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Test Directory Epinephrine, Plasma

Epinephrine, Plasma

Test Summary

This test, when used in conjunction with the measurements of other catecholamines, 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

Aliases

Specimen Collection

Special Instructions

N/A

Preferred Specimen

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

Minimum Volume

1 mL

Instructions

Draw specimen in a pre-chilled green-top Vacutainer®. Plasma should be separated in a refrigerated centrifuge within 30 minutes of collection and then frozen immediately at -20° C in plastic vials. Each specimen will be invoiced separately.

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.

Storage

Plastic screw-capped vials

Transport Temperature

Frozen

Specimen Stability

Room temperature: 6 hours
Refrigerated: 6 hours
Frozen: 60 days

Limitations

N/A

Other Acceptable Specimens

Plasma collected in an EDTA (lavender-top) tube - See instructions

Unacceptable Specimens

Thawed plasma • Received room temperature • Received refrigerated

Order Code

EPINEP

EPIC (Premier) Code

LAB4324

Includes

N/A

CPT Code

82542

Billing Code

670273

CPT Statement

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 the U.S. Food and Drug Administration. The FDA has determined that such clearance or approval is not necessary. This assay has been validated pursuant to the CLIA regulations and is used for clinical purposes.

Physician Attestation of Informed Consent

N/A

Testing Laboratory

Quest Diagnostics Nichols Institute
33608 Ortega Highway
San Juan Capistrano CA, 92675

Department

Reference Testing

Reference Range

Epinephrine

<18 years	No Reference Range Available
≥18 years	Supine: <58 pg/mL Upright: <82 pg/mL

Setup Schedule / Expected Turnaround Time

Monday - Friday; Report available: 4 - 7 days