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Metanephrines Fractionated by HPLC-MS/MS, Urine
2007996
Ordering Recommendation

First-line test in suspected pheochromocytoma.

Mnemonic
META URINE
Methodology
Quantitative High Performance Liquid Chromatography-Tandem Mass Spectrometry
Performed
Sun-Sat
Reported
1-4 days
New York DOH Approval Status
This test is New York DOH approved.
Submit With Order
ARUP Consult®
Disease Topics
Specimen Required
Patient Preparation
If possible, abstain from medications for 72 hours prior to collection. 
Collect
24-hour or random urine. Refrigerate 24-hour specimen during collection. 
Specimen Preparation
Thoroughly mix entire collection (24-hour or Random) in one container. Transfer a 4 mL aliquot to an ARUP Standard Transport Tube. (Min: 2.5 mL) A pH lower than 2 can cause assay interference. Record total volume and collection time interval on transport tube and test request form.
Specimen preservation can be extended to 1 month refrigerated by performing one of the following:
Option 1: Transfer a 4 mL aliquot to an ARUP Standard Transport Tube. (Min: 2.5 mL) Adjust pH to 2.0-4.0 with 6M HCl.
Option 2: Transfer a 4 mL aliquot to an ARUP Standard Transport Tube containing 20 mg sulfamic acid (ARUP Supply #48098), available online through eSupply using ARUP Connect™or contact ARUP Client Services at (800) 522-2787. (Min: 2.5 mL) 
Storage/Transport Temperature
Refrigerated. Also acceptable: Frozen. 
Unacceptable Conditions
Specimens preserved with boric acid or acetic acid. 
Remarks
 
Stability
Ambient: Unacceptable; Refrigerated: 2 weeks (unpreserved), 1 month (preserved); Frozen: 1 month 
Reference Interval
Reference Intervals for 24 Hour Calculations (24-Hour Urine)
Test Number
Components
Reference Interval
 Metanephrine, Urine - per 24h
Effective August 17, 2015
Male Age
Male Range
Female Age
Female Range
0-6 yearsNot Established0-6 yearsNot Established
7-12 years45-179 µg /d7-17 years42-135 µg /d
13-17 years61-202 µg /d18 years and older39-143 µg /d
18 years and older62-207 µg /d

 Normetanephrine, Urine - per 24h
Effective August 17, 2015
Male Age
Male Range
Female Age
Female Range
0-6 yearsNot Established0-6 yearsNot Established
7-12 years70-273 µg /d7-12 years52-247 µg /d
13-17 years92-312 µg /d13-17 years73-266 µg /d
18-29 years95-379 µg /d18 years and older109-393 µg /d
30 years and older125-510 µg /d

0020473Creatinine, 24-Hour Urine
Age
Male
Female
3-8 years140-700 mg/d140-700 mg/d
9-12 years300-1300 mg/d300-1300 mg/d
13-17 years500-2300 mg/d400-1600 mg/d
18-50 years1000-2500 mg/d700-1600 mg/d
51-80 years800-2100 mg/d500-1400 mg/d
81 years and older600-2000 mg/d400-1300 mg/d


Reference Intervals for Ratio-to-Creatinine (CRT) Calculations (Random Urine)
Components
Reference Interval

AgeMetanephrine
Metanephrine0-3 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
AgeNormetanephrine
Normetanephrine0-3 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 7 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 (if 18 years of age or older) or greater than 5000 mL (all ages). 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 400 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.

Compliance 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.

Note
CPT Code(s)
83835
Components
Component Test Code*Component Chart NameLOINC
0020207Creatinine, Urine - per volume2161-8
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.
Aliases