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Metanephrines Fractionated by HPLC-MS/MS, Urine
Ordering Recommendation
First-line test in suspected pheochromocytoma.
New York DOH Approval Status
Specimen Required
If possible, abstain from medications for 72 hours prior to collection.
24-hour or random urine. Refrigerate 24-hour specimen during collection.
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)
Refrigerated. Also acceptable: Frozen.
Specimens preserved with boric acid or acetic acid.
Ambient: Unacceptable; Refrigerated: 2 weeks (unpreserved), 1 month (preserved); Frozen: 1 month
Methodology
Quantitative High Performance Liquid Chromatography-Tandem Mass Spectrometry
Performed
Sun-Sat
Reported
1-5 days
Reference Interval
| Test Number |
Components |
Reference Interval |
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|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Creatinine, Urine - per 24h |
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| Metanephrine, Urine - per 24h |
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| Metanephrine, Urine - ratio to CRT |
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| Normetanephrine, Urine - per 24h |
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| Normetanephrine, Urine - ratio to CRT |
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Interpretive Data
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 ug/d and normetanephrine less than 900 ug/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.
Per 24h calculations are provided to aid interpretation for collections with a duration of 24 hours and an average daily urine volume. For specimens with notable deviations in collection time or volume, ratios of analytes to a corresponding urine creatinine concentration may assist in result interpretation.
Laboratory Developed Test (LDT)
Note
Hotline History
Hotline History
CPT Codes
83835
Components
| Component Test Code* | Component Chart Name | LOINC |
|---|---|---|
| 0020207 | Creatinine, Urine - per volume | 35674-1 |
| 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 |
