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HelpTest Code CATP Catecholamine Fractionation, Free, Plasma
Reporting Name
Catecholamine Fract, Free, PUseful For
Diagnosing pheochromocytoma and paraganglioma, as an auxiliary test to fractionated plasma and urine metanephrine measurements
Diagnosis follow-up of patients with neuroblastoma and related tumors, as an auxiliary test to urine vanillylmandelic acid and homovanillic acid measurements
Evaluation of patients with autonomic dysfunction or failure or autonomic neuropathy
Performing Laboratory
Mayo Clinic Laboratories in Rochester
Specimen Type
Plasma EDTA MetaOrdering Guidance
To preserve the quality of the specimen, this test should be its own collection. Sharing the specimen could introduce unforeseen analysis interferences.
This test is not the first-tier test for pheochromocytoma, as plasma catecholamine levels may not be continuously elevated. For the recommended first-tier laboratory test for pheochromocytoma, order either:
-PMET / Metanephrines, Fractionated, Free, Plasma
-METAF / Metanephrines, Fractionated, 24 Hour, Urine
Do not perform this test on patients withdrawing from legal or illegal drugs known to cause rebound plasma catecholamine release during withdrawal (see Cautions for details).
Specimen Required
Patient Preparation:
1. Discontinue drugs that release epinephrine, norepinephrine, or dopamine, or hinder their metabolism, for at least one week before obtaining the specimen (see Cautions for details). If this is not possible for medical reasons, contact the laboratory and discuss whether a shorter drug withdrawal period may be possible in a particular case.
2. Unless the purpose of the measurement is drug monitoring, discontinue any epinephrine, norepinephrine, or dopamine injections or infusions for at least 12 hours before specimen collection.
3. The patient must refrain from eating, using tobacco, and drinking caffeinated beverages for at least 4 hours before the specimen is collected.
Supplies: Catecholamine Tubes-EDTA (T066) (tubes contain sodium metabisulfite, may come as 10-mL or 6-mL tubes, and have a 6-month expiration time)
Collection Container/Tube:
Preferred: 10-mL Catecholamine tubes containing EDTA-sodium metabisulfite solution
Acceptable: 6-mL Catecholamine tubes containing EDTA-sodium metabisulfite solution
Submission Container/Tube: Plastic vial
Specimen Volume: 3 mL
Collection Instructions:
Note: If the collection instructions are not followed, falsely elevated test results are highly likely.
1. Drawing from an indwelling intravenous (IV) line/catheter/butterfly is required.
2. Calm the patient by giving complete instructions and reassurance regarding the procedure.
3. Insert an indwelling IV catheter. Flush with 3 mL of sodium chloride (NaCl) using positive pressure.
4. Have the patient rest for 30 minutes in the supine position in a quiet room.
5. At the end of the 30 minutes, withdraw and discard a minimum of 3 mL of blood to remove the saline out of the catheter.
6. If provocative sampling (eg, standing specimen) is required, perform provocative maneuver immediately after obtaining supine specimen. Obtain standing specimen immediately.
7. For each specimen, draw 10 mL of blood into the chilled 10 mL catecholamine tube containing EDTA-sodium metabisulfite solution. A 6 mL pink top EDTA-metabisulfite tube is an acceptable substitute.
8. Specimens must remain at refrigerated temperature during processing and transport.
9. Separate plasma in a refrigerated centrifuge within 30 minutes of collection.
10. Freeze specimen immediately.
Specimen Minimum Volume
2 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Plasma EDTA Meta | Frozen | 28 days |
Reference Values
NOREPINEPHRINE
Supine: 70-750 pg/mL
Standing: 200-1700 pg/mL
EPINEPHRINE
Supine: <111 pg/mL
Standing: <141 pg/mL
DOPAMINE
<30 pg/mL (no postural change)
For International System of Units (SI) conversion for Reference Values, see www.mayocliniclabs.com/order-tests/si-unit-conversion.html.
Day(s) Performed
Monday through Friday
Test Classification
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.CPT Code Information
82384
Clinical Information
The catecholamines (dopamine, epinephrine, and norepinephrine) are derived from tyrosine via a series of enzymatic conversions. All 3 catecholamines are important neurotransmitters in the central nervous system and play a crucial role in the autonomic regulation of many homeostatic functions, namely, vascular tone, intestinal and bronchial smooth muscle tone, cardiac rate and contractility, and glucose metabolism. Their actions are mediated via alpha- and beta-adrenergic and dopamine receptors, all existing in several subforms. The 3 catecholamines overlap but differ in their receptor activation profile and consequent biological actions. The systemically circulating fraction of the catecholamines is derived almost exclusively from the adrenal medulla, with small contributions from sympathetic ganglia.
Catecholamines are normally present in the plasma in minute amounts, but levels can increase dramatically and rapidly in response to change in posture, environmental temperature, physical and emotional stress, hypovolemia, blood loss, hypotension, hypoglycemia, and exercise.
In patients with pheochromocytoma (a potentially curable tumor of catecholamine-producing cells of the adrenal medulla) or, less commonly, paraganglioma (a tumor of the sympathetic ganglia that also produces catecholamine), plasma catecholamine levels may be continuously or episodically elevated. This results in episodic or sustained hypertension and intermittent attacks of palpitations, cardiac arrhythmias, headache, sweating, pallor, anxiety, tremor, and nausea. Intermittent or continuous elevations of the plasma levels of one or several of the catecholamines may be observed in patients with neuroblastoma and related tumors (ganglioneuroblastomas and ganglioneuromas) and, very occasionally, in other neuroectodermal tumors.
At the other end of the spectrum, inherited and acquired syndromes of autonomic dysfunction or failure and autonomic neuropathies are characterized by either inadequate production of one or several of the catecholamines or by insufficient release of catecholamines upon appropriate physiological stimuli (eg, change in posture from supine to standing, cold exposure, exercise, stress).
Report Available
2 to 6 daysReject Due To
| Gross hemolysis | Reject |
| Gross lipemia | OK |
| Gross icterus | OK |
Method Name
Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)
Disease States
- Neuroblastoma
Forms
If not ordering electronically, complete, print, and send an Oncology Test Request (T729) with the specimen.