Metanephrines Fractionated by HPLC-MS/MS, Urine
Ordering Recommendation
First-line test in suspected pheochromocytoma.
Quantitative High Performance Liquid Chromatography-Tandem Mass Spectrometry
1-4 days  
New York DOH Approval Status
This test is New York DOH approved.
Submit With Order
Specimen Required
Patient Preparation
If possible, abstain from medications for 72 hours prior to collection.  
24-hour or random urine. Refrigerate 24-hour specimen during collection.  
Specimen Preparation
Transfer a 4 mL aliquot from a well-mixed 24-hour or random collection to an ARUP Standard Transport Tube. (Min: 1.5 mL) Stability can be enhanced by adjusting the pH to 2-3 by using an acid such as 6 mol/L HCl. A pH lower than 2 may cause assay interference. Record total volume and collection time interval on transport tube and test request form.  
Storage/Transport Temperature
Refrigerated. Also acceptable: Frozen.  
Unacceptable Conditions
Ambient: Unacceptable; Refrigerated: 2 weeks; Frozen: 1 month  
Reference Interval
Reference Intervals for 24 Hour Calculations (24-​Hour Urine)
Test Number Components Reference Interval
Effective February 21, 2012
Age Metanephrine
0-​17 years Not Established
18 years and older 30-​350 µg/d
Effective February 21, 2012
Age Normetanephrine
0-​17 years Not Established
18 years and older 50-​650 µg/d
0020473Creatinine, 24-​Hour Urine  
Age Male Female
3-​8 years 140-​700 mg/d 140-​700 mg/d
9-​12 years 300-​1300 mg/d 300-​1300 mg/d
13-​17 years 500-​2300 mg/d 400-​1600 mg/d
18-​50 years 1000-​2500 mg/d 700-​1600 mg/d
51-​80 years 800-​2100 mg/d 500-​1400 mg/d
81 years and older 600-​2000 mg/d 400-​1300 mg/d

Reference Intervals for Ratio-​to-​Creatinine (CRT) Calculations (Random Urine)
Components Reference Interval  
 Age Metanephrine
Metanephrine 0-​3 months
4-​6 months
7-​11 months
1 year
2-​5 years
6-​17 years
18 years and older
0-​700 µg/g crt
0-​650 µg/g crt
0-​650 µg/g crt
0-​530 µg/g crt
0-​500 µg/g crt
0-​320 µg/g crt
0-​300 µg/g crt
 Age Normetanephrine
Normetanephrine 0-​3 months
4-​6 months
7-​11 months
1 year
2-​5 years
6-​17 years
18 years and older
0-​3400 µg/g crt
0-​2200 µg/g crt
0-​1100 µg/g crt
0-​1300 µg/g crt
0-​610 µg/g crt
0-​450 µg/g crt
0-​400 µg/g crt
Interpretive Data
The optimal specimen for this testing is a 24-hour urine collection. Per-day calculations are not reported for patients younger than 18 years of age and for the following specimen types: a random collection, a collection with duration of less than 20 hours, a collection with duration of greater than 28 hours, or a collection with total volume less than 400 mL. Ratios to creatinine may be useful for these evaluations.

Smaller increases in metanephrine and/or normetanephrine concentrations (less than two times the upper reference limit) usually are the result of physiological stimuli, drugs, or improper specimen collection. Essential hypertension is often associated with slight elevations (metanephrine less than 700 µg/d and normetanephrine less than 900 µg/d). Elevated concentrations may be due to intense physical activity, life-threatening illness, and drug interferences.
Significant elevation of one or both metanephrines (three or more times the upper reference limit) is associated with an increased probability of a neuroendocrine tumor.

See Compliance Statement B:
Statement B: This test was developed and its performance characteristics determined by ARUP Laboratories. The U.S. Food and Drug Administration has not approved or cleared this test; however, FDA clearance or approval is not currently required for clinical use. The results are not intended to be used as the sole means for clinical diagnosis or patient management decisions.
CPT Code(s)
Component Test Code*Component Chart NameLOINC
0020207Creatinine, Urine - per volume20624-3
0020208Creatinine, Urine - per 24h2162-6
0080228Metanephrines, Urine Interpretation49283-5
0097110Total Volume19153-6
0097111Hours Collected30211-7
2007997Metanephrine, Urine - per volume21019-5
2007998Normetanephrine, Urine - per volume21422-1
2007999Metanephrine, Urine - per 24h19049-6
2008000Metanephrine, Urine - ratio to CRT35644-4
2008001Normetanephrine, Urine - per 24h2671-6
2008002Normetanephrine, Urine - ratio to CRT44342-4
* Component test codes cannot be used to order tests. The information provided here is not sufficient for interface builds; for a complete test mix, please click the sidebar link to access the Interface Map.