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.
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 November 18, 2019
Male Age
Male Range
Female Age
Female Range
0-6 years Not Established 0-6 years Not Established
7-12 years 45-273 µg /d 7-17 years 40-209 µg /d
13-17 years 56-298 µg /d 18 years and older 36-229 µg /d
18 years and older 55-320 µg /d

  Normetanephrine, Urine - per 24h
Effective November 18, 2019
Male Age
Male Range
Female Age
Female Range
0-6 years Not Established 0-6 years Not Established
7-12 years 58-670 µg /d 7-12 years 48-474 µg /d
13-17 years 82-553 µg /d 13-17 years 65-406 µg /d
18-29 years 81-667 µg /d 18 years and older 95-650 µg /d
30 years and older 114-865 µg /d

0020473 Creatinine, Urine - per 24h
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 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: For laboratory developed tests not using a RUO kit, and for FDA approved, cleared or 510(k) exempt assays with alterations. 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
Hotline History
N/A
CPT Codes

83835

Components
Component Test Code* Component Chart Name LOINC
0020207 Creatinine, Urine - per volume 2161-8
0020208 Creatinine, Urine - per 24h 2162-6
0080228 Metanephrines, Urine Interpretation 49283-5
0097110 Total Volume 19153-6
0097111 Hours Collected 30211-7
2007997 Metanephrine, Urine - per volume 21019-5
2007998 Normetanephrine, Urine - per volume 21422-1
2007999 Metanephrine, Urine - per 24h 19049-6
2008000 Metanephrine, Urine - ratio to CRT 35644-4
2008001 Normetanephrine, Urine - per 24h 2671-6
2008002 Normetanephrine, Urine - ratio to CRT 44342-4
* 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
Metanephrines Fractionated by HPLC-MS/MS, Urine