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Test Code CATPA Catecholamine, Endocrine Study, Plasma


Ordering Guidance


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 the test on patients withdrawing from legal or illegal drugs known to cause rebound plasma catecholamine release during withdrawal (see Cautions for additional information).



Specimen Required


Patient Preparation:

1. Discontinue drugs that release epinephrine, norepinephrine, or dopamine, or hinder their metabolism, for at least 1 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/infusions for at least 12 hours before specimen draw.

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 containing EDTA-sodium metabisulfite solution (T066) (tubes 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 per collection

Collection Instructions:

1. Drawing from a catheter is required. 

2. Calm the patient by giving complete instructions and reassurance regarding the procedure.

3. Insert an indwelling intravenous catheter. Flush with 3 mL of saline, 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 blood into the chilled EDTA-sodium metabisulfite 10-mL tube.

8. Specimen must remain at refrigerated temperature during processing and transport.

9. Separate plasma in a refrigerated centrifuge within 30 minutes of draw.

10. Freeze specimen immediately.


Useful For

Diagnosis of pheochromocytoma and paraganglioma in specimens collected from individuals in both supine and standing positions, as an auxiliary test to fractionated plasma and urine metanephrine measurements

 

Diagnosis and 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/failure or autonomic neuropathy

Disease States

  • Neuroblastoma

Profile Information

Test ID Reporting Name Available Separately Always Performed
CTP0 Catecholamine, Fract, Supine, P No Yes
CTP10 Catecholamine, Fract, Standing, P No Yes

Method Name

Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS) Includes unconjugated norepinephrine, epinephrine, and dopamine.

Reporting Name

Catecholamine, Endocrine Study, P

Specimen Type

Plasma EDTA Meta

Specimen Minimum Volume

2 mL per collection

Specimen Stability Information

Specimen Type Temperature Time Special Container
Plasma EDTA Meta Frozen 28 days

Reject Due To

Gross hemolysis Reject
Gross lipemia OK
Gross icterus OK

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 also 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 in intermittent attacks of palpitations, cardiac arrhythmias, headache, sweating, pallor, anxiety, tremor, and nausea. Intermittent or continuous elevations of the plasma levels of 1 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/failure and autonomic neuropathies are characterized by either inadequate production of 1 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).

Reference Values

NOREPINEPHRINE

Supine: 70-750 pg/mL

Standing: 200-1,700 pg/mL

 

EPINEPHRINE

Supine: Undetectable-110 pg/mL

Standing: Undetectable-140 pg/mL

 

DOPAMINE

<30 pg/mL (no postural change)

Day(s) Performed

Monday through Friday

Report Available

2 to 6 days

Performing Laboratory

Mayo Clinic Laboratories in Rochester

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 x 2