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Test Directory Catecholamines, Fractionated, Random Urine

Catecholamines, Fractionated, Random Urine

Test Summary

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

Aliases

Frac Catecholamines, Random urine

Specimen Collection

Special Instructions

N/A

Preferred Specimen

10 mL random urine with 6N HCl, submitted in a plastic, screw-cap container

Minimum Volume

5 mL

Instructions

After urine collection, add 6N HCl to maintain a pH below 3. Urine without preservative is acceptable if pH is below 6 and the sample is shipped frozen.

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 and strenuous exercise prior to collection.

Storage

N/A

Transport Temperature

Preserved urine: Room temperature
Unpreserved urine: Frozen

Specimen Stability

Room temperature: 7 days
Refrigerated: 7 days
Frozen: 28 days

Limitations

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

Other Acceptable Specimens

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

Unacceptable Specimens

pH >3.0 • Received unfrozen

Order Code

CATFRU

EPIC (Premier) Code

LAB3559

Includes

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

CPT Code

82384
82570

Billing Code

670627
670628

CPT Statement

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 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
14225 Newbrook Drive
Chantilly VA, 20153

Department

Reference Testing

Reference Range

See Laboratory Report

Setup Schedule / Expected Turnaround Time

Monday - Friday; Report available: 3 - 6 days