Epinephrine

Overview

  • EPIC Code:
  • MISC
  • Soft Test Code:
  • MSOT
  • Send Out Test Code:
  • 375608
Alternate Names
  • Epinephrine, Plasma
Clinical Significance

This test, when used in conjunction with the measurements of other catecholamines, may aid in evaluating catecholamine-producing pheochromocytomas and paragangliomas (PPGLs). However, measurements of plasma free or urinary fractionated metanephrines (ie, the O-methylated catecholamine metabolites) are preferred for the initial biochemical evaluation of PPGLs because of their overall high diagnostic sensitivity [1].

Most PPGLs secrete catecholamines and can cause catecholamine excess, resulting in hypertension, arrhythmia, and hyperglycemia. Left untreated, PPGLs often lead to life-threatening cardiovascular complications. The estimated prevalence of PPGLs is 0.05% to 0.1% in adults with hypertension and 1.7% in children with hypertension [2]. Recognizing the possibility of a PPGL and performing appropriate biochemical testing are crucial for the diagnosis [1]. Plasma or urine catecholamine levels may be used, in addition to metanephrine levels, to provide additional information during the initial biochemical evaluation of PPGLs (eg, when detecting dopamine-secreting paragangliomas) [2].

Intermittent or insignificant secretion of catecholamines by some PPGLs may not increase catecholamine measurements. Physiological stress and certain medications (eg, acetaminophen, labetalol, and sotalol) may increase catecholamine measurements [1].

The results of this test should be interpreted in the context of pertinent clinical and family history and physical examination findings.

References
1. Lenders JW, et al. J Clin Endocrinol Metab. 2014;99(6):1915-1942.
2. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology (NCCN Guidelines®). Neuroendocrine and Adrenal Tumors. V1.2022. Accessed June 28, 2022. http://www.nccn.org


Specimen Collection & Preparation

Test Notes

Due to stress, plasma catecholamine levels are generally unreliable in infants and small children. Urinary catecholamine assays are more reliable.


Patient Preparation

Patient should avoid alcohol, coffee, tea, tobacco and strenuous exercise prior to collection. 

Overnight fasting is required.


Specimen Overview

Order must include body position as supine or upright when drawing patient

Specimen Requirements:

-OR-

4.0 mL Plasma from a Green Top Tube - Na Heparin in a Plastic Vial
Minimum Volume:
2.0 mL Plasma*

* This volume does not allow for repeat testing

Collection Instructions:

  1. Pre-Chill tube before collection
  2. Patient should be relaxed in either a supine or upright position before blood is drawn.
  3. Perform regular phlebotomy with prechilled tube


Processing Instructions:

  1. Centrifuge with 30 minutes of collection in a refrigerated centrifuge. 
  2. Separate plasma and transfer to clean, plastic, screw-capped vials
  3. Freeze immediately at -20° 


Rejection Criteria:

Thawed plasma

Received room temperature

Received refrigerated


Transport and Storage:
  • Ambient: 6 Hours
  • Refrigerated: 6 Hours
  • Frozen (-20 C or colder): 60 Days

    Transport 

Clinical Interpretation

Reference Range:

Adults: 

  Supine - <50 pg/mL 

  Upright - <95 pg/mL

3 - 15 years: 

  Supine - < 464 pg/mL 

  Upright - Not Available 

Pediatric data from J Chromatogr (1993) 617:304-307


Methodology:
  • Electrochemical Detection
  • High Performance Liquid Chromatography (HPLC)
Clinical Significance

This test, when used in conjunction with the measurements of other catecholamines, may aid in evaluating catecholamine-producing pheochromocytomas and paragangliomas (PPGLs). However, measurements of plasma free or urinary fractionated metanephrines (ie, the O-methylated catecholamine metabolites) are preferred for the initial biochemical evaluation of PPGLs because of their overall high diagnostic sensitivity [1].

Most PPGLs secrete catecholamines and can cause catecholamine excess, resulting in hypertension, arrhythmia, and hyperglycemia. Left untreated, PPGLs often lead to life-threatening cardiovascular complications. The estimated prevalence of PPGLs is 0.05% to 0.1% in adults with hypertension and 1.7% in children with hypertension [2]. Recognizing the possibility of a PPGL and performing appropriate biochemical testing are crucial for the diagnosis [1]. Plasma or urine catecholamine levels may be used, in addition to metanephrine levels, to provide additional information during the initial biochemical evaluation of PPGLs (eg, when detecting dopamine-secreting paragangliomas) [2].

Intermittent or insignificant secretion of catecholamines by some PPGLs may not increase catecholamine measurements. Physiological stress and certain medications (eg, acetaminophen, labetalol, and sotalol) may increase catecholamine measurements [1].

The results of this test should be interpreted in the context of pertinent clinical and family history and physical examination findings.

References
1. Lenders JW, et al. J Clin Endocrinol Metab. 2014;99(6):1915-1942.
2. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology (NCCN Guidelines®). Neuroendocrine and Adrenal Tumors. V1.2022. Accessed June 28, 2022. http://www.nccn.org


Production Schedule

Sites Performed
  • Quest - Chantilly to San Juan Capistrano
Days Performed
Monday
Tuesday
Wednesday
Thursday
Friday
Departments
  • Sendouts - Miscellaneous
Turn Around Time

4 to 7 days


Coding & Compliance

CDM

00913333


CPT Coding

82542