An auxiliary test to fractionated plasma and urine metanephrine measurements in the diagnosis of pheochromocytoma and paraganglioma
An auxiliary test to urine vanillylmandelic acid and homovanillic acid determination in the diagnosis and follow-up of patients with neuroblastoma and related tumors
Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
Adrenaline
Catecholamine Fractionation, Urine
Catecholamines, 24-Hour Urine
Catecholamines, Total
Catecholamines, Urine
Dopamine
Epinephrine
Noradrenaline
Norepinephrine
Pressor Amines
Urine
This assay is of greatest value when the specimen is collected during a hypertensive episode.
Do not perform the test on patients withdrawing from legal or illegal drugs known to cause rebound catecholamine release during withdrawal (see Cautions for details)
This test should not be used as the first-line test for pheochromocytoma. The recommended first-line laboratory tests for pheochromocytoma are PMET / Metanephrines, Fractionated, Free, Plasma and/or METAF / Metanephrines, Fractionated, 24 Hour, Urine.
24-Hour volume is required.
Question ID | Description | Answers |
---|---|---|
TM48 | Collection Duration | |
VL46 | Urine Volume |
1. Discontinue drugs that release or hinder metabolism of epinephrine, norepinephrine, or dopamine for at least 1 week before specimen collection (see Cautions for details). If this is not possible for medical reasons, contact the laboratory to discuss whether a shorter drug-withdrawal period may be acceptable.
2. Unless the reason for testing is drug monitoring, discontinue any epinephrine, norepinephrine, or dopamine injections or infusions for at least 12 hours before specimen collection.
Supplies: Plastic, 10-mL urine tube (T068)
Specimen Volume: 2 mL
Collection Instructions:
1. Collect urine for 24 hours.
2. Add 25 mL of 50% acetic acid as preservative at start of collection. Use 15 mL of 50% acetic acid for children less than 5 years old. This preservative is intended to achieve a pH of between approximately 2 and 4.
Additional Information: See Urine Preservatives-Collection and Transportation for 24-Hour Urine Specimens for multiple collections.
If not ordering electronically, complete, print, and send an Oncology Test Request (T729) with the specimen.
Note: The addition of preservative must occur prior to beginning the collection.
Ambient | No |
Refrigerate | OK |
Frozen | OK |
50% Acetic Acid | Preferred |
Boric Acid | OK |
Diazolidinyl Urea | No |
6M Hydrochloric Acid | OK |
6M Nitric Acid | OK |
Sodium Carbonate | No |
Thymol | No |
Toluene | No |
1.5 mL
Specimen Type | Temperature | Time | Special Container |
---|---|---|---|
Urine | Refrigerated (preferred) | 7 days | |
Frozen | 14 days | ||
Ambient | 7 days |
An auxiliary test to fractionated plasma and urine metanephrine measurements in the diagnosis of pheochromocytoma and paraganglioma
An auxiliary test to urine vanillylmandelic acid and homovanillic acid determination in the diagnosis and follow-up of patients with neuroblastoma and related tumors
The catecholamines (dopamine, epinephrine, and norepinephrine)
The systemically circulating fraction of the catecholamines is derived
In patients with pheochromocytoma, a potentially curable tumor of
At the other end of the spectrum, inherited and acquired syndromes of
NOREPINEPHRINE
<1 year: <11 mcg/24 hours
1 year: 1-17 mcg/24 hours
2-3 years: 4-29 mcg/24 hours
4-6 years: 8-45 mcg/24 hours
7-9 years: 13-65 mcg/24 hours
> or =10 years: 15-80 mcg/24 hours
EPINEPHRINE
<1 year: <2.6 mcg/24 hours
1 year: <3.6 mcg/24 hours
2-3 years: <6.1 mcg/24 hours
4-9 years: 0.2-10.0 mcg/24 hours
10-15 years: 0.5-20.0 mcg/24 hours
> or =16 years: <21 mcg/24 hours
DOPAMINE
<1 year: <86 mcg/24 hours
1 year: 10-140 mcg/24 hours
2-3 years: 40-260 mcg/24 hours
> or =4 years: 65-400 mcg/24 hours
For SI unit Reference Values, see https://www.mayocliniclabs.com/order-tests/si-unit-conversion.html
Diagnosis of Pheochromocytoma
This test should not be used as the first-line test for pheochromocytoma.
However, urine catecholamine measurements can still be useful in
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; 1 or more of these tests may be elevated.
Many alterations in physiologic and pathologic states can profoundly
Any environmental factors that may increase endogenous catecholamine
Other substances and drugs that may affect the results include:
1. Substances that result in increased release or diminished metabolism
-Monamine oxidase inhibitors (MOIs): a class of anti-
-Catecholamine reuptake inhibitors including cocaine and
-Some anesthetic gases, particularly halothane
-Withdrawal from sedative drugs, medical or recreational,
-Vasodilating drugs (eg, calcium antagonists, alpha-blockers)
-Tricyclic antidepressants usually exert a negligible effect
2. Substances that reduce or increase plasma volume acutely (eg,
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. Our current HPLC-based assay is not subject to any significant direct interference of this kind. In most cases, the following drugs do not cause problems with the current assay that cannot be resolved: acetaminophen, allopurinol, amphetamines and its derivatives (methamphetamine, methylphenidate [Ritalin], fenfluramine, methylenedioxymethamphetamine [MDMA: ecstasy]), atropine, beta blockers (atenolol, labetalol, metoprolol, sotalol), buspirone, butalbital, carbamazepine, clorazepate, 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, entazocine, phenacetin, phenformin, phenobarbital, phenytoin, prednisone, probenecid, progesterone, propoxyphene, propranolol, quinidine, spironolactone, tetracycline, thyroxine, and tripelennamine.
On occasion, when interference cannot be resolved, an interference
The variability associated with age, gender, and renal failure is uncertain
1. Young WF Jr: Pheochromocytoma and primary aldosteronism. In Endocrine Neoplasms. Edited by A Arnold. Kluwer Academic Publishers, 1997, pp 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
7. Shen Y, Cheng L: Chapter 2: Biochemical diagnosis of pheochromocytoma and paraganglioma. In Paraganglioma: A Multidisciplinary Approach. Edited by R Mariani-Costantini. Codon Publications; 2019 doi:10.15586/paraganglioma.2019.ch2. Available at www.ncbi.nlm.nih.gov/books/NBK543224/
8. Pussard E, Neveux M, Guiqueno N: Reference intervals for urinary catecholamines and metabolites from birth to adulthood. Clin Biochem 2009 Apr;42(6):536-539
Norepinephrine (NE), epinephrine (E), and dopamine (DA) are derivatized with acetaldehyde before being adsorbed onto activated alumina at pH 8.6, washed with water, and eluted with 2% acetic acid. The eluate is analyzed using liquid chromatography/tandem mass spectrometry (LC-MS/MS) and quantified using stable isotope labeled internal standards, d6-norepinephrine (d6-NE), d6-epinephrine (d6-E), and d4-dopamine (d4-DA). Derivatized analytes and internal standards are ionized using electro spray ionization (ESI) and are detected in the multiple reaction-monitoring (MRM) mode.(Unpublished Mayo method)
Monday through Saturday
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.
82384
Test Id | Test Order Name | Order LOINC Value |
---|---|---|
CATU | Catecholamine Fract, Free, U | 92938-0 |
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.
|
---|---|---|
TM48 | Collection Duration | 13362-9 |
VL46 | Urine Volume | 3167-4 |
2106 | Norepinephrine | 2668-2 |
2107 | Epinephrine | 2232-7 |
2108 | Dopamine | 2218-6 |