 1.84; 95% CI, 1.25-2.7src; tertile 2 vs 3: HR, 1.49; 95% CI, 1.src9-2.src3).
• The association between tU-normetanephrines and an increased risk for mortality was more prominent in smokers than in non-smokers.

IN PRACTICE:

“Our findings suggest that tU-normetanephrine, additionally, might prove a clinically helpful marker for risk assessment in patients with adrenal incidentalomas constituted by adenomas,” the authors wrote.

SOURCE:

This study was led by Albin Kjellbom, Faculty of Medicine, Lund University, Lund, Sweden. It was published online on April src1, 2src25, in Scientific Reports.

LIMITATIONS:

A significant proportion of patients were excluded on the basis of the established exclusion criteria. The largest group of exclusions included patients who did not have tU-metanephrines, most of whom were evaluated using plasma metanephrines. Despite adjustments for known confounders, there may have been a risk of unmeasured bias. 

DISCLOSURES: 

This study received open access funding from Lund University, the Lisa and Johan Grönberg Foundation, and the Gyllenstiernska Krapperup Foundation. One author reported being an employee of Eli Lilly and Company.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.