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- Adrenaline, Plasma
- Epinephrine, Plasma
- Noradrenaline, Plasma
- Norepinephrine, Plasma
- Plasma Catecholamines
Catecholamines, total, plasma (base); catecholamines, total (two-hour); catecholamines, total (three-hour); epinephrine, plasma (base); epinephrine, plasma (two-hour); epinephrine, plasma (three-hour); norepinephrine, plasma (base); norepinephrine, plasma (two-hour); norepinephrine, plasma (three-hour)
Diagnose pheochromocytoma and those paragangliomas that may secrete epinephrine, norepinephrine, or both. Such tumors may cause paroxysmal or persistent hypertension. Investigation of hypertensive patients, especially younger individuals, particularly when hypertension is paroxysmal, suggesting pheochromocytoma.2
Plasma levels are useful if elevated, especially during or immediately following an episode of hypertension, but false-negatives occur when the specimen is drawn during an uneventful period. Normotensive pheochromocytoma has been reported.3 False-positive results are common. Epinephrine secretion increases in response to cold and hypoglycemia. Drugs that may affect plasma norepinephrine levels include α- and β-adrenergic blockers, vasodilators, clonidine, bromocriptine, theophylline, phenothiazine, tricyclic antidepressants, labetalol, calcium channel blockers, converting enzyme inhibitors, bromocriptine, chlorpromazine, haloperidol, and cocaine.
High-pressure liquid chromatography (HPLC) with electrochemical (EC) detection
Several medications have been shown to prevent clonidine suppression, thus rendering false-positive results. These include β-adrenergic blockers, tricyclic antidepressants, and thiazide diuretics. If possible, these drugs should be discontinued 48 hours before collection. The α-adrenergic blocking agents do not interfere with clonidine suppression.2 Several definitions of a normal plasma catecholamine response to clonidine have been postulated:
• A minimum plasma norepinephrine level ≤500 pg/mL4
• ≥50% norepinephrine decline from baseline and a norepinephrine level ≤500 pg/mL5
• A minimum plasma total catecholamine (norepinephrine+epinephrine) concentration ≤500 pg/mL6
Sjoberg et al have concluded that minimal suppression occurs two to three hours after clonidine administration with the greatest diagnostic accuracy (92%) obtained when the normal response is defined as a level of total plasma catecholamine ≤500 pg/mL. Taylor et al7 have demonstrated an increase in false-positive results by using the 50% reduction criteria. This is especially true if the baseline results are within the established reference interval.
One tube (3 mL) each for baseline specimen, two-hour specimen, and three-hour specimen
One tube (2.2 mL) each for baseline specimen, two-hour specimen, and three-hour specimen
Chilled lavender-top (EDTA) tube
The patient should fast overnight and abstain from smoking. Walnuts, bananas, and interfering medications should be avoided for a week prior to specimen collection. An indwelling heparinized catheter is recommended, as venipuncture can cause an increase in the substances for which testing is being performed. The patient should remain recumbent during the entire collection procedure. Thirty minutes after the insertion of the indwelling catheter, blood is drawn for the baseline catecholamine determination. Clonidine hydrochloride (0.3 mg) is given orally, and repeat specimens for plasma catecholamines are collected two and three hours later.1
Draw blood in chilled lavender-top (EDTA) tube. Invert tube to allow preservatives to mix thoroughly. Centrifuge at 4°C (chill carriers if a refrigerated centrifuge is unavailable). Transfer plasma to labeled plastic transport tubes. Freeze immediately at -20°C and ship frozen. “Baseline,” “two-hour,” and “three-hour” should be prelabeled on the transport tubes. To avoid delays in turnaround time when requesting multiple tests on frozen samples, please submit separate frozen specimens for each test requested.
Causes for Rejection
Specimen not drawn in correct tube; plasma not received frozen; thawed specimen; inadequate patient preparation
|Order Code||Order Code Name||Order Loinc||Result Code||Result Code Name||UofM||Result LOINC|
|123133||Clonidine Suppression (3-Hour)||123143||Norepineph, Pl(Base)||pg/mL||1606-3|
|123133||Clonidine Suppression (3-Hour)||123142||Epinephrine,Pl(Base)||pg/mL||1464-7|
|123133||Clonidine Suppression (3-Hour)||123141||Catechol,Pl,T(Base)||pg/mL||1388-8|
|123133||Clonidine Suppression (3-Hour)||123136||Norepineph, Pl(2 hr)||pg/mL||1604-8|
|123133||Clonidine Suppression (3-Hour)||123135||Epinephrine,Pl(2 hr)||pg/mL||1462-1|
|123133||Clonidine Suppression (3-Hour)||123134||Catechol,Pl,T(2 hr)||pg/mL||16558-9|
|123133||Clonidine Suppression (3-Hour)||123139||Norepineph, Pl(3 hr)||pg/mL||1605-5|
|123133||Clonidine Suppression (3-Hour)||123138||Epinephrine,Pl(3 hr)||pg/mL||1463-9|
|123133||Clonidine Suppression (3-Hour)||123137||Catechol,Pl,T(3 hr)||pg/mL||16559-7|