Test Catalog

Test Id : CATU

Catecholamine Fractionation, Free, 24 Hour, Urine

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

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

Special Instructions
Library of PDFs including pertinent information and forms related to the test

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

Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)

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, U

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

Adrenaline

Catecholamine Fractionation, Urine

Catecholamines, 24-Hour Urine

Catecholamines, Total

Catecholamines, Urine

Dopamine

Epinephrine

Noradrenaline

Norepinephrine

Pressor Amines

Specimen Type
Describes the specimen type validated for testing

Urine

Ordering Guidance

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.

Necessary Information

24-Hour volume is required.

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 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 in Special Instructions for multiple collections.

Special Instructions
Library of PDFs including pertinent information and forms related to the test

Forms

If not ordering electronically, complete, print, and send an Oncology Test Request (T729) with the specimen.

Urine Preservative Collection Options

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

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

1.5 mL

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

All specimens will be evaluated at Mayo Clinic Laboratories for test suitability.

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
Urine Refrigerated (preferred) 7 days
Frozen 14 days
Ambient 7 days

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

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

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 crucial roles 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. They 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), urine catecholamine levels may be elevated. This results in episodic or sustained hypertension and often in intermittent attacks of palpitations, cardiac arrhythmias, headache, sweating, pallor, anxiety, tremor, and nausea ("spells"). Elevations of the urine levels of 1 or several of the catecholamines also may 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/failure and autonomic neuropathies are characterized by either inadequate production of 1 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

 <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

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. PMET / Metanephrines, Fractionated, Free, Plasma (the most sensitive assay) and/or METAF / Metanephrines, Fractionated, 24 Hour, Urine (almost as sensitive and highly specific) are the recommended first-line laboratory tests for pheochromocytoma.

 

However, urine catecholamine measurements can still be useful in patients whose plasma metanephrines or urine metanephrines measurements do not completely exclude the diagnosis. In such cases, urine catecholamine specimens have an 86% diagnostic sensitivity when cut-offs of >80 mg/24 hour for norepinephrine and >20 mg/24 hour for epinephrine are employed. Unfortunately, the specificity of these cut-off levels for separating tumor patients from other patients with similar symptoms is only 88%. When more specific (98%) decision levels of >170 mg/24 hours for norepinephrine or >35 mg/24 hours for epinephrine are used, the assay’s sensitivity falls to about 77%.

 

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.

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

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

 

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

 

Other substances and drugs that may affect the results include:

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

-Monamine oxidase inhibitors (MOIs): a class of anti-depressants 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, which also can be 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])

 

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 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 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

Special Instructions
Library of PDFs including pertinent information and forms related to the test

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

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)

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 through Saturday

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 4 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

Test Id Test Order Name Order LOINC Value
CATU Catecholamine Fract, Free, U 92938-0
Result Id Test Result Name Result LOINC Value
Result LOINC Value Tooltip
TM48 Collection Duration 13362-9
VL46 Urine Volume 3167-4
2106 Norepinephrine 2668-2
2107 Epinephrine 2232-7
2108 Dopamine 2218-6

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 | 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