Over the last 20 years, the prevalence of the metabolic syndrome has steadily increased in all populations worldwide, changing slowly the phenotype of the human race and potentially our concept of physiological normality. Our affluent phenotype reflects progressive adaptation to the external environment, which in turn changes the standards of the metabolic variables such as body weight, blood pressure, lipid values and glucose homeostasis. The human survivors of the difficult times of the hunter-gatherer period have probably benefited from genes which have allowed for more efficient food utilization, fat deposition and weight gain, a concept referred to as the ‘thrifty gene’ hypothesis. This genetic background has now become detrimental in our society of high energy consumption, little physical activity and lifestyles that favour stress and anxiety. These genetic and environmental interactions explain the explosion in the prevalence of the metabolic syndrome and diabetes. If future estimates for the number of patients with diabetes and impaired glucose tolerance are valid, this will have a major and adverse impact on the number of stroke patients globally.

Objective: To define the test characteristics of an enzyme immunoassay (EIA) for plasma-free metanephrines (metanephrine and normetanephrine) in the diagnosis of pheochromocytoma and paraganglioma. Design: Prospective observational design from a single University Hospital. Twenty-four hour urine for catecholamines and plasma for free metanephrines were collected from patients with a clinical suspicion of pheochromocytoma or paraganglioma. Patient records were reviewed for clinical data, follow-up, imaging and laboratory results to establish or exclude the diagnosis of pheochromocytoma. Patients and methods: Out of 178 consecutive patients, 10 had a paraganglioma and 12 had a pheochromocytoma: 156 were finally judged not to harbour active tumors and were therefore considered as controls. The main outcome measure was the diagnosis or exclusion of paraganglioma or pheochromocytoma and test characteristics of plasma-free metanephrines measured by EIA. Results: Urinary epinephrine had a sensitivity of 45.5% and norepinephrine a sensitivity of 75% (98.8% specificity) for the diagnosis of pheochromocytoma. Plasma-free metanephrine and normetanephrine both had a sensitivity of 66.7% and a specificity of 100%, but when combined (either positive) they demonstrated a 91.7% sensitivity with a preserved specificity of 100%. For the diagnosis of paraganglioma, urinary norepinephrine gave slightly better results than plasma-free metanephrines, but combined testing was of no additional value. Conclusions: Plasma-free metanephrines measured by EIA have better diagnostic test characteristics than urinary catecholamines in the diagnosis of pheochromocytoma. The EIA offers a simple and effective measurement of plasma-free metanephrines.

The authors and journal apologize for the error in the above paper which appeared in 161 (1) 131–140. The kits for the assay of free metanephrines were supplied by both Immunodiagnostic Systems Ltd (IDS), Tyne and Wear, UK and also Biotech-IgG (UK) Ltd, Wilmslow, UK.

Adrenal oncocytoma (AO) is an extremely rare adrenocortical neoplasm and little is known about its malignant potential, secretory properties, and hereditary origin. We present the case of a benign AO with concomitant incidentally found papillary thyroid cancer (PTC) and review similar cases in the literature. Immunohistochemistry and next-generation sequencing (NGS) were performed. A 66-year-old women was incidentally found to have a large, androgen-secreting right adrenal mass. 18F-Fluorodeoxyglucose positron emission tomography showed intense uptake (SUVmax 88.7) of this mass and found a hypermetabolic right thyroid mass. Open adrenalectomy was performed for this highly suspicious adrenal mass. Histopathology revealed benign AO that was BRAFV600E negative, with low Ki-67, and no somatic mutation found on NGS. Thyroidectomy revealed invasive, BRAFV600E-positive PTC. At 6 months follow-up, androgen levels returned to normal, and no recurrence was seen on imaging. To our knowledge, this is the first report of an androgen-secreting AO with concomitant PTC. Possibly the simultaneous discovery of two independent neoplasms was observed. In conclusion, this case highlights that care should be given to exclude concomitant neoplasms. Long-term and regular imaging with biochemical follow-up is warranted, since the outcome and clinical behavior of AO remains uncertain.

Thyroid nodules are a very frequent finding in particular within the feminine population. Their prevalence increases with age and the vast majority (>95%) are benign and without dangerous consequences. A true cancer of the thyroid is rare. Following the discovery of a thyroid nodule by the patient himself or by the doctor, a relatively simple strategy should exclude the rare event of an underlying cancer. Thyroid ultrasound will confirm that the nodule is of thyroid origin. Furthermore, the ultrasound will measure the size of the nodule and reveal if other nodules or if suspicious lymph nodes are present. The next step is to measure the TSH level. If the TSH is normal, a fine needle aspiration is indicated for nodules larger than 1.0-1.5 centimetres. The choice between clinical follow up and a surgical thyroidectomy will be based upon the cytological analysis (hence the key role of an experimented pathologist in thyroid cytology). A thyroid scan is useless (except in case of hyperthyroidism with a low TSH).