Metanephrines Fractionated by HPLC-MS/MS, Urine

2007996
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High
Normal

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

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.  

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.

This test was developed and its performance characteristics determined by ARUP Laboratories. It has not been cleared or approved by the US Food and Drug Administration. This test was performed in a CLIA certified laboratory and is intended for clinical purposes.

Compliance Category

Laboratory Developed Test (LDT)

Note

Hotline History

N/A

CPT Codes

83835

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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