Catecholamines, Fractionated, Random Urine

Test Code

5244

Alias/See Also

LAB962

CPT Codes
82384, 82570

Includes

Epinephrine, Norepinephrine, Dopamine, Total Catecholamines (calculated), and Creatinine

Preferred Specimen

10 mL urine with 6N HCl collected in a plastic urine container

Patient Preparation
It is preferable for the patient to be off medications for a minimum of 18-24 hours 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 and strenuous exercise for 8-12 hours prior to collection.

Minimum Volume

5 mL

Other Acceptable Specimens

10 mL unpreserved urine with pH <6 collected in a plastic urine container

Transport Container

Plastic urine container

Transport Temperature

Frozen

Specimen Stability

Preserved urine
Room temperature: 7 days
Refrigerated: 30 days
Frozen: 49 days

Unpreserved urine
Room temperature: Unacceptable
Refrigerated: 7 days
Frozen: 28 days

Methodology
High Performance Liquid Chromatography (HPLC)

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

Mon-fri

Report Available

4-8 days

Limitations

Recent surgery, traumatic injury, upright posture, cold, anxiety, pain, clonidine withdrawal, and concurrent acute or chronic illness may produce elevated results.

Reference Range

See Laboratory Report

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]. To adjust for the concentration differences in random urine specimens, results are expressed as catecholamine to creatinine ratios.

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].

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].

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

Performing Laboratory

Quest Diagnostics Nichols Institute-San Juan Capistrano, CA

33608 Ortega Highway

San Juan Capistrano, CA 92675-2042

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.