Catecholamines, Fractionated, Plasma

Test Code

CATPL

CPT Codes
82384

Includes

Dopamine, Epinephrine, Norepinephrine and Total Catecholamines (calculated)

Preferred Specimen

2 mL frozen plasma collected in a sodium heparin (green-top) tube

Patient Preparation
Patients should be relaxed in either a supine or upright position before blood is drawn. States of anxiety and stress can cause fluctuations in the catecholamine levels. Patient should avoid alcohol, coffee, tea, tobacco and strenuous exercise prior to collection. Overnight fasting is preferred.

Minimum Volume

1 mL

Other Acceptable Specimens

Frozen plasma collected in: EDTA (lavender-top) tube

Instructions

Draw specimen in a pre-chilled green-top vacutainer. After drawing specimen, place green-top tube in an ice bath. Centrifuge 20 minutes 1000xg. The plasma must be free of RBCs. Freeze on dry ice to transport.

Transport Temperature

Frozen

Specimen Stability

Room temperature: 6 hours
Refrigerated: 6 hours
Frozen: 30 days

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

Received room temperature • Received refrigerated

Methodology
Liquid Chromatography/Mass Spectrometry (LC/MS)

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-Sat; Report available: 2-4 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

Catecholamines, Total (<18 years)	Not established

Catecholamines, Total (≥18 years)
Epinephrine
Supine	<58 pg/mL
Upright	<82 pg/mL

Norepinephrine
Supine	149-564 pg/mL
Upright	199-937 pg/mL

Dopamine
Supine	<16 pg/mL
Upright	<27 pg/mL

Total Catecholamines
Supine	<632 pg/mL
Upright	<1046 pg/mL

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].

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
33608 Ortega Highway
San Juan Capistrano, CA 92690-6130

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.