Test Catalog

Test Id : CATP

Catecholamine Fractionation, Free, Plasma

Useful For
Suggests clinical disorders or settings where the test may be helpful

Diagnosis of pheochromocytoma and paraganglioma, as an auxiliary test to fractionated plasma and urine metanephrine measurements (plasma metanephrine is the preferred test for this diagnosis)

 

Diagnosis and follow-up of patients with neuroblastoma and related tumors, as an auxiliary test to urine vanillylmandelic acid and homovanillic acid measurements

 

Evaluation of patients with autonomic dysfunction or failure or autonomic neuropathy

Highlights

This test includes measurement of unconjugated norepinephrine, epinephrine, and dopamine.

Method Name
A short description of the method used to perform the test

High-Performance Liquid Chromatography (HPLC)

NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.

Yes

Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test

Catecholamine Fract, Free, P

Aliases
Lists additional common names for a test, as an aid in searching

Adrenaline

Catecholamine Fractionation, Pharmacy Solution

Catecholamines, Unconjugated

Dopamine

Epinephrine

Noradrenaline

Norepinephrine

Pheochromocytoma

Pressor Amines

Specimen Type
Describes the specimen type validated for testing

Plasma EDTA Meta

Ordering Guidance

This test is not the first-tier test for pheochromocytoma, as plasma catecholamine levels may not be continuously elevated. For the recommended first-tier laboratory test for pheochromocytoma, order either:

-PMET / Metanephrines, Fractionated, Free, Plasma

-METAF / Metanephrines, Fractionated, 24 Hour, Urine

 

Do not perform this test on patients withdrawing from legal or illegal drugs known to cause rebound plasma catecholamine release during withdrawal (see Cautions for details)

Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing

Patient Preparation:

1. Discontinue drugs that release epinephrine, norepinephrine, or dopamine, or hinder their metabolism for at least one week before obtaining the specimen (see Cautions for details). If this is not possible for medical reasons, contact the laboratory and discuss whether a shorter drug withdrawal period may be possible in a particular case.

2. Unless the purpose of the measurement is drug monitoring, discontinue any epinephrine, norepinephrine, or dopamine injections or infusions for at least 12 hours before specimen collection.

3. The patient must refrain from eating, using tobacco, and drinking caffeinated beverages for at least 4 hours before the specimen is collected.

 

Supplies: Catecholamine Tubes-EDTA (T066) (tubes contain sodium metabisulfite, may come as 10-mL or 6-mL tubes, and have a 6-month expiration time)

Collection Container/Tube:

Preferred: 10-mL Catecholamine tubes containing EDTA-sodium metabisulfite solution

Acceptable: 6-mL Catecholamine tubes containing EDTA-sodium metabisulfite solution

Submission Container/Tube: Plastic vial

Specimen Volume: 3 mL

Collection Instructions:

Note: If the collection instructions are not followed, falsely-elevated test results are highly likely.

1. Drawing from an indwelling intravenous (IV) line/catheter/butterfly is required.

2. Calm the patient by giving complete instructions and reassurance regarding the procedure.

3. Insert an indwelling IV catheter. Flush with 3 mL of sodium chloride (NaCl), using positive pressure.

4. Have the patient rest for 30 minutes in the supine position in a quiet room.

5. At the end of the 30 minutes, withdraw and discard a minimum of 3 mL of blood to remove the saline out of the catheter.

6. If provocative sampling (eg, standing specimen) is required, perform provocative maneuver immediately after obtaining supine specimen. Obtain standing specimen immediately.

7. For each specimen, draw 10 mL of blood into the chilled 10 mL catecholamine tube containing EDTA-sodium metabisulfite solution. A 6 mL pink top EDTA-metabisulfite tube is an acceptable substitute.

8. Specimens must remain at refrigerated temperature during processing and transport.

9. Separate plasma in a refrigerated centrifuge within 30 minutes of collection.

10. Freeze specimen immediately.

Forms

Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the Testing Laboratory

2 mL

Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected

Gross hemolysis Reject
Gross lipemia OK
Gross icterus OK

Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included

Specimen Type Temperature Time Special Container
Plasma EDTA Meta Frozen (preferred) 7 days

Useful For
Suggests clinical disorders or settings where the test may be helpful

Diagnosis of pheochromocytoma and paraganglioma, as an auxiliary test to fractionated plasma and urine metanephrine measurements (plasma metanephrine is the preferred test for this diagnosis)

 

Diagnosis and follow-up of patients with neuroblastoma and related tumors, as an auxiliary test to urine vanillylmandelic acid and homovanillic acid measurements

 

Evaluation of patients with autonomic dysfunction or failure or autonomic neuropathy

Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

The catecholamines (dopamine, epinephrine, and norepinephrine) are derived from tyrosine via a series of enzymatic conversions. All 3 catecholamines are important neurotransmitters in the central nervous system and play a crucial role in the autonomic regulation of many homeostatic functions, namely, vascular tone, intestinal and bronchial smooth muscle tone, cardiac rate and contractility, and glucose metabolism. Their actions are mediated via alpha- and beta-adrenergic receptors and dopamine receptors, all existing in several subforms. The 3 catecholamines overlap, but also differ in their receptor activation profile and consequent biological actions. The systemically circulating fraction of the catecholamines is derived almost exclusively from the adrenal medulla, with small contributions from sympathetic ganglia.

 

The catecholamines are normally present in the plasma in minute amounts, but levels can increase dramatically and rapidly in response to change in posture, environmental temperature, physical and emotional stress, hypovolemia, blood loss, hypotension, hypoglycemia, and exercise.

 

In patients with pheochromocytoma (a potentially curable tumor of catecholamine-producing cells of the adrenal medulla), or less commonly of sympathetic ganglia (paraganglioma), plasma catecholamine levels may be continuously or episodically elevated. This results in episodic or sustained hypertension and in intermittent attacks of palpitations, cardiac arrhythmias, headache, sweating, pallor, anxiety, tremor, and nausea. Intermittent or continuous elevations of the plasma levels of one or several of the catecholamines may also be observed in patients with neuroblastoma and related tumors (ganglioneuroblastomas and ganglioneuromas) and, very occasionally, in other neuroectodermal tumors.

 

At the other end of the spectrum, inherited and acquired syndromes of autonomic dysfunction or failure and autonomic neuropathies are characterized by either inadequate production of one or several of the catecholamines or by insufficient release of catecholamines upon appropriate physiological stimuli (eg, change in posture from supine to standing, cold exposure, exercise, stress).

Reference Values
Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

NOREPINEPHRINE

Supine: 70-750 pg/mL

Standing: 200-1,700 pg/mL

 

EPINEPHRINE

Supine: < or =111 pg/mL

Standing: < or =141 pg/mL

 

DOPAMINE

<30 pg/mL (no postural change)

 

For SI unit Reference Values, see https://www.mayocliniclabs.com/order-tests/si-unit-conversion.html

Interpretation
Provides information to assist in interpretation of the test results

Diagnosis of Pheochromocytoma:

This test should not be used as the first-line test for pheochromocytoma, as plasma catecholamine levels may not be continuously elevated but only secreted during a "spell." By contrast, production of metanephrines (catecholamine metabolites) appears to be increased continuously. The recommended first-line laboratory tests for pheochromocytoma are:

-PMET / Metanephrines, Fractionated, Free, Plasma: the most sensitive assay

-METAF / Metanephrines, Fractionated, 24 Hour, Urine: highly specific and almost as sensitive as PMET

 

However, plasma catecholamine measurements can still be useful in patients whose plasma metanephrine or urine metanephrine measurements do not completely exclude the diagnosis. In such cases, plasma catecholamine specimens, if drawn during a "spell," have a 90% to 95% diagnostic sensitivity when cutoffs of greater than 750 pg/mL for norepinephrine and greater than 110 pg/mL for epinephrine are employed. A lower value during a "spell," particularly when plasma or urinary metanephrine measurements were also normal, essentially rules out pheochromocytoma. Unfortunately, the specificity of these high-sensitivity cutoff levels is not good for separating tumor patients from other patients with similar symptoms. When more specific (95%) decision levels of 2000 pg/mL for norepinephrine or 200 pg/mL for epinephrine are used, the assay's sensitivity falls to about 85%.

 

Diagnosis of Neuroblastoma:

Vanillylmandelic acid, homovanillic acid, and sometimes urine catecholamine measurements on spot urine or 24-hour urine are the mainstay of biochemical diagnosis and follow-up of neuroblastoma. Plasma catecholamine levels can aid diagnosis in some cases, but diagnostic decision levels are not well established. The most useful finding is disproportional elevations in 1 of the 3 catecholamines, particularly dopamine, which may be observed in these tumors.

 

Diagnosis of Autonomic Dysfunction or Failure and Autonomic Neuropathy:

Depending on the underlying cause and pathology, autonomic dysfunction or failure and autonomic neuropathies are associated with subnormal resting norepinephrine levels, or an absent rise of catecholamine levels in response to physiological release stimuli (eg, change in posture from supine to standing, cold exposure, exercise, stress), or both. In addition, there may be significant abnormalities in the ratios of the plasma values of the catecholamines to each other (normal: norepinephrine>epinephrine>dopamine). This is observed most strikingly in the inherited dysautonomic disorder dopamine-beta-hydroxylase deficiency, which results in markedly elevated plasma dopamine levels and a virtually total absence of plasma epinephrine and norepinephrine.

Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

Catecholamines in plasma are chemically labile and the specimens must be handled carefully, both because of rapid specific metabolism and rapid oxidation on exposure to air. For example, plasma-free norepinephrine has a half-life of approximately 2 minutes. To enhance accuracy, one must pay careful attention to the circumstances of specimen collection and to the preparation of the patient (see Specimen Required).

 

Many alterations in physiologic and pathologic states can profoundly affect catecholamine concentrations.

 

Any environmental factor that may increase endogenous catecholamine production should be avoided. These include noise, stress, discomfort, body position, and the consumption of food, caffeinated beverages, or nicotine. Caffeine and nicotine effects are short term, a few minutes to hours only.

 

Other substances and drugs that may also affect the results include:

1. Substances that result in increased release or diminished metabolism of endogenous catecholamines

-Monamine oxidase inhibitors (MOIs): a class of antidepressants with marked effects on catecholamine levels, particularly if the patient consumes tyrosine rich foods, such as nuts, bananas, or cheese

-Catecholamine reuptake inhibitors including cocaine and synthetic cocaine derivatives, such as many local anesthetics, some of which are also antiarrhythmic drugs (eg, lidocaine)

-Some anesthetic gases, particularly halothane

-Withdrawal from sedative drugs, medical or recreational, in particular alcohol, benzodiazepines (eg, Valium), opioids and some central-acting antihypertensive drugs, particularly clonidine, but, generally not cannabis or other hallucinogens such as lysergic acid diethylamide (LSD), mescal, or peyote

-Vasodilating drugs (eg, calcium antagonists, alpha-blockers)

-Tricyclic antidepressants usually exert a negligible effect

 

2. Substances that reduce or increase plasma volume acutely (eg, diuretics, radiographic contrast media, synthetic antidiuretic hormone [eg, desmopressin 1-deamino-8-d-arginine vasopressin: DDAVP])

 

3. Drugs that are metabolized to endogenous catecholamines. In the main, this concerns carbidopa and L-dopa. These drugs are converted to dopamine, and dopamine measurements in patients taking these drugs will be artifactually elevated. Since isolated dopamine elevations are extremely rare, they should always be viewed with suspicion. A review of the high-performance liquid chromatography (HPLC) trace should be requested. On a careful review, our methodology usually, but not always, allows us to identify the unmetabolized parent drug, alongside dopamine.

 

Historically, a third category of potentially interfering substances was represented by molecules that are either similar in chemical structure, antibody epitopes, or chromatographic migration pattern to the catecholamines, or have metabolites that can be mistaken for the catecholamines. The current HPLC-based assay is not subject to any significant direct interference of this kind. In particular, the following drugs, which used to be considered potential interferences, do not cause problems that cannot be resolved, in most cases, with the current assay: acetaminophen, allopurinol, amphetamines and its derivatives (methamphetamine, methylphenidate [Ritalin], fenfluramine, methylenedioxymethamphetamine [MDMA: ecstasy]), atropine, beta-blockers (atenolol, labetolol, metoprolol, sotalol), buspirone, butalbital, carbamazepine, chlorazepate, chlordiazepoxide, chlorpromazine, chlorothiazide, chlorthalidone, clonidine, codeine, diazepam, digoxin, dimethindene, diphenhydramine, diphenoxylate, dobutamine, doxycycline, ephedrine and pseudoephedrine, fludrocortisone, flurazepam, guanethidine, hydralazine, hydrochlorothiazide, hydroflumethiazide, indomethacin, insulin, isoprenaline, isosorbide dinitrate, L-Dopa, methenamine mandelate (mandelic acid), methyldopa, methylprednisolone, nitrofurantoin, nitroglycerine, oxazepam, pentazocine, phenacetin, phenformin, phenobarbital, phenytoin, prednisone, probenecid, progesterone, propoxyphene, propranolol, quinidine, spironolactone, tetracycline, thyroxine, and tripelennamine.

 

On occasion when interference cannot be resolved an interference comment will be reported.

 

The variability associated with age, gender, and renal failure is uncertain.

Clinical Reference
Recommendations for in-depth reading of a clinical nature

1. Young WF Jr: Pheochromocytoma and primary aldosteronism. In: Arnold A, ed. Endocrine Neoplasms. Kluwer Academic Publishers; 1997:239-261

2. Hernandez FC, Sanchez M, Alvarez A, et al: A five-year report on experience in the detection of pheochromocytoma. Ann Intern Med. 2000;33:649-655

3. Pacak K, Linehan WM, Eisenhofer G, et al: Recent advances in genetics, diagnosis, localization, and treatment of pheochromocytoma. Ann Intern Med. 2001;134:315-329

4. Alexander F: Neuroblastoma. Urol Clin North Am. 2000;27:383-392

5. McDougall AJ, McLeod JG: Autonomic neuropathy, I. Clinical features, investigation, pathophysiology, and treatment. J Neurol Sci. 1996;137:79-88

6. Lenders JW, Pacak K, Walther MM, et al: Biochemical diagnosis of pheochromocytoma: which test is best? JAMA. 2002;287:1427-1434

Method Description
Describes how the test is performed and provides a method-specific reference

Following chromatographic purification, which results in a highly purified and concentrated final eluate, the purified amines are quantitated by using high-performance liquid chromatography (HPLC) with electrochemical detection.(Jiang NS, Machacek D, Wadel OP: Further study on the two-column plasma catecholamine assay. Mayo Clin Proc. 1976;51:112-116; Jiang NS, Machacek D: Measurement of catecholamines in blood and urine by liquid chromatography with amperometric detection. In: Parvez V, ed. Progress in HPLC. Vol 2. VNU Science Press; 1987:397-426)

PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information

No

Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.

Monday, Tuesday, Thursday, Friday

Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.

2 to 5 days

Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded

14 days

Performing Laboratory Location
Indicates the location of the laboratory that performs the test

Rochester

Fees
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.

  • Authorized users can sign in to Test Prices for detailed fee information.
  • Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
  • Prospective clients should contact their Regional Manager. For assistance, contact Customer Service.

Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.

This test was developed, and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.

CPT codes are provided by the performing laboratory.

82384

LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.

Test Id Test Order Name Order LOINC Value
CATP Catecholamine Fract, Free, P 34551-2
Result Id Test Result Name Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
2846 Norepinephrine 2666-6
2901 Epinephrine 2230-1
2906 Dopamine 2216-0

Test Setup Resources

Setup Files
Test setup information contains test file definition details to support order and result interfacing between Mayo Clinic Laboratories and your Laboratory Information System.

Excel | Create a PDF

Sample Reports
Normal and Abnormal sample reports are provided as references for report appearance.

Normal Reports | Abnormal Reports

SI Sample Reports
International System (SI) of Unit reports are provided for a limited number of tests. These reports are intended for international account use and are only available through MayoLINK accounts that have been defined to receive them.

SI Normal Reports | SI Abnormal Reports