Ordering Recommendation

First-line test in suspected pheochromocytoma.

New York DOH Approval Status

This test is New York state approved.

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

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.


Ambient: Unacceptable; Refrigerated: 2 weeks (unpreserved), 1 month (preserved); Frozen: 1 month


Quantitative High Performance Liquid Chromatography-Tandem Mass Spectrometry




1-5 days

Reference Interval

Test Number
Reference Interval
  Creatinine, Urine - per 24h
Male (mg/d)
Female (mg/d)
3-8 years 140-700 140-700
9-12 years 300-1300 300-1300
13-17 years 500-2300 400-1600
18-50 years 1000-2500 700-1600
51-80 years 800-2100 500-1400
81 years and older 600-2000 400-1300

  Metanephrine, Urine - per 24h
Age Male (µg/d) Female (µg/d)
0-6 years Not Applicable Not Applicable
7-12 years 45-273 40-209
13-17 years 56-298 40-209
18 years and older 55-320 36-229

  Metanephrine, Urine - ratio to CRT
Age µg/g CRT
0-3 months 0-700
4-6 months 0-650
7-11 months 0-650
1 year 0-530
2-5 years 0-500
6-17 years 0-320
18 years and older 0-300

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

  Normetanephrine, Urine - ratio to CRT
Age µg/g CRT
0-3 months 0-3400
4-6 months 0-2200
7-11 months 0-1100
1 year 0-1300
2-5 years 0-610
6-17 years 0-450
18 years and older 0-400

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.

Compliance Category

Laboratory Developed Test (LDT)


Hotline History


CPT Codes



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.


Metanephrines Fractionated by HPLC-MS/MS, Urine