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22413 Catecholamine, Fractionation, Free Plasma (CATP)

Catecholamine, Fractionation, Free Plasma (CATP)
Test Code: CATMAYO
Synonyms/Keywords
​​Adrenaline, Catecholamine Fractionation Pharmacy Solution, Catecholamines Unconjugated, Dopamine, Epinephrine, Noradrenaline, Norepinephrine, Pheochromocytoma, Pressor Amines
Useful For
Diagnosis of pheochromocytoma and paraganglioma, as an auxiliary test to fractionated plasma and urine metanephrine measurements (plasma metanephrine is the preferred test for this diagnosis)
 
Diagnosis and follow-up of patients with neuroblastoma and related tumors, as an auxiliary test to urine vanillylmandelic acid and homovanillic acid measurements
 
Evaluation of patients with autonomic dysfunction or failure or autonomic neuropathy
Specimen Requirements
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
Plasma EDTA Meta​ Catecholamine tubes containing EDTA-sodium metabisulfite solution ​ ​ 3 mL​ 2 mL​ ​
Collection Processing Instructions
Must use special EDTA sodium metabisulfate tube available from Marshfield Labs - Specimen Processing at 800-222-5835.
1. Drawing from a catheter is required.
2. Unless the purpose of the measurement is drug monitoring, discontinue any epinephrine, norepinephrine, or dopamine injections or infusions for at least 12 hours before specimen draw.
3. Discontinue drugs that release epinephrine, norepinephrine, or dopamine or hinder their metabolism for at least 1 week before obtaining the specimen (see Cautions for details). If this is not possible for medical reasons, contact Mayo Clinical Labs and discuss whether a shorter drug withdrawal period may be possible in a particular case.
4. Do not perform the test on patients withdrawing from legal or illegal drugs known to cause rebound plasma catecholamine release during withdrawal (see Cautions for details).
5. The patient must refrain from eating, using tobacco, and drinking caffeinated beverages for at least 4 hours before the specimen is drawn.
6. Calm the patient by giving complete instructions and reassurance regarding the procedure.
7. Insert an indwelling intravenous catheter. Flush with 3 mL of NaCl, using positive pressure.
8. Have the patient rest for 30 minutes in the supine position in a quiet room.
9. At the end of the 30 minutes, withdraw and discard a minimum of 3 mL of blood to remove the saline out of the catheter.
10. If provocative sampling (eg, standing specimen) is required, perform provocative maneuver immediately after obtaining supine specimen. Obtain standing specimen immediately.
11. For each specimen, draw 10 mL of blood into the chilled EDTA-sodium metabisulfite 10-mL tube.
12. Specimens must remain at refrigerated temperature during processing and transport.
13. Separate plasma in a refrigerated centrifuge within 30 minutes of draw.
14. Freeze specimen immediately.
Specimen Stability Information
Specimen Type Temperature Time
Plasm EDTA Meta​ ​Frozen ​7 days
Rejection Criteria
Gross Hemolysis
Specimens that are not drawn, processed and stored according to specific protocol are not acceptable. Regular EDTA tubes are not acceptable and will be rejected. Must use special EDTA sodium metabisulfate tube available from Marshfield Labs - Specimen Processing at 800-222-5835.
Performing Laboratory Information
Performing Location Day(s) Test Performed Report Available Methodology/Instrumentation
Mayo Clinic Laboratories​​
Monday, Tuesday, Thursday, Friday 
​		 2 to 5 days​
Liquid Chromatogr​aphy Tandem Mass Spectrometry (LC-MS/MS)
Reference Lab
Mayo Clinic Laboratories
Test Information

The catecholamines (dopamine, epinephrine, and norepinephrine) are derived from tyrosine via a series of enzymatic conversions. All 3 catecholamines are important neurotransmitters in the central nervous system and also play a crucial role in the autonomic regulation of many homeostatic functions, namely, vascular tone, intestinal and bronchial smooth muscle tone, cardiac rate and contractility, and glucose metabolism. Their actions are mediated via alpha and beta adrenergic receptors and dopamine receptors, all existing in several subforms. The 3 catecholamines overlap, but also differ in their receptor activation profile and consequent biological actions. The systemically circulating fraction of the catecholamines is derived almost exclusively from the adrenal medulla, with small contributions from sympathetic ganglia.

The catecholamines are normally present in the plasma in minute amounts, but levels can increase dramatically and rapidly in response to change in posture, environmental temperature, physical and emotional stress, hypovolemia, blood loss, hypotension, hypoglycemia, and exercise.

In patients with pheochromocytoma (a potentially curable tumor of catecholamine-producing cells of the adrenal medulla), or less commonly of sympathetic ganglia (paraganglioma), plasma catecholamine levels may be continuously or episodically elevated. This results in episodic or sustained hypertension and in intermittent attacks of palpitations, cardiac arrhythmias, headache, sweating, pallor, anxiety, tremor, and nausea. Intermittent or continuous elevations of the plasma levels of 1 or several of the catecholamines may also be observed in patients with neuroblastoma and related tumors (ganglioneuroblastomas and ganglioneuromas) and, very occasionally, in other neuroectodermal tumors.

At the other end of the spectrum, inherited and acquired syndromes of autonomic dysfunction or failure and autonomic neuropathies are characterized by either inadequate production of 1 or several of the catecholamines or by insufficient release of catecholamines upon appropriate physiological stimuli (eg, change in posture from supine to standing, cold exposure, exercise, stress).

Reference Range Information
Reference Range
NOREPINEPHRINE
Supine: 70-750 pg/mL
Standing: 200-1,700 pg/mL
 
EPINEPHRINE
Supine: < or = 111 pg/mL
Standing: < or = 141 pg/mL
 
DOPAMINE
<30 pg/mL (no postural change)
​
Interpretation
Diagnosis of Pheochromocytoma
This test should not be used as the first-line test for pheochromocytoma, as plasma catecholamine levels may not be continuously elevated, but only secreted during a "spell." By contrast, production of metanephrines (catecholamine metabolites) appears to be increased continuously. The recommended first-line laboratory tests for pheochromocytoma are:
-PMET/81609 Metanephrines, Fractionated, Free, Plasma: the most sensitive assay
-METAF/83006 Metanephrines, Fractionated, 24 Hour, Urine: highly specific and almost as sensitive as PMET
 
However, plasma catecholamine measurements can still be useful in patients whose plasma metanephrine or urine metanephrine measurements do not completely exclude the diagnosis. In such cases, plasma catecholamine specimens, if drawn during a "spell," have a 90% to 95% diagnostic sensitivity when cutoffs of >750 pg/mL for norepinephrine and >110 pg/mL for epinephrine are employed. A lower value during a "spell," particularly when plasma or urinary metanephrine measurements were also normal, essentially rules-out pheochromocytoma. Unfortunately, the specificity of these high-sensitivity cutoff levels is not good for separating tumor patients from other patients with similar symptoms. When more specific (95%) decision levels of 2,000 pg/mL for norepinephrine or 200 pg/mL for epinephrine are used, the assay's sensitivity falls to about 85%. 
 
Diagnosis of Neuroblastoma
Vanillylmandelic acid, homovanillic acid, and sometimes urine catecholamine measurements on spot urine or 24-hour urine are the mainstay of biochemical diagnosis and follow-up of neuroblastoma. Plasma catecholamine levels can aid diagnosis in some cases, but diagnostic decision levels are not well established. The most useful finding is disproportional elevations in 1 of the 3 catecholamines, particularly dopamine, which may be observed in these tumors.
 
Diagnosis of Autonomic Dysfunction or Failure and Autonomic Neuropathy
Depending on the underlying cause and pathology, autonomic dysfunction or failure and autonomic neuropathies are associated with subnormal resting norepinephrine levels, or an absent rise of catecholamine levels in response to physiological release stimuli (eg, change in posture from supine to standing, cold exposure, exercise, stress), or both. In addition, there may be significant abnormalities in the ratios of the plasma values of the catecholamines to each other (normal: norepinephrine>epinephrine>dopamine). This is observed most strikingly in the inherited dysautonomic disorder dopamine-beta-hydroxylase deficiency, which results in markedly elevated plasma dopamine levels and a virtually total absence of plasma epinephrine and norepinephrine.
Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
​82384 ​ ​1 ​ ​
Synonyms/Keywords
​​Adrenaline, Catecholamine Fractionation Pharmacy Solution, Catecholamines Unconjugated, Dopamine, Epinephrine, Noradrenaline, Norepinephrine, Pheochromocytoma, Pressor Amines
Ordering Applications
Ordering Application Description
​Cerner ​Catecholamine, Fractionation, Plasma Free (8532)
If the ordering application you are looking for is not listed, contact your local laboratory for assistance.
Specimen Requirements
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
Plasma EDTA Meta​ Catecholamine tubes containing EDTA-sodium metabisulfite solution ​ ​ 3 mL​ 2 mL​ ​
Collection Processing
Must use special EDTA sodium metabisulfate tube available from Marshfield Labs - Specimen Processing at 800-222-5835.
1. Drawing from a catheter is required.
2. Unless the purpose of the measurement is drug monitoring, discontinue any epinephrine, norepinephrine, or dopamine injections or infusions for at least 12 hours before specimen draw.
3. Discontinue drugs that release epinephrine, norepinephrine, or dopamine or hinder their metabolism for at least 1 week before obtaining the specimen (see Cautions for details). If this is not possible for medical reasons, contact Mayo Clinical Labs and discuss whether a shorter drug withdrawal period may be possible in a particular case.
4. Do not perform the test on patients withdrawing from legal or illegal drugs known to cause rebound plasma catecholamine release during withdrawal (see Cautions for details).
5. The patient must refrain from eating, using tobacco, and drinking caffeinated beverages for at least 4 hours before the specimen is drawn.
6. Calm the patient by giving complete instructions and reassurance regarding the procedure.
7. Insert an indwelling intravenous catheter. Flush with 3 mL of NaCl, using positive pressure.
8. Have the patient rest for 30 minutes in the supine position in a quiet room.
9. At the end of the 30 minutes, withdraw and discard a minimum of 3 mL of blood to remove the saline out of the catheter.
10. If provocative sampling (eg, standing specimen) is required, perform provocative maneuver immediately after obtaining supine specimen. Obtain standing specimen immediately.
11. For each specimen, draw 10 mL of blood into the chilled EDTA-sodium metabisulfite 10-mL tube.
12. Specimens must remain at refrigerated temperature during processing and transport.
13. Separate plasma in a refrigerated centrifuge within 30 minutes of draw.
14. Freeze specimen immediately.
Specimen Stability Information
Specimen Type Temperature Time
Plasm EDTA Meta​ ​Frozen ​7 days
Rejection Criteria
Gross Hemolysis
Specimens that are not drawn, processed and stored according to specific protocol are not acceptable. Regular EDTA tubes are not acceptable and will be rejected. Must use special EDTA sodium metabisulfate tube available from Marshfield Labs - Specimen Processing at 800-222-5835.
Useful For
Diagnosis of pheochromocytoma and paraganglioma, as an auxiliary test to fractionated plasma and urine metanephrine measurements (plasma metanephrine is the preferred test for this diagnosis)
 
Diagnosis and follow-up of patients with neuroblastoma and related tumors, as an auxiliary test to urine vanillylmandelic acid and homovanillic acid measurements
 
Evaluation of patients with autonomic dysfunction or failure or autonomic neuropathy
Reference Range Information
Reference Range
NOREPINEPHRINE
Supine: 70-750 pg/mL
Standing: 200-1,700 pg/mL
 
EPINEPHRINE
Supine: < or = 111 pg/mL
Standing: < or = 141 pg/mL
 
DOPAMINE
<30 pg/mL (no postural change)
​
Interpretation
Diagnosis of Pheochromocytoma
This test should not be used as the first-line test for pheochromocytoma, as plasma catecholamine levels may not be continuously elevated, but only secreted during a "spell." By contrast, production of metanephrines (catecholamine metabolites) appears to be increased continuously. The recommended first-line laboratory tests for pheochromocytoma are:
-PMET/81609 Metanephrines, Fractionated, Free, Plasma: the most sensitive assay
-METAF/83006 Metanephrines, Fractionated, 24 Hour, Urine: highly specific and almost as sensitive as PMET
 
However, plasma catecholamine measurements can still be useful in patients whose plasma metanephrine or urine metanephrine measurements do not completely exclude the diagnosis. In such cases, plasma catecholamine specimens, if drawn during a "spell," have a 90% to 95% diagnostic sensitivity when cutoffs of >750 pg/mL for norepinephrine and >110 pg/mL for epinephrine are employed. A lower value during a "spell," particularly when plasma or urinary metanephrine measurements were also normal, essentially rules-out pheochromocytoma. Unfortunately, the specificity of these high-sensitivity cutoff levels is not good for separating tumor patients from other patients with similar symptoms. When more specific (95%) decision levels of 2,000 pg/mL for norepinephrine or 200 pg/mL for epinephrine are used, the assay's sensitivity falls to about 85%. 
 
Diagnosis of Neuroblastoma
Vanillylmandelic acid, homovanillic acid, and sometimes urine catecholamine measurements on spot urine or 24-hour urine are the mainstay of biochemical diagnosis and follow-up of neuroblastoma. Plasma catecholamine levels can aid diagnosis in some cases, but diagnostic decision levels are not well established. The most useful finding is disproportional elevations in 1 of the 3 catecholamines, particularly dopamine, which may be observed in these tumors.
 
Diagnosis of Autonomic Dysfunction or Failure and Autonomic Neuropathy
Depending on the underlying cause and pathology, autonomic dysfunction or failure and autonomic neuropathies are associated with subnormal resting norepinephrine levels, or an absent rise of catecholamine levels in response to physiological release stimuli (eg, change in posture from supine to standing, cold exposure, exercise, stress), or both. In addition, there may be significant abnormalities in the ratios of the plasma values of the catecholamines to each other (normal: norepinephrine>epinephrine>dopamine). This is observed most strikingly in the inherited dysautonomic disorder dopamine-beta-hydroxylase deficiency, which results in markedly elevated plasma dopamine levels and a virtually total absence of plasma epinephrine and norepinephrine.
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Performing Laboratory Information
Performing Location Day(s) Test Performed Report Available Methodology/Instrumentation
Mayo Clinic Laboratories​​
Monday, Tuesday, Thursday, Friday 
​		 2 to 5 days​
Liquid Chromatogr​aphy Tandem Mass Spectrometry (LC-MS/MS)
Reference Lab
Mayo Clinic Laboratories
For billing questions, see Contacts
Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
​82384 ​ ​1 ​ ​
For most current information refer to the Marshfield Laboratory online reference manual.