At a Glance
Why Get Tested?
To help diagnose or rule out a pheochromocytoma
When to Get Tested?
When you have persistent or episodic high blood pressure and symptoms such as headaches, rapid heart rate, and sweating
A blood sample drawn from a vein in your arm
Test Preparation Needed?
Preparation for the test is important for accurate results. You should discontinue epinephrine and epinephrine-like drugs for at least one week before the test, stop using acetaminophen 48 hours beforehand, and fast for 8-10 hours prior to collection. It is especially important not to have any caffeine-containing food (soda, chocolate), coffee (including decaf), tobacco (smoking cigarettes or cigars), tea, or alcohol for at least 4 hours before specimen collection. Talk to your doctor about all the medications you are taking as well since several different drugs may interfere with the test.
The Test Sample
What is being tested?
The plasma free metanephrines test measures the amount of metanephrine and normetanephrine in the blood. These substances are metabolites of epinephrine (adrenaline) and norepinephrine. Epinephrine and norepinephrine are catecholamine hormones that help regulate the flow and pressure of blood throughout the body and play important roles in the body's response to stress.
Catecholamines are produced in the medulla – the interior portion of the adrenal glands – and secreted into the blood. Once these hormones have completed their actions, they are metabolized to inactive compounds. Norepinephrine breaks down into normetanephrine and vanillylmandelic acid (VMA) and epinephrine becomes metanephrine and VMA. Both of the catecholamines and their metabolites are normally found in small fluctuating quantities in the blood and urine.
A rare tumor called a pheochromocytoma can produce large amounts of catecholamines, resulting in significantly increased concentrations of metanephrine and normetanephrine. About 90% of pheochromocytomas form in the adrenal glands and, while a few are cancerous, most are benign – they continue to grow but usually do not spread beyond their original location.
The catecholamines produced by pheochromocytomas can cause persistent hypertension and episodes of severe high blood pressure. This can cause symptoms such as headaches, palpitations, sweating, nausea, anxiety, and tingling in the extremities. Left untreated, the symptoms may worsen as the pheochromocytoma grows. Over time, hypertension caused by the tumor may cause kidney damage, heart disease, and raise the risk of a stroke or heart attack.
Several tests, including plasma free metanephrines, can detect the presence of pheochromocytomas. Although they are rare, it is important to diagnose these tumors because they cause a potentially curable form of hypertension. In most cases, the pheochromocytomas can be surgically removed, which eliminates the high blood pressure and its associated symptoms and complications.
How is the sample collected for testing?
A blood sample is obtained by inserting a needle into a vein in the arm. Although there is some disagreement over the specifics of how the sample should be collected, it may be necessary to lie down and rest quietly for 15 to 30 minutes prior to and during sample collection. In other circumstances, you may just be seated upright with little rest time before the sample collection.
NOTE: If undergoing medical tests makes you or someone you care for anxious, embarrassed, or even difficult to manage, you might consider reading one or more of the following articles: Coping with Test Pain, Discomfort, and Anxiety, Tips on Blood Testing, Tips to Help Children through Their Medical Tests, and Tips to Help the Elderly through Their Medical Tests.
Another article, Follow That Sample, provides a glimpse at the collection and processing of a blood sample and throat culture.
Is any test preparation needed to ensure the quality of the sample?
Preparation for the test is important for accurate results. It may be necessary to discontinue epinephrine and epinephrine-like drugs for at least one week before the test, stop using acetaminophen 48 hours beforehand, and fast for 8-10 hours prior to collection. It is especially important not to have any caffeine-containing food (soda, chocolate), coffee (including decaf), tobacco (smoking cigarettes or cigars), tea, or alcohol for at least 4 hours before specimen collection. Talk to the doctor about all medications being taken. Since several different drugs may interfere with the test, he may instruct the person being tested to stop taking all medications except those that are necessary for one week prior to the test. However, do not stop taking any medications without first consulting the doctor.
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NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used.
Sources Used in Current Review
Pagana, K. D. & Pagana, T. J. (© 2011). Mosby's Diagnostic and Laboratory Test Reference 10th Edition: Mosby, Inc., Saint Louis, MO. Pp 673-675.
Vuguin, P. M. (Updated 2011 October 4). Pediatric Pheochromocytoma. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/988683-overview through http://emedicine.medscape.com. Accessed December 2011.
(Reviewed 2011 January). Pheochromocytoma. American Urological Association AUA Foundation [On-line information]. Available online at http://www.urologyhealth.org/urology/index.cfm?article=14 through http://www.urologyhealth.org. Accessed December 2011.
Blake, M. and Sweeney, A. (Updated 2011 October 19). Pheochromocytoma. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/124059-overview through http://emedicine.medscape.com. Accessed December 2011.
Frank, E. et. al. (Updated 2011 June). Pheochromocytoma. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/Pheochromocytoma.html?client_ID=LTD through http://www.arupconsult.com. Accessed December 2011.
Sources Used for Previous Reviews
Thomas, Clayton L., Editor (1997). Taber's Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition].
Pagana, Kathleen D. & Pagana, Timothy J. (2001). Mosby's Diagnostic and Laboratory Test Reference 5th Edition: Mosby, Inc., Saint Louis, MO. Pp (900-903).
(© 2004). Metanephrines, Plasma. ARUP's Guide to Clinical Laboratory Testing [On-line information]. Available online at http://www.aruplab.com/guides/clt/tests/clt_a76b.jsp#2461156 through http://www.aruplab.com.
(© 2004). Metanephrines, Plasma. ARUP's User's Guide [On-line test information]. Available online at http://www.aruplab.com/guides/ug/tests/0050184.jsp through http://www.aruplab.com.
Eisenhofer, G. et. al. (© 2003). Biochemical Diagnosis of Pheochromocytoma: How to Distinguish True- from False-Positive Test Results. The Journal of Clinical Endocrinology & Metabolism Vol. 88, No. 6 2656-2666 [On-line journal]. Available online at http://jcem.endojournals.org/cgi/content/full/88/6/2656 through http://jcem.endojournals.org.
Yogish, C. (2003 October). The Laboratory Diagnosis of Adrenal Pheochromocytoma: The Mayo Clinic Experience. The Journal of Clinical Endocrinology & Metabolism Vol. 88, No. 10 4533-4539 [On-line journal]. Available online at http://jcem.endojournals.org/cgi/content/full/88/10/4533 through http://jcem.endojournals.org.
(1999 June 16). Researchers Develop Better Means to Diagnose Adrenal Gland Tumors. NIH News Release [On-line press release]. Available online at http://www.nih.gov/news/pr/jun99/ninds-16.htm through http://www.nih.gov.
Sadovsky, R. (2003 September 15). Management of the Clinically Inapparent Adrenal Mass. American Family Physician, Tips from Other Journals [On-line journal]. Available online at http://www.aafp.org/afp/20030915/tips/9.html through http://www.aafp.org.
(2003 December 18). Pheochromocytoma (PDQ®): Treatment, Health Professional Version. National Cancer Institute [On-line information]. Available online at http://www.cancer.gov/cancertopics/pdq/treatment/pheochromocytoma/HealthProfessional through http://www.cancer.gov.
Howard, S. (2002 August 29). heochromocytoma. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/000340.htm.
(2002 September). Pheochromocytoma. NIH, Warren Grant Magnuson Clinical Center, Patient Information Publications [On-line information]. PDF available for download at http://www.cc.nih.gov/ccc/patient_education/pepubs/pheo.pdf through http://www.cc.nih.gov.
Schwartz, G. and Sheps, S. (2004 May 6). Hypertension. Medscape from ACP Medicine 2004. © 2004 WebMD Inc. [On-line article]. Available online at http://www.medscape.com/viewarticle/474790 through http://www.medscape.com.
(© 2004). Pheochromocytoma. The Merck Manual Second Home Edition [On-line information]. Available online at http://www.merck.com/mmhe/sec13/ch164/ch164f.html through http://www.merck.com.
Wu, A. (2006). Tietz Clinical Guide to Laboratory Tests, Fourth Edition. Saunders Elsevier, St. Louis, Missouri. Pp 728-279.
(2008 June 18, Modified). Pheochromocytoma Treatment, Patient Version. National Cancer Institute [On-line information]. Available online at http://www.cancer.gov/cancertopics/pdq/treatment/pheochromocytoma/patient/allpages throughhttp://www.cancer.gov. Accessed on 7-28-08.
(2007 April 17, Updated). Pheochromocytoma. National Institute of Child Health and Human Development [On-line information]. Available online at http://www.nichd.nih.gov/health/topics/pheochromocytoma.cfm throughhttp://www.nichd.nih.gov. Accessed on 7-27-08.
Nanda, R. (2006 September 11, Update). Pheochromocytoma. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/000340.htm. Accessed on 7-28-08.
Sweeney, A. et. al. (2007 September 11, Updated). Pheochromocytoma. eMedicine [On-line information]. Available online at http://www.emedicine.com/med/TOPIC1816.HTM through http://www.emedicine.com. Accessed on 7-28-08.
(© 2006-2008). Pheochromocytoma. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/OncologicDz/NeuroendocrineTumors/Pheochromocytoma.html throughhttp://www.arupconsult.com. Accessed on 7-28-08.