Systematic Review Of Recommendations And Evidences In Guidelines For The Diagnosis Of Pheochromocytoma

Objective: To summarize recommendations of existing guidelines on diagnosis of pheochromocytoma, and to assess the methodological quality of guidelines providing diagnostic recommendations for pheochromocytoma by using a standardized and validated instrument and to examine whether differences in recommendations could be explained by different research evidences.Research Design And Methods: Using a MEDLINE search and electronic databases with the terms hypertension diagnosis, adrenal incidentaloma hypertension,refractory hypertension,resistant hypertension, arterial blood pressure, high blood pressure, arterial hypertension, pheochromocytoma for the period 1 January 1999 and 31 December 2008. The guidelines were selected according to study design, and we extracted the diagnostic recommendations about pheochromocytoma and linked evidences. Methodological quality of guidelines was evaluated using the Appraisal of Guidelines Research and Evaluation(AGREE) instrument, which were independently reviewed by 2 appraisers, any disagreements between appraisers were resolved by discussion and consensus within the study team.Results: 1).Ten guidelines were included in the study. Amajority of guidelines except one guideline did not provide comprehensive diagnostic recommendations about pheochromocytoma. 2).We gained 105 references linked to the diagnostic recommendations about PHEO from 6 guidelines; 85 of 105 references were different. Only 19.0%(20/105) of these were shared by any other guidelines. National guidelines were significantly more likely to cite studies from investigators from the same country. There was the lack of high-quality studies, and the evidence was not the sole factory of varible recommendations. 3).The Guidelines in our sutdy had shortcomings in methodological quality according to the AGREE criteria, but the overall quality remained effective, although significantly difference may be in some items.Conclusions: Our study suggested that the methodology of the guidelines was similar, although we found a high degree of international consensus on the diagnosis of pheochromocytoma, there were differences in details. The different reference often had similar conclusions; on the other hand, the same evidence may induce a different recommendation. Research evidence was not necessarily the most powerful influence on the content of recommendations in the current generation of guideliens on the diagnosis of pheochromocytoma, due to the variable availability of technical resources, professional skills and the changing prevalence of pheochromocytoma in different regions of the world. Our study suggested different societies and countries should join in the guideline development and use systematic methods to search for evidence according to the AGREE criteria to support and promote good clinical practice.