Catecholamines, Fractionated, Urinary Free, Random Urine

CPT: 82384; 82570
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Test Details

Synonyms

  • Dopamine, Random Urine
  • Epinephrine, Random Urine
  • Fractionation, Urinary Free Catecholamines
  • Free Catecholamine Fractionation
  • Norepinephrine, Random Urine

Test Includes

Urinary epinephrine; urinary norepinephrine; urinary dopamine; creatinine

Use

Work up neuroblastoma; diagnose pheochromocytoma. Pheochromocytomas and occasional paragangliomas may cause persistent or paroxysmal hypertension. Work up palpitation, severe headache, diaphoresis. Evaluate for possible multiple endocrine adenomatosis type II.

Limitations

False-negatives and false-positives occur. Since a 24-hour urine collection represents a longer sampling time than a random, or symptom-directed serum sample, and because catecholamine secretion by pheochromocytomas is intermittent, the 24-hour urine test may detect some cases missed by a blood or random urine level.

Methodology

Liquid chromatography/tandem mass spectrometry (LC/MS-MS)

Reference Interval

Pediatric3 and adults:

• Epinephrine:

− 0 to 9 years: 0−37 μg/g creatinine

− 10 to 19 years: 0−17 μg/g creatinine

− >19 years: 0−19 μg/g creatinine

• Norepinephrine:

− 0 to 9 years: 0−150 μg/g creatinine

− 10 to 19 years: 0−67 μg/g creatinine

− >19 years: 0−111 μg/g creatinine

• Dopamine:

− 0 to 9 years: <1488 μg/g creatinine

− 10 to 19 years: <354 μg/g creatinine

− >19 years: <348 μg/g creatinine

Additional Information

The expression “free” in free catecholamine fractionation means unconjugated. This assay is of most value for pheochromocytoma when specimen is collected during a hypertensive episode.

Specimen Requirements

Specimen

Urine (random)

Volume

10 mL aliquot

Minimum Volume

4 mL aliquot

Container

Use random urine transport tube containing 6N HCl or urine Monovette® with pH stabilizer (LabCorp N° 56015). Monovette® instructions accompany units. Preservative must be added to the container prior to the start of the collection. If collecting without Monovette®, use plastic urine container and adjust urine pH to <5 with 6N HCI. Caution: Strong acid. May cause skin burns.

Patient Preparation

Avoid patient stress. Many drugs (reserpine and alpha methyldopa, levodopa, monoamine oxidase inhibitors, and sympathomimetic amines) may interfere and should be discontinued two weeks prior to specimen collection. Nose drops, sinus and cough medicines, bronchodilators and appetite suppressants, α2-agonists, calcium channel blockers, converting enzyme inhibitors, bromocriptine, phenothiazine, tricyclic antidepressants, α- and β-blockers, and labetalol may interfere.1 Mandelamine® interferes, but thiazides do not. Caffeine products should be avoided before and during collection. The patient should not be subjected to hypoglycemia or exertion. Increased intracranial pressure and clonidine withdrawal can cause false-positive results.1,2

Collection

Refer to the Preservative Quick Reference Chart in Specimen Collection: Urine Specimens.

Storage Instructions

Refrigerate

Stability Requirements

Temperature

Period

Room temperature

3 days

Refrigerated

14 days

Frozen

30 days at 70°C

Causes for Rejection

Specimen with no preservative; original container with pH >5

Clinical Information

Special Instructions

Random urine collection. Note: If original container is received with pH >3, but <5, adjust pH to <3 with 6N HCl.

Footnotes

1. Sheps SG, Jiang N-S, Klee GG, et al. Recent developments in the diagnosis and treatment of pheochromocytoma. Mayo Clin Proc. 1990; 65(1):88-95. 1967325
2. Landsberg L, Young JB. Pheochromocytoma. In: Braunwald E, Isselbacher KJ, Petersdorf RG, et al, eds. Harrison's Principles of Internal Medicine. New York, NY: McGraw-Hill Information Services Co;1987:1775-1778.
3. Soldin SJ, Lam G, Pollard A, et al. High performance liquid chromatographic analysis of urinary catecholamines employing amperometric detection: Reference values and use in laboratory diagnosis of neural crest tumors. Clin Biochem. 1980; 13(6):285-291.7214697

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
316203 Catecholamines,Ur.,Free,Random 070016 Creatinine, Random U mg/dL 2161-8
316203 Catecholamines,Ur.,Free,Random 004193 Epinephrine, Urine ug/L 11046-0
316203 Catecholamines,Ur.,Free,Random 070025 Epinephrine ug/g Creat 13734-9
316203 Catecholamines,Ur.,Free,Random 004201 Norepinephrine, Ur ug/L 2667-4
316203 Catecholamines,Ur.,Free,Random 070026 Norepinephrine ug/g Creat 13782-8
316203 Catecholamines,Ur.,Free,Random 004203 Dopamine, Urine ug/L 2217-8
316203 Catecholamines,Ur.,Free,Random 070027 Dopamine ug/g Creat 13733-1

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