Laboratory Services

Catecholamine Fractionation, Free, 24 Hour, Urine

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Updated Test Information:

Test Description
Catecholamine Fractionation, Free, 24 Hour, Urine
Synonym(s)

Adrenaline; Catecholamine Fractionation, Urine; Catecholamines, 24-Hour Urine; Catecholamines, Total; Catecholamines, Urine; Dopamine; Epinephrine; Noradrenaline; Norepinephrine; Pressor Amines

Test ID
CATU
General Information

Useful for:



  • 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

  • This assay is of greatest value when the specimen is collected during a hypertensive episode

  • Do not order this test on patients withdrawing from legal or illegal drugs known to cause rebound catecholamine release during withdrawal (see Limitations 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

Specimen Type

24-Hr Urine

Specimen Collection / Processing Instructions

  • Discontinue drugs that release or hinder metabolism of epinephrine, norepinephrine, or dopamine for at least 1 week before specimen collection (see Limitations for details). If this is not possible for medical reasons, contact the laboratory to discuss whether a shorter drug-withdrawal period may be acceptable

  • 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

  • Collect urine for 24 hours

  • Add 25 mL of 50% acetic acid as preservative at start of collection (15 mL of 50% acetic acid for children < 5 years old). This preservative is intended to achieve a pH of between approximately 2 and 4.

  • Urine Preservative Collection Options

    • 50% Acetic Acid: Preferred

    • Refrigerate: OK

    • Frozen: OK

    • Boric Acid: OK

    • 6M Hydrochloric Acid: OK

    • 6M Nitric Acid: OK



  • Additional Information: See Urine Preservatives - Collection and Transportation for 24-Hour Urine Specimens for multiple collections

Minimum Sample Volume

1.5 mL

Required Information

24-Hour volume is required

Stability

  • Refrigerated (preferred): 7 days

  • Frozen: 14 days

  • Ambient: 7 days


Unacceptable Specimen Conditions

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

Limitations

  • 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:

    • 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



    • 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

Methodology

High-Performance Liquid Chromatography (HPLC)

Estimated TAT

2-4 days

Testing Schedule

Monday-Saturday

Test Includes

  • Collection Duration

  • Urine Volume

  • Norepinephrine

  • Epinephrine

  • Dopamine

Retention

14 days

CPT Code(s)

82384

Reference Range

 

Norepinephrine Age (years) Ref Range (mcg/24H)
  < 1  < 11
  1 1 - 17
  2 - 3 4 - 29
  4 - 6 8 - 45
  7 - 9 13 - 65
  ≥ 10 15 - 80
Epinephrine Age (years) Ref Range (mcg/24H)
  < 1 < 2.6
  1 < 3.6
  2 - 3 < 6.1
  4 - 9 0.2 - 10.0
  10 - 15 0.5 - 20.0
  ≥ 16 < 21.0
Dopamine Age (years) Ref Range (mcg/24H)
  < 1 < 86
  1 10 - 140
  2 - 3 40 - 260
  ≥ 4 65 - 400

 

 

Performing Lab

Mayo

LOINC Code(s)

13362-9, 3167-4, 2668-2, 2232-7, 2218-6

Additional Information