Objective: The aim was to formulate clinical practice guidelines for pheochromocytoma and paraganglioma (PPGL). Participants: The Task Force included a chair selected by the Endocrine Society Clinical Guidelines Subcommittee (CGS), seven experts in the field, and a methodologist. The authors received no corporate funding or remuneration. Evidence: This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe both the strength of recommendations and the quality of evidence. The Task Force reviewed primary evidence and commissioned two additional systematic reviews. Consensus Process: One group meeting, several conference calls, and e-mail communications enabled consensus. Committees and members of the Endocrine Society, European Society of Endocrinology, and Americal Association for Clinical Chemistry reviewed drafts of the guidelines. Conclusions: The Task Force recommends that initial biochemical testing for PPGLs shou...

/pdf/pheochromocytoma-and-paraganglioma-an-endocrine-society-4ij7m1t7fo.pdf

Pheochromocytoma and paraganglioma: An endocrine society clinical practice guideline

ContextDiagnosis of pheochromocytoma depends on biochemical evidence of catecholamine
production by the tumor. However, the best test to establish the diagnosis
has not been determined.ObjectiveTo determine the biochemical test or combination of tests that provides
the best method for diagnosis of pheochromocytoma.Design, Setting, and ParticipantsMulticenter cohort study of patients tested for pheochromocytoma at
4 referral centers between 1994 and 2001. The analysis included 214 patients
in whom the diagnosis of pheochromocytoma was confirmed and 644 patients who
were determined to not have the tumor.Main Outcome MeasuresTest sensitivity and specificity, receiver operating characteristic
curves, and positive and negative predictive values at different pretest prevalences
using plasma free metanephrines, plasma catecholamines, urinary catecholamines,
urinary total and fractionated metanephrines, and urinary vanillylmandelic
acid.ResultsSensitivities of plasma free metanephrines (99% [95% confidence interval
{CI}, 96%-100%]) and urinary fractionated metanephrines (97% [95% CI, 92%-99%])
were higher than those for plasma catecholamines (84% [95% CI, 78%-89%]),
urinary catecholamines (86% [95% CI, 80%-91%]), urinary total metanephrines
(77% [95% CI, 68%-85%]), and urinary vanillylmandelic acid (64% [95% CI, 55%-71%]).
Specificity was highest for urinary vanillylmandelic acid (95% [95% CI, 93%-97%])
and urinary total metanephrines (93% [95% CI, 89%-97%]); intermediate for
plasma free metanephrines (89% [95% CI, 87%-92%]), urinary catecholamines
(88% [95% CI, 85%-91%]), and plasma catecholamines (81% [95% CI, 78%-84%]);
and lowest for urinary fractionated metanephrines (69% [95% CI, 64%-72%]).
Sensitivity and specificity values at different upper reference limits were
highest for plasma free metanephrines using receiver operating characteristic
curves. Combining different tests did not improve the diagnostic yield beyond
that of a single test of plasma free metanephrines.ConclusionPlasma free metanephrines provide the best test for excluding or confirming
pheochromocytoma and should be the test of first choice for diagnosis of the
tumor.

https://jamanetwork.com/journals/jama/articlepdf/194752/JTO10005.pdf

Biochemical diagnosis of pheochromocytoma: which test is best?

Objective: To assess the performance of current clinical recommendations for the evaluation of an adrenal incidentaloma. Design and methods: Literature review. Electronic databases (Pubmed, Ovid and citation searches from key articles) from 1980 to 2008 were searched. Eligible studies were those deemed most applicable to the clinical scenario of a patient referred to an endocrinologist for assessment of an incidentally detected adrenal mass. Surgical series, histopathological series and oncological series were reviewed and most were excluded. Results: The prevalence of functional and malignant lesions presenting as adrenal incidentaloma was similar to that quoted in most reviews, other than a lower incidence of adrenal carcinoma (1.9 vs 4.7%) and metastases (0.7 vs 2.3%). The development of functionality or malignancy during follow-up was rare (!1% becoming functional and 0.2% becoming malignant). During follow-up, false-positive rates of the recommended investigations are typically 50 times greater than true positive rates. The average recommended computed tomography (CT) scan follow-up exposes each patient to 23 mSv of ionising radiation, equating to a 1 in 430 to 2170 chance of causing fatal cancer. This is similar to the chance of developing adrenal malignancy during 3-year follow-up of adrenal incidentaloma. Conclusion: Current recommendations for evaluation of adrenal incidentaloma are likely to result in significant costs, both financial and emotional, due to high false-positive rates. The dose of radiation involved in currently recommended CT scan follow-up confers a risk of fatal cancer that is similar to the risk of the adrenal becoming malignant. This argues for a review of current guidelines.

/pdf/recommended-evaluation-of-adrenal-incidentalomas-is-costly-204wd09zhp.pdf

Recommended evaluation of adrenal incidentalomas is costly, has high false-positive rates and confers a risk of fatal cancer that is similar to the risk of the adrenal lesion becoming malignant; time for a rethink?

Context: Pheochromocytomas and paragangliomas (PHEO/PGL) are neuroendocrine tumors that arise from sympathetic and parasympathetic paraganglia. Diagnosed rarely during childhood, PHEO/PGL are nonetheless important clinical entities, particularly given our evolving understanding of their pathophysiology. Evidence Acquisition: We identified articles through the U.S. National Library of Medicine by using the search terms pheochromocytoma and paraganglioma. Results were narrowed to manuscripts that included children and studies related to the genetics of PHEO/PGL. Web-based resources for genetic disorders were also used. For all articles, we performed subsequent reference searches and verification of source data. Evidence Synthesis: Up to 20% of PHEO/PGL are diagnosed in children. Most are functional tumors, and clinical presentation includes symptoms related to catecholamine hypersecretion and/or tumor mass effect. Increasingly, PHEO/PGL are identified during presymptomatic screening in children with genetic...

/pdf/a-current-review-of-the-etiology-diagnosis-and-treatment-of-4a2wxcxvwo.pdf

A current review of the etiology, diagnosis, and treatment of pediatric pheochromocytoma and paraganglioma.

http://soched.cl/guias_clinicas/061814_Phecochromocytoma_FinalA2.pdf

Pheochromocytoma and paraganglioma

Over the last few years, most of the attempts to introduce active learning methodologies in the classroom have made use of Information and Communication Technology (ICT). Many of these efforts have been directed to collaborative scenarios used in remote, blended or face-to-face experiences, in order to take advantage of the flexibility provided by ICT. However competitive learning could also have some positive effects on the success of the learning process, to be added to those of collaborative virtual environments. This paper explores the effects of competitive learning on the satisfaction and the academic achievement of telecommunications students. A tool for active and competitive learning (called QUEST) has been used in the ldquoCommunications Networksrdquo undergraduate course. Significant results on the use of competitive e-learning tools in university students' outcomes and satisfaction are presented.

Effects of Competitive E-Learning Tools on Higher Education Students: A Case Study

A five-year report on experience in the detection of pheochromocytoma.

This study examines the evidence for the effectiveness of adaptive learning and the satisfaction level of students when using this type of learning. It first analyses the different classifications of adaptive learning systems existing in the literature, to focus later on describing some adaptive and intelligent e-learning systems, mainly those included in the groups of Intelligent Tutoring Systems (ITS), Adaptive Hypermedia Systems (AHS) and Intelligent Collaborative Learning systems. Next, the Effect Size (ES) tool is adopted as a standard way to compare the results of one pedagogical experiment to another. ES is used to analyse the effectiveness of some of the systems previously described, in order to demonstrate that adaptive learning can provide significant improvements in the learning process of students. Secondly, the learners' opinion is analysed in order to estimate their satisfaction and to know their preferred mode of studying. Finally, a number of conclusions and future trends are discussed.

/pdf/an-analysis-of-the-research-on-adaptive-learning-the-next-3xfeq0ljqs.pdf

An analysis of the research on adaptive learning: the next generation of e-learning

This study examines the evidence for the effectiveness of adaptive learning. It first analyses the different classifications of adaptive learning systems existing in the literature, to focus later on Intelligent Tutoring System (ITS) and Adaptive Hypermedia Systems (AHS) describing some examples of both types of systems. Next, the Effect Size (ES) tool is adopted as a standard way to compare the results of one pedagogical experiment to another. ES is used to analyse the effectiveness of the systems previously described, in order to demonstrate that adaptive learning can provide significant improvements in the learning process of students. Finally, a number of conclusions and future trends are discussed.

http://www.wseas.us/e-library/conferences/2008/hangzhou/acacos/119-586-637.pdf

Is Adaptive Learning Effective? A Review of the Research

The Bologna model pursues to improve the quality of Higher Education and, in turn, human resources across Europe. One of the action lines of the Bologna Process is the promotion of the attractiveness of the European Higher Education Area (EHEA). In this context, motivated students are a key element. Motivation can be reached in a number of different ways, one of which is explored in this paper, and consists in the use of active e-learning methodologies to force students to compete among themselves during their learning process. The relationship between motivation and competition is analysed through a number of hypotheses focusing on elements such as the level of satisfaction of students with different learning styles (competitive, collaborative...) when using the competitive active e-learning tool called QUESTournament. This system has been used in several University courses belonging to different degrees and diplomas taught at the University of Valladolid (Spain). Data collected from these experiences are analysed and discussed.

María Ángeles Pérez

Papers

Effects of Competitive E-Learning Tools on Higher Education Students: A Case Study

A five-year report on experience in the detection of pheochromocytoma.

An analysis of the research on adaptive learning: the next generation of e-learning

Is Adaptive Learning Effective? A Review of the Research

Motivating Students through On-Line Competition: An Analysis of Satisfaction and Learning Styles