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Test ID METRN Metanephrines, Fractionated, Random, Urine


Specimen Required


Patient Preparation: Patient should refrain from cold medicines, nose drops, and nasal sprays for at least 48 hours prior to test. Tricyclic antidepressants and labetalol and sotalol (beta blockers) may elevate levels of metanephrines. If clinically feasible, these medications should be discontinued at least 1 week before collection.

Supplies: Urine Tubes, 10 mL (T068)

Collection Container/Tube: Clean, plastic urine collection container

Submission Container/Tube: Plastic, 10 mL urine tube

Specimen Volume: 10 mL

Collection Instructions:

1. Collect a random urine specimen.

2. No preservative


Useful For

A second-order screening test for the presumptive diagnosis of pheochromocytoma in patients with non-episodic hypertension

 

Confirming positive plasma metanephrine results in patients with non-episodic hypertension

Profile Information

Test ID Reporting Name Available Separately Always Performed
METAU Metanephrines, Fractionated, U No Yes
CRETR Creatinine, Random, U Yes, (Order RCTUR) Yes

Method Name

METAU: Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS) Stable Isotope Dilution Analysis

CRETR: Enzymatic Colorimetric Assay

Reporting Name

Metanephrines, Fract., Random, U

Specimen Type

Urine

Specimen Minimum Volume

3 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Urine Refrigerated (preferred) 28 days
  Frozen  28 days
  Ambient  14 days

Clinical Information

Pheochromocytoma is a rare, potentially lethal, tumor of chromaffin cells of the adrenal medulla that produces episodes of hypertension with palpitations, severe headaches, and sweating ("spells").

 

Pheochromocytomas and other tumors derived from neural crest cells (eg, paragangliomas and neuroblastomas) secrete catecholamines (epinephrine and norepinephrine).

 

Metanephrine and normetanephrine are the 3-methoxy metabolites of epinephrine and norepinephrine, respectively. Metanephrine and normetanephrine are both further metabolized to vanillylmandelic acid.

 

Pheochromocytoma cells also have the ability to oxymethylate catecholamines into metanephrines that are secreted into circulation.

Reference Values

METANEPHRINE/CREATININE

Normotensives

0-2 years: 82-418 mcg/g creatinine

3-8 years: 65-332 mcg/g creatinine

9-12 years: 41-209 mcg/g creatinine

13-17 years: 30-154 mcg/g creatinine

≥18 years: 29-158 mcg/g creatinine

 

NORMETANEPHRINE/CREATININE

Males

Normotensives

0-2 years: 121-946 mcg/g creatinine

3-8 years: 92-718 mcg/g creatinine

9-12 years: 53-413 mcg/g creatinine

13-17 years: 37-286 mcg/g creatinine

18-29 years: 53-190 mcg/g creatinine

30-39 years: 60-216 mcg/g creatinine

40-49 years: 69-247 mcg/g creatinine

50-59 years: 78-282 mcg/g creatinine

60-69 years: 89-322 mcg/g creatinine

≥70 years: 102-367 mcg/g creatinine

 

Females

Normotensives

0-2 years: 121-946 mcg/g creatinine

3-8 years: 92-718 mcg/g creatinine

9-12 years: 53-413 mcg/g creatinine

13-17 years: 37-286 mcg/g creatinine

18-29 years: 81-330 mcg/g creatinine

30-39 years: 93-379 mcg/g creatinine

40-49 years: 107-436 mcg/g creatinine

50-59 years: 122-500 mcg/g creatinine

60-69 years: 141-574 mcg/g creatinine

≥70 years: 161-659 mcg/g creatinine

 

TOTAL METANEPHRINE/CREATININE

Males

Normotensives

0-2 years: 241-1,272 mcg/g creatinine

3-8 years: 186-980 mcg/g creatinine

9-12 years: 110-582 mcg/g creatinine

13-17 years: 78-412 mcg/g creatinine

18-29 years: 96-286 mcg/g creatinine

30-39 years: 106-316 mcg/g creatinine

40-49 years: 117-349 mcg/g creatinine

50-59 years: 130-386 mcg/g creatinine

60-69 years: 143-427 mcg/g creatinine

≥70 years: 159-472 mcg/g creatinine

 

Females

Normotensives

0-2 years: 241-1,272 mcg/g creatinine

3-8 years: 186-980 mcg/g creatinine

9-12 years: 110-582 mcg/g creatinine

13-17 years: 78-412 mcg/g creatinine

18-29 years: 131-467 mcg/g creatinine

30-39 years: 147-523 mcg/g creatinine

40-49 years: 164-585 mcg/g creatinine

50-59 years: 184-655 mcg/g creatinine

60-69 years: 206-733 mcg/g creatinine

≥70 years: 230-821 mcg/g creatinine

Interpretation

Increased metanephrine and normetanephrine levels are found in patients with pheochromocytoma and tumors derived from neural crest cells.

 

Increased urine metanephrines can be detected in non-pheochromocytoma hypertensive patients; quantification may help distinguish these patients from those with tumor-induced symptoms.

Clinical Reference

1. van Duinen N, Corssmit EPM, de Jong WHA, Brookman D, Kema P, Romijn JA: Plasma levels of free metanephrines and 3-methoxytyramine indicate a higher number of biochemically active HNPGL than 24-h urinary excretion rates of catecholamines and metabolites. Eur J Endocrinol. 2013 Aug 28;169(3):377-382 doi: 10.1530/EJE-13-0529

2. Pacak K, Linehan WM, Eisenhofer G, Walther MM, Goldstein DS: Recent advances in genetics, diagnosis, localization, and treatment of pheochromocytoma. Ann Intern Med. 2001 Feb 20;134(4):315-329

3. Sawka AM, Singh RJ, Young WF Jr: False positive biochemical testing for pheochromocytoma caused by surreptitious catecholamine addition to urine. Endocrinologist 2001;11:421-423

4. Eisenhofer G, Grebe S, Cheung NKV: Monoamine-producing tumors. In: Rifai N, Horvath AR, Wittwer CT, eds. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 6th ed. Elsevier; 2018:1421

5. Shen Y, Cheng L: Biochemical diagnosis of pheochromocytoma and paraganglioma. In: Mariani-Costantini R, ed. Paraganglioma: A Multidisciplinary Approach. Codon Publications; 2019. Accessed July 20, 2021. Available at www.ncbi.nlm.nih.gov/books/NBK543224/

6. Hernandez FC, Sanchez M, Alvarez A, et al: A five-year report on experience in the detection of pheochromocytoma. Clin Biochem. 2000 Nov;33(8):649-55. doi: 10.1016/s0009-9120(00)00172-7

7. van Duinen N, Steenvoorden D, Kema IP, et al: Increased urinary excretion of 3-methoxytyramine in patients with head and neck paragangliomas. J Clin Endocrinol Metab. 2010 Jan;95(1):209-14. doi: 10.1210/jc.2009-1632

8. Le Jacques A, Abalain JH, Le Saos F, Carre JL: Significance of 3-methoxytyramine urine measurement in the diagnosis of pheochromocytomas and paragangliomas: about 28 patients. Ann Biol Clin (Paris). 2011 Sep-Oct;69(5):555-9. French. doi: 10.1684/abc.2011.0612

9. Muskiet FA, Thomasson CG, Gerding AM, Fremouw-Ottevangers DC, Nagel GT, Wolthers BG. Determination of catecholamines and their 3-O-methylated metabolites in urine by mass fragmentography with use of deuterated internal standards. Clin Chem. 1979 Mar;25(3):453-60

10. Hirsch D, Grossman A, Nadler V, Alboim S, Tsvetov G. Pheochromocytoma: Positive predictive values of mildly elevated urinary fractionated metanephrines in a large cohort of community-dwelling patients. J Clin Hypertens (Greenwich). 2019 Oct;21(10):1527-1533. doi: 10.1111/jch.13657

Day(s) Performed

Monday through Friday

Report Available

3 to 5 days

Test Classification

This test was developed, and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information

83835

82570

LOINC Code Information

Test ID Test Order Name Order LOINC Value
METRN Metanephrines, Fract., Random, U 68317-7

 

Result ID Test Result Name Result LOINC Value
21546 Metanephrine/Creatinine 9645-3
CRETR Creatinine, Random, U 2161-8
21547 Normetanephrine/Creatinine 13783-6
21548 Total Metanephrine/Creatinine 13771-1

Forms

If not ordering electronically, complete, print, and send a Oncology Test Request (T729) with the specimen.