Catecholamines and metabolites

In diagnostics, catecholamines and metabolites are mainly used for detecting and ruling out the presence of catecholamine-producing tumours.

Indication
When there are suspicions of:

  • Pheochromocytoma
  • Neuroblastoma or ganglioneuroma
  • Arterial hypertension

Diagnostic strategy
Pheochromocytoma should be ruled out if there is:

  • Arterial hypertension, especially among young people and paroxysmal blood pressure increases
  • Symptomatic hypertension with beta-blocker therapy
  • Rising values with beta-blockers (beta-adrenergic noradrenaline effect not inhibited by a beta-blockade)
  • Hypertensive reaction to tricyclic antidepressants (e.g. during contrast medium tests, etc.)
  • DD of a tumour in the adrenal region
  • Conditions with an increased incidence of pheochromocytoma (for an index case, possibly for family screening as well)
  • Multiple endocrine neoplasia, e.g. MEN type II a / II b
  • Diseases that could be part of MEN (preoperative!), e.g. medullary thyroid cancer, primary hyperparathyroidism.
  • Phacomatosis, e.g. neurofibromatosis (von Recklinghausen’s disease), Hippel-Lindau syndrome, tuberous sclerosis, Sturge Weber syndrome.
  • Pheochromocytoma in first-degree relatives

Metabolism of Catecholamines

Basic diagnostics

Recommendation
Profile of catecholamines

Use 24-hour urine collection to determine adrenaline, noradrenaline, vanillylmandelic acid, homovanillic acid, metanephrine, normetanephrine.

Test material
24-hour urine collection (when collecting more than 10 ml, add 20 % hydrochloric acid and store in a cool and dark place) or send 20 ml to the lab and inform us of the total quantity.

Patients should not eat bananas or anything containing vanilla, such as ice cream, pudding or cakes, nor coffee, cheese, nuts, citrus fruits
Medications: Phenothiazine, theophylline, MAO inhibitors.

Advanced Diagnostics

If the basic diagnostics do not clearly rule out a catecholamine-producing tumour or confirm the diagnosis, then epinephrine, norepinephrine and dopamine should be determined in the plasma (problematic sampling) / EDTA plasma (refrigerated transport, better frozen).

In contrast to the catecholamines and their metabolites, it is not permissible to use acidification when determining porphyrins in the urine.

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