Catecholamines, Fractionated and VMA, 24-Hour Urine without Creatinine

Test Code

8061

CPT Codes
82384, 84585

Includes

Catecholamines, Fractionated, 24-Hour Urine without Creatinine
VMA (Vanillylmandelic Acid), 24-Hour Urine without Creatinine

CPT code 81050 may be added at an additional charge for volume measurement

Preferred Specimen

20 mL aliquot from a 24-hour urine that has been preserved with 25 mL 6N HCl, collected in a plastic 24-hour urine container

Patient Preparation
It is preferable for the patient to be off medications for three days prior to collection. However, common antihypertensives (diuretics, ACE inhibitors, calcium channel blockers, alpha and beta blockers) cause minimal or no interference. Patient should avoid alcohol, coffee, tea, tobacco (including use of nicotine patch), bananas, citrus fruits and strenuous exercise prior to collection.

Minimum Volume

10 mL

Other Acceptable Specimens

Aliquot from a 24-hour urine, unpreserved, with a pH ≤6, collected in a plastic 24-hour urine container

Instructions

Collect 24-hour urine with 25 mL 6N HCl to maintain a pH ≤3. If no preservative is used, specimen must be stored refrigerated during collection but shipped frozen and pH must be ≤6.
Record 24-hour urine volume and patient's age on test request form and on urine container.

Transport Temperature

Frozen

Specimen Stability

Preserved urine
Room temperature: 7 days
Refrigerated: 14 days
Frozen: 49 days

Unpreserved urine
Room temperature: Unacceptable
Refrigerated: Unacceptable
Frozen: 30 days

Reject Criteria (Eg, hemolysis? Lipemia? Thaw/Other?)

Preserved urine received refrigerated with pH >3 • Unpreserved urine received frozen with pH >6

Methodology
See individual tests

FDA Status
This test was developed and its analytical performance characteristics have been determined by Quest Diagnostics. It has not been cleared or approved by FDA. This assay has been validated pursuant to the CLIA regulations and is used for clinical purposes.

Setup Schedule

Set up: Mon-Fri; Report available: 3-6 days

Reference Range

See individual tests

Clinical Significance

This panel may aid in evaluating catecholamine-producing pheochromocytomas and paragangliomas (PPGLs). However, measurements of plasma free or urinary fractionated metanephrines (ie, the O-methylated catecholamine metabolites) are preferred for the initial biochemical evaluation of PPGLs because of their overall high diagnostic sensitivity [1].

Most PPGLs secrete catecholamines and can cause catecholamine excess, resulting in hypertension, arrhythmia, and hyperglycemia. Left untreated, PPGLs often lead to life-threatening cardiovascular complications. The estimated prevalence of PPGLs is 0.05% to 0.1% in adults with hypertension and 1.7% in children with hypertension [2]. Recognizing the possibility of a PPGL and performing appropriate biochemical testing are crucial for the diagnosis [1]. Plasma or urine catecholamine levels may be used, in addition to metanephrine levels, to provide additional information during the initial biochemical evaluation of PPGLs (eg, when detecting dopamine-secreting paragangliomas) [2]. Urinary VMA level can be elevated in PPGLs as well as in neuroblastomas [3].

Intermittent or insignificant secretion of catecholamines by some PPGLs may not increase catecholamine measurements. Physiological stress and certain medications (eg, acetaminophen, labetalol, and sotalol) may increase catecholamine measurements [1].

This test is also available with creatinine (Catecholamines, Fractionated and VMA, 24-Hour Urine with Creatinine). Because daily urine excretion of creatinine generally shows minimal fluctuation, creatinine excretion is useful in determining whether 24-hour urine specimens for other analytes have been completely and accurately collected.

The results of this test should be interpreted in the context of pertinent clinical and family history and physical examination findings.

References
1. Lenders JW, et al. J Clin Endocrinol Metab. 2014;99(6):1915-1942.
2. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology (NCCN Guidelines®). Neuroendocrine and Adrenal Tumors. V1.2022. Accessed June 28, 2022. http://www.nccn.org
3. Eisenhofer G. Monoamine-producing tumors. In: Rifai R, et al. eds. Tietz Textbook of Laboratory Medicine. 7th ed. Elsevier Inc; 2022.

The CPT Codes provided in this document are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payor being billed. Any Profile/panel component may be ordered separately. Reflex tests are performed at an additional charge.