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Catecholamines (Adrenaline and Nor – adrenaline) – 24 Hours Urine

Reproductive
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Report in 192Hrs

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No Fasting Required

Details

Measures adrenaline & noradrenaline levels.

₹6,660₹9,514

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Catecholamines (Adrenaline and Nor-adrenaline) – 24 Hours Urine

  • Why is it done?
    • Detects abnormal levels of catecholamines (epinephrine/adrenaline and norepinephrine/nor-adrenaline) excreted in urine over a 24-hour period, which reflect adrenal medulla and sympathetic nervous system activity
    • Screening and diagnosis of pheochromocytoma, a rare neuroendocrine tumor of the adrenal medulla that produces excessive catecholamines
    • Evaluation of unexplained or resistant hypertension (high blood pressure) with symptoms such as sweating, palpitations, headaches, and anxiety
    • Investigation of symptoms suggestive of catecholamine excess including tremor, excessive perspiration, chest or abdominal pain, and palpitations
    • Diagnosis of familial syndromes associated with pheochromocytoma such as Multiple Endocrine Neoplasia (MEN) type 2A and 2B, Von Hippel-Lindau disease, and Neurofibromatosis type 1
    • Monitoring patients with a history of pheochromocytoma after surgical removal to detect recurrence
    • Evaluation of anxiety disorders and panic attacks to differentiate organic causes from psychiatric conditions
  • Normal Range
    • Epinephrine (Adrenaline): 0-20 mcg/24 hours (or 0-109 nmol/24 hours in SI units); some laboratories report up to 50 mcg/24 hours as normal
    • Norepinephrine (Nor-adrenaline): 15-80 mcg/24 hours (or 89-473 nmol/24 hours in SI units); normal ranges vary by laboratory
    • Total Catecholamines: 20-100 mcg/24 hours (or 118-590 nmol/24 hours in SI units)
    • Interpretation of Results:
    • Normal Results: Values within laboratory reference ranges indicate normal adrenal medullary function and sympathetic nervous system activity; rules out pheochromocytoma with high probability
    • Mildly Elevated (1-4 times upper limit of normal): May suggest emotional stress, anxiety, exercise, recent illness, or certain medications; does not necessarily indicate pheochromocytoma; further testing recommended
    • Significantly Elevated (>4 times upper limit of normal): Highly suggestive of pheochromocytoma or paraganglioma; warrants immediate further investigation with imaging studies such as CT or MRI and specialist referral
    • Borderline Values: May require repeat testing, particularly if clinical suspicion remains high; plasma catecholamine or metanephrine testing may be performed for confirmation
  • Interpretation
    • Elevated Epinephrine and Norepinephrine: Suggests pheochromocytoma or paraganglioma (benign or malignant catecholamine-producing tumor); adrenal or extra-adrenal tumors release excessive hormones into circulation
    • Predominant Norepinephrine Elevation: May indicate extra-adrenal pheochromocytoma (paraganglioma) located along sympathetic chain
    • Predominant Epinephrine Elevation: More suggestive of adrenal medullary pheochromocytoma, as only adrenal medulla produces epinephrine in significant amounts
    • Factors Affecting Results:
    • Physiological Stress: Physical exercise, emotional stress, fear, pain, acute illness, and hypoglycemia can increase catecholamine excretion
    • Medications: Decongestants, stimulants, certain antidepressants, sympathomimetic agents, bronchodilators, and some anesthetics can elevate results; must be discontinued 1-2 weeks before testing
    • Caffeine and Nicotine: Both are sympathomimetic substances that increase catecholamine levels; should be avoided during the collection period
    • Foods: Tyramine-rich foods (aged cheese, cured meats, soy sauce, fermented products) can elevate results in patients taking certain medications
    • Improper Specimen Collection or Storage: Catecholamines are unstable; urine must be collected in proper preservative (usually acidic container), kept cool, and delivered promptly to laboratory
    • Clinical Significance of Result Patterns:
    • Intermittent Elevation (Paroxysmal Pheochromocytoma): Some tumors release catecholamines episodically; normal results do not exclude pheochromocytoma; may require repeat testing or alternative diagnostic methods
    • Sustained Elevation: Continuous catecholamine excess characteristic of pheochromocytoma with continuous hormone secretion
  • Associated Organs
    • Primary Organ System:
    • Adrenal Medulla: The inner portion of the adrenal glands (small organs atop the kidneys) that produces and secretes epinephrine and norepinephrine in response to sympathetic nervous system stimulation
    • Sympathetic Nervous System: The neural pathways that regulate stress responses and release catecholamines
    • Kidneys: Filter and excrete catecholamines (and their metabolites) into urine
    • Diseases and Conditions Associated with Abnormal Results:
    • Pheochromocytoma: Benign or malignant neuroendocrine tumor arising from chromaffin cells of adrenal medulla; produces excessive catecholamines causing hypertension, sweating, tremor, and palpitations
    • Paraganglioma: Extra-adrenal catecholamine-producing tumors arising from sympathetic or parasympathetic paraganglia; can occur along the sympathetic chain from neck to pelvis
    • Resistant or Severe Hypertension: Elevated catecholamines cause vasoconstriction and increased cardiac output, leading to persistent high blood pressure unresponsive to standard antihypertensive medications
    • Multiple Endocrine Neoplasia (MEN) 2A and 2B: Inherited syndromes with high prevalence of pheochromocytoma (approximately 50% of MEN 2 patients); screening with catecholamine testing is essential
    • Von Hippel-Lindau (VHL) Disease: Hereditary cancer syndrome associated with pheochromocytoma in 10-20% of cases; requires regular catecholamine monitoring
    • Neurofibromatosis Type 1 (NF1): Autosomal dominant disorder with increased risk of pheochromocytoma (2-5% of NF1 patients); catecholamine testing recommended for symptomatic patients
    • Familial Paraganglioma Syndrome: Hereditary predisposition to extra-adrenal paragangliomas caused by SDH gene mutations
    • Potential Complications of Abnormal Results (Untreated Pheochromocytoma):
    • Hypertensive Crisis: Sudden severe elevation of blood pressure that can result in stroke, myocardial infarction, or acute kidney injury
    • Cardiac Arrhythmias: Excessive catecholamines increase cardiac irritability; palpitations, atrial fibrillation, and ventricular arrhythmias can occur
    • Cardiovascular Complications: Myocardial infarction, cardiomyopathy, pulmonary edema, and sudden cardiac death can result from prolonged catecholamine excess
    • Cerebrovascular Accident (Stroke): Severe hypertension from catecholamine excess increases risk of ischemic or hemorrhagic stroke
    • Acute Kidney Injury: Hypertensive nephrosclerosis and acute glomerular injury can develop from sustained high blood pressure
    • Tumor Rupture or Hemorrhage: Spontaneous rupture can precipitate massive catecholamine release and life-threatening hypertensive emergency
    • Malignant Transformation: Approximately 10% of pheochromocytomas are malignant and can metastasize to bone, liver, or lymph nodes
  • Follow-up Tests
    • If 24-Hour Urine Catecholamines Are Elevated:
    • Plasma Free Catecholamines and Metanephrines: Confirmatory test; measures catecholamines and their metabolites in blood; higher sensitivity and specificity for pheochromocytoma diagnosis
    • Plasma Metanephrines (or 24-Hour Urine Metanephrines): Alternative confirmatory tests with excellent diagnostic performance; metanephrines are more stable metabolites of catecholamines
    • Abdominal CT Scan: First-line imaging to locate adrenal pheochromocytoma; provides anatomical detail and characterization of adrenal mass
    • Abdominal/Pelvic MRI with MIBG Sequence: Alternative imaging modality particularly useful for detecting paragangliomas and extra-adrenal tumors; better soft tissue contrast than CT
    • MIBG Scintigraphy (Metaiodobenzylguanidine Scan): Functional imaging that identifies catecholamine-producing tissues; superior sensitivity for detecting tumors and metastases; particularly useful for extra-adrenal and malignant tumors
    • PET Scan (18F-DOPA or 18F-FDG-PET): Advanced functional imaging for detecting metastatic disease and malignant pheochromocytoma; helps assess tumor aggressiveness
    • Genetic Testing: DNA sequencing for mutations in predisposition genes (RET, NF1, VHL, SDH genes) if family history or syndromic features present; determines hereditary risk
    • Blood Pressure Monitoring: 24-hour ambulatory blood pressure monitoring or home monitoring to assess degree of hypertension and assess treatment response
    • If 24-Hour Urine Catecholamines Are Normal But Clinical Suspicion Remains High:
    • Repeat 24-Hour Urine Catecholamines: If pheochromocytoma has episodic secretion (paroxysmal), repeat testing during or shortly after symptomatic episodes improves diagnostic yield
    • Plasma Free Metanephrines: More sensitive alternative test; superior to catecholamines for initial screening in some centers
    • Supine Plasma Catecholamines: Blood test performed in supine position to minimize positional effects and improve diagnostic accuracy
    • Post-Treatment Monitoring (After Surgical Removal):
    • Repeat 24-Hour Urine Catecholamines: Performed 1-2 weeks post-operatively to confirm normalization; normal results confirm complete tumor removal
    • Annual Surveillance Testing: Ongoing 24-hour urine catecholamine or metanephrine testing annually to detect recurrent or metastatic disease; especially important for malignant tumors or hereditary syndromes
    • Imaging Follow-up: Periodic CT or MRI of adrenal region and MIBG scintigraphy at regular intervals (typically 6-12 months initially, then annually) to assess for recurrence
  • Fasting Required?
    • No fasting is required for the 24-hour urine collection for catecholamines; however, normal dietary intake should be maintained to avoid false results from metabolic stress
    • Medications to Avoid Prior to Testing (1-2 weeks before collection):
    • Decongestants and Sympathomimetic Agents: Pseudoephedrine, phenylephrine, ephedrine, phenylpropanolamine (found in cold and allergy medications)
    • Tricyclic Antidepressants: Amitriptyline, doxepin, imipramine (may increase catecholamine excretion)
    • Other Antidepressants: Venlafaxine, duloxetine, and other SNRIs (serotonin-norepinephrine reuptake inhibitors)
    • Bronchodilators and Asthma Medications: Albuterol/salbutamol, terbutaline, isoproterenol
    • Stimulants: Amphetamines, methylphenidate (Ritalin), atomoxetine
    • Appetite Suppressants: Phentermine and other sympathomimetic weight loss agents
    • Certain Blood Pressure Medications: Decongestant-containing products; discuss with physician which antihypertensives to continue or hold
    • Substances to Avoid During Collection Period:
    • Caffeine: Coffee, tea, energy drinks, cola, chocolate, and caffeine-containing products should be completely avoided during the 24-hour collection period
    • Nicotine: Smoking, tobacco products, and nicotine replacement therapy must be avoided; nicotine is a strong sympathomimetic
    • Alcohol: Alcoholic beverages can affect catecholamine levels and should be avoided during collection period
    • Tyramine-Rich Foods: Aged cheeses, cured or processed meats, soy sauce, fermented foods, overripe bananas, certain beers, and other high-tyramine products should be minimized or avoided
    • Patient Preparation and Collection Instructions:
    • Rest Before Collection: Rest in supine position (lying down) for 30 minutes before initiating 24-hour collection to establish baseline catecholamine levels
    • Stress Minimization: Maintain calm, relaxed state during collection; avoid strenuous exercise, emotional stress, and physical exertion as these artificially elevate catecholamine levels
    • Collection Container: Use only the designated 24-hour urine collection bottle provided by the laboratory; typically contains acidic preservative (hydrochloric acid or acetic acid) to prevent catecholamine degradation
    • Collection Procedure: Discard first morning urine; collect all urine from second void through first morning void of next day into the collection bottle; mark exact collection start and end times
    • Sample Storage: Keep collection bottle refrigerated (2-8°C) or on ice throughout the 24-hour collection period; do not freeze
    • Specimen Transport: Transport specimen to laboratory promptly upon completion (ideally within 1-2 hours) while maintaining cool temperature; if significant delay expected, freeze specimen
    • Medical Consultation: Inform physician of all current medications before testing; some medications may need to be temporarily discontinued or special instructions provided; never stop prescribed medications without medical guidance

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