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Nor-Metanephrine - Free, Urine 24 Hrs

Blood
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Report in 120Hrs

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At Home

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Fasting Required

Details

Catecholamine metabolites.

₹3,700₹5,286

30% OFF

Nor-Metanephrine - Free Urine 24 Hrs

  • Why is it done?
    • Detects normetanephrine, a metabolite of norepinephrine produced by the adrenal medulla and sympathetic nervous system
    • Primary indication: Screening for pheochromocytoma and paraganglioma - rare catecholamine-secreting tumors
    • Evaluates patients presenting with sustained or paroxysmal hypertension, palpitations, sweating, and headaches
    • Assists in diagnosis of familial syndromes predisposed to catecholamine-secreting tumors (MEN 2A, MEN 2B, NF1, SDH mutations)
    • More sensitive and specific than plasma metanephrines due to collection over 24 hours and reduced false positives
    • Performed during hypertensive episodes or following clinical suspicion of catecholamine excess
  • Normal Range
    • Reference Range: 0-170 mcg/24 hours (micrograms per 24-hour urine collection)
    • Alternative units: 0-900 nmol/24 hours (nanomoles per 24-hour collection)
    • Normal Result: Values within the reference range indicate no significant catecholamine excess; pheochromocytoma or paraganglioma is unlikely
    • Abnormal Result: Elevated levels above 170 mcg/24 hours indicate possible catecholamine-secreting tumor or other conditions causing norepinephrine excess
    • Borderline Values: Results 150-170 mcg/24 hours warrant clinical correlation and may necessitate repeat testing or additional imaging studies
    • Units of Measurement: Micrograms per 24-hour urine collection (mcg/24h) or nanomoles per 24-hour collection (nmol/24h); results expressed as free (unconjugated) normetanephrine
  • Interpretation
    • Markedly Elevated (>400 mcg/24h): Highly suggestive of pheochromocytoma or paraganglioma; probability increases substantially with values greater than 4 times the upper limit of normal
    • Mildly to Moderately Elevated (170-400 mcg/24h): Warrants imaging studies (CT, MRI, or PET scan) and repeat testing; differential includes pheochromocytoma, medications, anxiety disorders, or physiologic stress
    • Negative/Normal Result: Pheochromocytoma is virtually excluded; excellent negative predictive value makes this test reliable for ruling out catecholamine-secreting tumors
    • Factors Affecting Results:
    • Medications: Decongestants, stimulants, sympathomimetics, tricyclic antidepressants, methylphenidate, phentermine, and some antipsychotics can increase levels
    • Physiologic Stress: Acute illness, infection, surgery, myocardial infarction, stroke, and severe emotional stress can elevate normetanephrine
    • Lifestyle Factors: Caffeine intake, nicotine, alcohol withdrawal, and vigorous exercise during collection period increase levels
    • Collection Issues: Incomplete urine collection or improper sample handling can affect accuracy
    • Medical Conditions: Thyroid disorders, diabetes, chronic kidney disease, and certain neurologic conditions may influence results
    • Clinical Significance: Normetanephrine represents 60% of total metanephrines; elevated levels indicate norepinephrine production is predominating. Combined assessment with metanephrine levels provides comprehensive catecholamine evaluation and improves diagnostic accuracy for neuroendocrine tumors
  • Associated Organs
    • Primary Organ System: Adrenal medulla (neuroendocrine tissue); also sympathetic nervous system and extra-adrenal chromaffin tissue
    • Pheochromocytoma: Catecholamine-producing tumor arising from adrenal medulla; accounts for 0.1-0.6% of hypertensive cases; rule of 10s: 10% bilateral, 10% extra-adrenal, 10% malignant, 10% familial
    • Paraganglioma: Extra-adrenal neuroendocrine tumor that can secrete catecholamines; located along sympathetic chain from neck to bladder; associated with hereditary syndromes
    • Hypertensive Complications: Catecholamine excess causes severe hypertension leading to left ventricular hypertrophy, myocardial infarction, stroke, acute coronary syndrome, and hypertensive crisis
    • Cardiovascular Manifestations: Palpitations, arrhythmias, cardiomyopathy, congestive heart failure, and orthostatic hypotension
    • Familial Syndromes: Multiple Endocrine Neoplasia type 2A and 2B (RET mutations), von Hippel-Lindau syndrome (VHL), Neurofibromatosis type 1 (NF1), and SDH gene mutations predispose to pheochromocytoma/paraganglioma
    • Potential Complications: Catecholamine crisis with uncontrolled hypertension, pulmonary edema, dissecting aortic aneurysm, cerebral hemorrhage, acute renal failure, and metabolic complications
  • Follow-up Tests
    • If Normetanephrine is Elevated:
    • 24-hour urine metanephrine (to assess epinephrine excess); combined metanephrine and normetanephrine levels improve diagnostic specificity
    • Plasma free metanephrines to confirm diagnosis with alternative specimen type
    • CT or MRI of abdomen and pelvis to localize adrenal tumor or extra-adrenal mass
    • Functional imaging: 123I-MIBG scintigraphy, PET scan with 18F-DOPA or 68Ga-DOTATATE for identifying catecholamine-secreting lesions
    • Plasma chromogranin A and urine chromogranin A (additional neuroendocrine markers)
    • Genetic testing for familial syndromes (RET, VHL, NF1, SDHA, SDHB, SDHD mutations) if indicated by family history
    • If Normetanephrine is Normal:
    • Clinical reassurance; pheochromocytoma effectively ruled out with high probability
    • If suspicion remains high, consider repeat testing after medication adjustment or during symptomatic episodes
    • Monitoring Frequency:
    • Annual screening in patients with familial predisposition syndromes or family history of pheochromocytoma
    • Post-surgical monitoring after tumor resection to detect recurrence
    • Imaging surveillance every 3-5 years for incidental adrenal masses discovered on other studies
  • Fasting Required?
    • Fasting: NO - Fasting is not required for this 24-hour urine collection
    • Patient Preparation Instructions:
    • Patient should void at the start of the 24-hour collection period (discard this urine); start collection from the next void
    • Collect all urine for exactly 24 hours, including the final void on the second morning
    • Use the container provided by the laboratory, which typically contains preservative acid
    • Keep urine collection refrigerated or on ice throughout the collection period
    • Avoid contamination with stool or toilet paper; use a clean urinal or collection hat for female patients
    • Medications to Avoid:
    • Decongestants (pseudoephedrine, phenylephrine) - discontinue 1 week prior if possible
    • Sympathomimetic amines and stimulants (methylphenidate, phentermine, amphetamines)
    • Tricyclic antidepressants (amitriptyline, imipramine) if clinically feasible
    • Some antipsychotics and antiemetics - consult with physician regarding discontinuation
    • Dietary and Lifestyle Modifications:
    • Avoid caffeine (coffee, tea, chocolate, energy drinks) for 24 hours before and during collection period
    • Avoid nicotine and tobacco products during collection period
    • Avoid alcohol and alcohol withdrawal during collection
    • Minimize strenuous exercise and emotional stress during 24-hour collection period
    • Maintain normal hydration and adequate fluid intake throughout collection
    • Special Considerations:
    • Inform provider of all current medications; some essential medications should not be discontinued
    • Delay collection if acute illness, infection, or significant stress is present; retest when patient is stable
    • Ensure proper labeling with date, time of start and completion of 24-hour collection
    • Transport specimen to laboratory promptly; do not allow extended delays at room temperature

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