Catecholamines, Plasma

About Disease

This testing is done in patients suspected to have adrenal gland tumors or a rare tumor called paraganglioma which occurs outside the gland. However, at times patients with these tumors may not show elevated plasma levels of adrenaline and nor-adrenaline due to episodic elevations in catecholamines. In such individuals, with clinical symptoms and signs of pheochromocytoma and normal catecholamine levels, evaluation of 24 hours urinary catecholamines or urinary metanephrine is recommended. Blood concentration of catecholamines like adrenaline and its metabolites in urine are of clinical interest especially in the diagnosis of tumors like pheochromocytoma, neuroblastoma, ganglioneuroma, and paraganglioma. So this testing is done for tumor diagnosis, prognosis, and during recurrence.

Any Other Information

1. What are the symptoms of pheochromocytoma?

In patients having pheochromocytoma, tumor cells release catecholamines which are responsible for most of the symptoms. Various signs and symptoms are high blood pressure not responsive to standard hypertensive medicines, severe headache, increased sweating, flushing, palpitations and rapid heartbeat, tremors, paleness on the face, breathing difficulty, dyspnea, nausea, constipation, tingling in hands and feet, weight loss, panic attack-type symptoms and anxiety or sense of doom. Tumors produce large amounts of these hormones which get released into the blood and subsequently into the urine.

2. What are the complications of pheochromocytoma?

Complications occur due to long-standing high blood pressure. It damages multiple organs like the cardiovascular system, brain, and kidneys leading to heart diseases and attacks, brain stroke and paralysis, kidney failure, and issues in vision due to problems in the eye nerves. Rarely pheochromocytoma is cancerous/malignant and the tumor can metastasize to bone, lungs, liver, or lymphatic system.

3. What is the outcome or prognosis of these tumors?

Pheochromocytoma and paraganglioma are mostly benign and do not spread beyond their site of origin. They can be easily treated by surgical excision of the tumor. However, if left untreated, the tumor may continue to grow and symptoms may worsen. Very few of them are malignant and cancerous in nature.

4. What are the special instructions for doing the 24 hours urine sample testing?

For 24 hours urine sample collection, on Day 1, the first-morning urine sample has to be discarded. Afterward second urine onwards all the urine passed throughout the day and night needs to be collected in a can provided by the laboratory. On Day 2 the first-morning urine passed needs to be collected. This completes a 24 hrs cycle. Collection can be provided by the lab contains 15ml 2N hydrochloric acid as a preservative. The sample needs to be refrigerated during the period of collection. It is important to mention 24 hrs urine volume as well.

5. Why is urine testing better over blood testing?

Since urine testing is done over a period of 24 hrs, it takes care of episodic fluctuations in hormonal levels which occur in the patient’s blood. These episodic events may get missed during blood collection.

6. Which drugs interfere with Catecholamine testing?

Drug-related variance in catecholamine levels is seen in individuals on alpha- methyldopa, MAO (Monoamine Oxidase), and COMT (Catechol-O-methyl transferase) inhibitors and medications related to hypertension. Discontinuation of these medications 72 hours prior to sample collection ensures the accuracy of results. Interference in catecholamine assay due to synthetic catecholamine analyses e.g. isoproterenol and isoetharine need correlation with clinical inputs.

7. What are the food items which interfere with Catecholamine testing?

The in-vivo adrenalin release is influenced by several foods like vitamin B, coffee, bananas, vanilla ice cream, chocolates, alcohol, and smoking. So it is important to give this food history to your doctor before testing.

8. Do I need to add any other test?

Yes. Addition of tests like plasma-free metanephrines, urinary metanephrines, and 24hrs urinary VMA (vanillyl mandelic acid) test helps in cases of pheochromocytoma. This is because after completing their physiologic actions, catecholamines are broken down into inactive compounds. Dopamine becomes homovanillic acid, nor-epinephrine into nor-metanephrine and VMA, and epinephrine becomes metanephrine and VMA. All of these are removed from the body via urine. Blood testing has to be followed by radiological imaging to find out the exact location and size of the tumor.

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