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}\n.co-urgence .co-urgence-titre { font-size: 13px; font-weight: 700; color: #c0392b; letter-spacing: 1.5px; text-transform: uppercase; margin-bottom: 10px; }\n.co-urgence p { color: #5a2020; font-size: 14px; margin: 0 0 10px; line-height: 1.7; }\n.co-urgence p:last-child { margin-bottom: 0; }\n.co-disclaimer { font-size: 13px; color: #8a9aaa; font-style: italic; border-top: 1px solid rgba(77,101,119,.15); padding-top: 24px; margin-top: 40px; line-height: 1.6; }\n<\/style>\n<\/head>\n<body>\n<div class=\"co-wrap\">\n <span class=\"co-label\">Endocrinology & Clinical Biochemistry<\/span>\n <h1>Urinary catecholamines - Adrenaline, noradrenaline, dopamine, VMA and metanephrines<\/h1>\n<style>.oc-fiche-cta{margin:8px 0 34px;padding:22px 24px;border:1.5px solid rgba(50,60,82,.15);border-left:4px solid #FF611C;border-radius:12px;background:#F4F6F8;font-family:Poppins,sans-serif}.oc-fiche-cta-t{font-size:18px;font-weight:600;color:#323C52;margin:0 0 4px;line-height:1.35}.oc-fiche-cta-x{font-size:15px;color:#323C52;margin:0 0 14px;line-height:1.55}.oc-fiche-cta-b{display:flex;flex-wrap:wrap;gap:10px}.oc-fiche-cta-b a{display:inline-flex;align-items:center;justify-content:center;min-height:44px;padding:10px 18px;border-radius:8px;font-size:14px;font-weight:600;text-decoration:none;box-sizing:border-box}.oc-fiche-cta-b .oc-p{background:#FF611C;color:#fff}.oc-fiche-cta-b .oc-p:hover{background:#E04E0C}.oc-fiche-cta-b .oc-s{background:#fff;color:#323C52;border:1.5px solid rgba(50,60,82,.25)}@media (max-width:600px){.co-wrap h1{font-size:24px;line-height:1.25;text-transform:none}.oc-fiche-cta{padding:18px 16px}.oc-fiche-cta-b a{flex:1 1 100%}body .co-wrap > .co-table,body .co-wrap > .co-table tbody,body .co-wrap > .co-table tr,body .co-wrap > .co-table td{display:block;width:100%;box-sizing:border-box}body .co-wrap > .co-table{min-width:0;table-layout:auto}body .co-wrap > .co-table thead{display:none}body .co-wrap > .co-table tr{margin:0 0 10px;border:1px solid rgba(77,101,119,.18);border-radius:8px;overflow:hidden}body .co-wrap > .co-table td{padding:9px 12px;border:0}body .co-wrap > .co-table td:first-child{font-weight:600;color:#323C52;background:rgba(77,101,119,.07)}#ocw{transform:scale(.8);transform-origin:bottom right}}<\/style><div class=\"oc-fiche-cta\" data-oc-cta=\"fiche-haut-lab\"><p class=\"oc-fiche-cta-t\">Conduct this analysis<\/p><p class=\"oc-fiche-cta-x\">Blood draws at our service locations in Quebec. A healthcare professional can also review your results with you.<\/p><div class=\"oc-fiche-cta-b\"><a class=\"oc-p\" href=\"https:\/\/cliniqueomicron.ca\/en\/medical-samples\/\">Blood sampling<\/a><a class=\"oc-s\" href=\"https:\/\/cliniqueomicron.ca\/en\/appointment\/\">Make an appointment<\/a><a class=\"oc-s\" href=\"tel:+15146063350\">514 606-3350<\/a><\/div><\/div>\n\n\n <div class=\"co-intro\">\n Catecholamines are a group of tyrosine-derived neuromediators and hormones - mainly adrenalin (epinephrine), noradrenalin (norepinephrine) and dopamine - synthesized by the chromaffin cells of the adrenal medulla (adrenalin at 80 %, noradrenalin at 20 %), by post-ganglionic sympathetic nerve endings (mainly noradrenalin), and by dopaminergic neurons of the central nervous system. Biological investigation of catecholamines is based on the determination of these molecules and their metabolites in 24-hour urine or plasma. The main urinary metabolites measured are metanephrines (direct metabolite of adrenalin and noradrenalin via catechol-O-methyltransferase - COMT) and vanylmandelic acid or VMA (common terminal metabolite after action of COMT and monoamine oxidase - MAO). Dopamine is eliminated in the form of its own metabolites - notably homovanillic acid (HVA). The main indication for urinary catecholamine assays is the detection and diagnosis of pheochromocytoma and secretory paraganglioma - rare tumors of the chromaffin cells of the adrenal medulla (pheo) or para-aortic sympathetic ganglia (paraganglioma) responsible for catecholamine hypersecretion, often paroxysmal secondary hypertension, and potentially fatal hypertensive crises if left undiagnosed. Neuroblastoma - a malignant tumor of the sympathetic nervous system in children - is another major indication, with a preferential elevation of urinary catecholamines (notably HVA and VMA) that serves both diagnostic and therapeutic purposes. Plasma fractionated (free) metanephrines are now recognized as the most sensitive first-line test for pheochromocytoma (sensitivity 97-99 %), with urinary fractionated metanephrines (sensitivity 90-97 %) as the alternative of choice; the determination of urinary free catecholamines (adrenalin, noradrenalin) is less sensitive but can provide additional information on the secretion profile.\n <\/div>\n\n <h2>Catecholamine biosynthesis and metabolism<\/h2>\n <ul class=\"co-list\">\n <li>Synthetic pathway (Blaschko cascade) : tyrosine (dietary amino acid or synthesized from phenylalanine) \u2192 DOPA (dihydroxyphenylalanine) by tyrosine hydroxylase (limiting enzyme, inhibited by feedback) \u2192 dopamine by DOPA decarboxylase (aromatic L-amino acid decarboxylase) \u2192 noradrenaline by dopamine beta-hydroxylase (DBH) in storage vesicles \u2192 adrenaline by phenylethanolamine N-methyltransferase (PNMT) - enzyme expressed only in the adrenal medulla, induced by glucocorticoids ; adrenalin biosynthesis therefore requires direct anatomical proximity between the adrenal cortex (glucocorticoids) and the adrenal medulla (chromaffin cells)<\/li>\n <li>Catabolism and measurable metabolites: catecholamines are metabolized by two main enzymes - catechol-O-methyltransferase (COMT) and monoamine oxidase (MAO); COMT (cytoplasmic, intracellular) converts adrenalin into metanephrine and noradrenalin into normetanephrine - this conversion occurs continuously within the tumor cells (chromaffins) of pheochromocytomas, independently of secretion episodes - which is why metanephrines are more stable and sensitive markers than free catecholamines; MAO (mitochondrial) degrades catecholamines to aldehydes \u2192 MHPG (3-methoxy-4-hydroxyphenylglycol) and VMA (vanylmandelic acid = terminal metabolite of adrenalin and noradrenalin); dopamine \u2192 HVA (homovanillic acid) via MAO + COMT<\/li>\n <li>Very short plasma half-life: adrenaline 1-2 minutes, noradrenaline 2-3 minutes \u2192 marked instability of free plasma catecholamines (sensitive to the stress of blood sampling, standing, smoking, caffeine) \u2192 justifies the superiority of metanephrines (stable intracellular metabolites with longer half-life) for the biological diagnosis of pheochromocytoma<\/li>\n <\/ul>\n\n <h2>24-hour urine reference values<\/h2>\n <table class=\"co-table\">\n <colgroup>\n <col style=\"width:230px;\">\n <col style=\"width:180px;\">\n <col>\n <\/colgroup>\n <thead>\n <tr>\n <th>Analyst<\/th>\n <th style=\"text-align:center;\">Adult normal values<\/th>\n <th>Remarks<\/th>\n <\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>Adrenaline (epinephrine)<\/td>\n <td style=\"text-align:center;\">< 100 nmol\/24 h<br><small>(< 18 \u00b5g\/24 h)<\/small><\/td>\n <td>Secreted almost exclusively by the adrenal medulla; isolated elevation highly suggestive of adrenal pheochromocytoma; values vary according to laboratory (HPLC or LC-MS\/MS method)<\/td>\n <\/tr>\n <tr>\n <td>Noradrenaline (norepinephrine)<\/td>\n <td style=\"text-align:center;\">< 570 nmol\/24 h<br><small>(< 97 \u00b5g\/24 h)<\/small><\/td>\n <td>Produced by the adrenal medulla and peripheral sympathetic endings; higher than basal adrenaline; preferential elevation in extra-adrenal paragangliomas and noradrenaline-secreting pheochromocytomas (SDHB mutated)<\/td>\n <\/tr>\n <tr>\n <td>Dopamine<\/td>\n <td style=\"text-align:center;\">< 3,000 nmol\/24 h<br><small>(< 460 \u00b5g\/24 h)<\/small><\/td>\n <td>Strongly influenced by diet (bananas, pineapples, nuts); elevated in neuroblastomas, dopaminergic pheochromocytomas (rare - SDHB\/SDHD mutations) and some head-neck paragangliomas; to be interpreted in conjunction with diet.<\/td>\n <\/tr>\n <tr>\n <td>Vanylmandelic acid (VMA)<\/td>\n <td style=\"text-align:center;\">< 35 \u00b5mol\/24 h<br><small>(< 7 mg\/24 h)<\/small><\/td>\n <td>Common terminal metabolite of adrenaline and noradrenaline; old colorimetric method (less specific - numerous dietary interferences) gradually replaced by LC-MS\/MS fractionated metanephrines in modern laboratories; still required in current practice for neuroblastoma<\/td>\n <\/tr>\n <tr>\n <td>Fractionated urinary metanephrine<\/td>\n <td style=\"text-align:center;\">< 1,200 nmol\/24 h<br><small>(< 220 \u00b5g\/24 h)<\/small><\/td>\n <td>Adrenalin metabolite - most specific marker of adrenal pheochromocytoma; determination by LC-MS\/MS (reference method); little influenced by stress or diet (stable intracellular metabolite)<\/td>\n <\/tr>\n <tr>\n <td>Fractionated urinary normetanephrine<\/td>\n <td style=\"text-align:center;\">< 3100 nmol\/24 h<br><small>(< 570 \u00b5g\/24 h)<\/small><\/td>\n <td>Noradrenaline metabolite - high in noradrenaline-dominant pheochromocytomas and paragangliomas; slightly more sensitive than metanephrine for the detection of extra-adrenal paragangliomas<\/td>\n <\/tr>\n <tr>\n <td>Homovanillic acid (HVA)<\/td>\n <td style=\"text-align:center;\">< 36 \u00b5mol\/24 h<br><small>(< 7 mg\/24 h)<\/small><\/td>\n <td>Terminal metabolite of dopamine; elevated in neuroblastomas (often associated with elevated VMA) and in dopaminergic pheochromocytomas (rare); influenced by diet rich in dopamine precursors<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n\n <div class=\"co-infobox\">\n <span class=\"ico\">\u2139\ufe0f<\/span>\n <span>Reference values vary from laboratory to laboratory and from analytical method to analytical method (fluorimetric HPLC, LC-MS\/MS - liquid chromatography coupled with tandem mass spectrometry). Results must always be interpreted in the light of the reference values specific to the laboratory carrying out the analysis. Today, LC-MS\/MS is the reference method for fractionated metanephrines - it offers the best analytical specificity with the least interference from drugs and food.<\/span>\n <\/div>\n\n <h2>Main causes of elevation<\/h2>\n <table class=\"co-table\">\n <colgroup>\n <col style=\"width:220px;\">\n <col>\n <\/colgroup>\n <thead>\n <tr>\n <th>Cause<\/th>\n <th>Mechanism and biological characteristics<\/th>\n <\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>Pheochromocytoma<\/td>\n <td>Chromaffin cell tumor of the adrenal medulla - secretes excess adrenaline and\/or noradrenaline; fractionated metanephrines elevated in > 95 % of cases; elevation typically > 3 to 4 times the upper limit of normal - highly suggestive of malignancy below this threshold; 10 % malignant, 10 % bilateral, 10 % extra-adrenal, 10 % familial (10 % rule - now outdated: 25-40 % associated with a germline mutation); mutations: SDHB (malignant paraganglioma), SDHD, VHL (Von Hippel-Lindau disease), NF1 (neurofibromatosis type 1), RET (NEM2A and NEM2B), MAX, TMEM127<\/td>\n <\/tr>\n <tr>\n <td>Secretory paraganglioma<\/td>\n <td>Extra-adrenal sympathetic ganglion tumor (para-aortic, vesical, thoracic) secreting mainly noradrenaline \u00b1 dopamine; normetanephrine preferentially elevated; head and neck paragangliomas (carotid, jugular, vagal) - non-secreting in 95 % of cases; SDHB associated with highest metastatic risk (30-40 %)<\/td>\n <\/tr>\n <tr>\n <td>Neuroblastoma<\/td>\n <td>Malignant tumor of the sympathetic nervous system in children ( 1 - usual; very high levels correlated with extension and prognosis; used for initial diagnosis and monitoring of response to treatment<\/td>\n <\/tr>\n <tr>\n <td>Acute stress and intense pain<\/td>\n <td>Physiological activation of the sympathoadrenal system - moderate elevations (generally < 2 times the normal limit) of free adrenaline and noradrenaline; fractionated metanephrines are little influenced by acute stress (continuous intracellular metabolism independent of secretion episodes); 24-hour urine collection during a calm period is recommended<\/td>\n <\/tr>\n <tr>\n <td>Chronic renal failure<\/td>\n <td>Accumulation of catecholamines and their metabolites through reduced renal clearance - interference with diagnostic thresholds; urinary catecholamine\/creatinine ratios or free plasma metanephrines are preferable in severe CKD (GFR < 30 mL\/min)<\/td>\n <\/tr>\n <tr>\n <td>Interfering drugs<\/td>\n <td>Antidepressants (tricyclics, SSRIs, SNRIs - particularly venlafaxine) \u2192 elevation of urinary normetanephrines; MAO inhibitors (MAOIs) \u2192 accumulation of catecholamines; labetalol (beta-blocker) \u2192 false-positive elevation of catecholamines by fluorimetric method (analytical interference - absent with LC-MS\/MS) ; buspirone, phenoxybenzamine, amphetamines, cocaine, levodopa (elevated dopamine and HVA); high-dose acetaminophen (paracetamol) \u2192 false-positive VMA by old colorimetric method<\/td>\n <\/tr>\n <tr>\n <td>Food interferences<\/td>\n <td>Bananas, pineapple, nuts, chocolate, vanilla, coffee, tea (catecholamines and VMA); avoid 3 days prior to urine collection if colorimetric VMA method - less interference with LC-MS\/MS; diet rich in tyrosine or phenylalanine \u2192 slight increase in precursors<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n\n <h2>Dosage indications and collection conditions<\/h2>\n <ul class=\"co-list\">\n <li>Main indications: suspected pheochromocytoma or secretory paraganglioma (paroxysmal hypertension in crises, classic Menard's triad: pulsatile headache + sweats + palpitations, resistant hypertension, discovery of an adrenal incidentaloma); at-risk family syndrome (NEM2, VHL, NF1, SDHx mutations) \u2192 periodic screening; neuroblastoma in children (diagnosis and follow-up); assessment of secondary hypertension in young subjects (< 40 years) or in cases of treatment-resistant hypertension.<\/li>\n <li>24-hour urine collection: collection in a container supplied by the laboratory containing an acid preservative (hydrochloric acid 6 N - maintains pH < 3 to stabilize catecholamines); measure total volume and note start and end time of collection; keep refrigerated during collection; note creatininuria (collection validation - normal 24h creatinine: 8-18 mmol\/24h in women, 10-22 mmol\/24h in men); avoid intense exercise and major stress during collection; stop interfering drugs 5 days before if medically possible (in consultation with prescribing physician)<\/li>\n <li>Free plasma metanephrines - first-line test: assay on blood sample after 30 minutes' rest in supine position in a calm environment (minimize sympathetic stress); sensitivity 97-99 % for pheochromocytoma; specificity 85-89 % (non-negligible false positive rate); slightly higher values in standing position and during stress \u2192 strict collection in basal conditions essential; recommended as initial test by ETA 2014 and Endocrine Society 2014 guides.<\/li>\n <li>Recommended diagnostic strategy: start with free plasma metanephrines or fractionated urinary metanephrines (LC-MS\/MS) depending on local availability; if result > 3 times the upper limit of normal \u2192 very high probability of pheochromocytoma \u2192 direct imaging (MRI\/adrenal scanner); if result 1 to 3 times limit \u2192 grey zone \u2192 repeat assay under better conditions (stop interfering drugs, minimal stress) or use pharmacological suppression test (clonidine - not routinely performed in Quebec); if normal result \u2192 pheochromocytoma very unlikely (VPN > 99 %)<\/li>\n <\/ul>\n\n <h2>Action to be taken according to results<\/h2>\n <table class=\"co-table\">\n <colgroup>\n <col style=\"width:240px;\">\n <col>\n <\/colgroup>\n <thead>\n <tr>\n <th>Results<\/th>\n <th>Recommended course of action<\/th>\n <\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>Normal metanephrines, typical background of pheochromocytoma<\/td>\n <td>Negative predictive value > 99 % - pheochromocytoma is highly unlikely; if strong clinical suspicion (typical Menard's triad + adrenal incidentaloma) \u2192 repeat assay or perform free plasma metanephrines; no adrenal imaging as first-line treatment if biological workup negative<\/td>\n <\/tr>\n <tr>\n <td>Moderate elevation (1-3 \u00d7 LN)<\/td>\n <td>Grey zone - exclude causes of false positives (drugs, stress, CKD); repeat assay under optimal conditions (no interferants for 5 days, calm collection, decubitus for plasma); endocrinology consultation recommended; clonidine suppression test may be considered in a specialized context.<\/td>\n <\/tr>\n <tr>\n <td>Clear elevation (> 3 \u00d7 LN)<\/td>\n <td>Very suggestive of pheochromocytoma or secretory paraganglioma - probability > 90 %; adrenal MRI or CT scan as first-line treatment (MRI preferred - better tissue characterization, no radiation) ; if imaging negative \u2192 extra-adrenal investigation (whole-body MRI + MIBG \u00b9\u00b2\u00b3I scan or PET-DOTA-TATE if SDHB mutated); urgent endocrinology consultation; medical preparation for surgery (alpha-blocker phenoxybenzamine 10-14 days pre-op + beta-blocker secondarily - never beta-blocker alone before alpha-blocker).<\/td>\n <\/tr>\n <tr>\n <td>High VMA and HVA in children<\/td>\n <td>Neuroblastoma until proven otherwise - emergency abdominal and thoracic CT scans, MIBG scintigraphy, osteomedullary biopsy, onco-pediatric consultations; amplitude of elevation correlates with tumor extension and prognosis; monitoring of markers during treatment to assess response<\/td>\n <\/tr>\n <tr>\n <td>Germline mutation SDHx \/ VHL \/ RET \/ NF1 identified<\/td>\n <td>Annual to biannual biochemical screening (urinary or plasma metanephrines) depending on the mutated gene; whole-body MRI imaging every 1 to 3 years; follow-up in a neuroendocrine tumour expert center; genetic screening of first-degree relatives.<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n\n <div class=\"co-urgence\">\n <div class=\"co-urgence-titre\">Paroxysmal hypertensive crisis - absolute emergency<\/div>\n <p>Dial <strong>911<\/strong> or go immediately to the emergency department in the event of a paroxysmal hypertensive crisis (BP > 180\/120 mmHg) accompanied by intense headache, profuse sweating, palpitations, chest pain or major anxiety - this picture may correspond to a massive catecholaminergic discharge from an undiagnosed pheochromocytoma. In an emergency, the crisis is treated with phentolamine IV or nicardipine IV (never beta-blockers alone as first-line treatment without a prior alpha-blocker - risk of major paradoxical vasoconstriction). A diagnosis of untreated pheochromocytoma exposes the patient to the risk of sudden death from arrhythmia or hemorrhagic stroke during any invasive procedure (surgery, childbirth, colonoscopy, intubation).<\/p>\n <\/div>\n\n <h2>Consult at Clinique Omicron<\/h2>\n <p>Les m\u00e9decins de Clinique Omicron prescrivent le dosage des cat\u00e9cholamines et m\u00e9tan\u00e9phrines urinaires, informent sur les conditions de recueil optimal, interpr\u00e8tent les r\u00e9sultats en contexte clinique et orientent vers l'endocrinologue ou le sp\u00e9cialiste en m\u00e9decine nucl\u00e9aire pour la prise en charge diagnostique et th\u00e9rapeutique des ph\u00e9ochromocytomes, paragangliomes et neuroblastomes. Des consultations sont disponibles dans nos points de service au Qu\u00e9bec ainsi qu'en t\u00e9l\u00e9m\u00e9decine. Pour prendre rendez-vous, <a href=\"https:\/\/cliniqueomicron.ca\/en\/appointment\/\" data-oc-cta=\"fiche-consulter\">Choose your online service<\/a>.<\/p>\n\n <p class=\"co-disclaimer\">The contents of this page are provided for information purposes only and do not replace the advice of a qualified healthcare professional. Reference values for catecholamines and their metabolites vary between laboratories and analytical methods - always refer to the reference values of the laboratory that performed the analysis.<\/p>\n<\/div>\n<\/body>\n<\/html>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Cat\u00e9cholamines urinaires (adr\u00e9naline, dopamine, VMA) : valeurs normales et interpr\u00e9tation | Clinique Omicron Endocrinologie & Biochimie clinique Cat\u00e9cholamines urinaires : Adr\u00e9naline, noradr\u00e9naline, dopamine, VMA et m\u00e9tan\u00e9phrines Les cat\u00e9cholamines sont un groupe de neurom\u00e9diateurs et d’hormones d\u00e9riv\u00e9s de la tyrosine, principalement l’adr\u00e9naline (\u00e9pin\u00e9phrine), la noradr\u00e9naline (nor\u00e9pin\u00e9phrine) et la dopamine, synth\u00e9tis\u00e9es par les cellules chromaffines de la… <a href=\"https:\/\/cliniqueomicron.ca\/en\/catecholamines-urinaires-adrenaline-dopamine-vma\/\" rel=\"bookmark\">Read More \"<span class=\"screen-reader-text\">Urinary catecholamines (adrenaline, dopamine, VMA): normal values and interpretation | Clinique Omicron<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"off","neve_meta_content_width":100,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","_themeisle_gutenberg_block_has_review":false,"_metasync_otto_title":"","_metasync_otto_description":"","_metasync_otto_keywords":"","_metasync_otto_canonical":"","_metasync_metakeywords":"","_metasync_otto_og_title":"Cat\u00e9cholamines urinaires | Brossard | Clinique Omicron","_metasync_otto_og_description":"Les cat\u00e9cholamines urinaires (adr\u00e9naline, noradr\u00e9naline, dopamine, VMA, m\u00e9tan\u00e9phrines) permettent de d\u00e9pister le ph\u00e9ochromocytome et le neuroblastome. Valeur...","_metasync_otto_twitter_title":"Cat\u00e9cholamines urinaires | Brossard | Clinique Omicron","_metasync_otto_twitter_description":"","_metasync_seo_title":"Cat\u00e9cholamines urinaires : test | Clinique Omicron","_metasync_seo_desc":"Les cat\u00e9cholamines urinaires (adr\u00e9naline, noradr\u00e9naline, dopamine, m\u00e9tan\u00e9phrines) aident \u00e0 d\u00e9pister le ph\u00e9ochromocytome. 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}\n.co-urgence .co-urgence-titre { font-size: 13px; font-weight: 700; color: #c0392b; letter-spacing: 1.5px; text-transform: uppercase; margin-bottom: 10px; }\n.co-urgence p { color: #5a2020; font-size: 14px; margin: 0 0 10px; line-height: 1.7; }\n.co-urgence p:last-child { margin-bottom: 0; }\n.co-disclaimer { font-size: 13px; color: #8a9aaa; font-style: italic; border-top: 1px solid rgba(77,101,119,.15); padding-top: 24px; margin-top: 40px; line-height: 1.6; }\n<\/style>\n<\/head>\n<body>\n<div class=\"co-wrap\">\n <span class=\"co-label\">Endocrinology & Clinical Biochemistry<\/span>\n <h1>Urinary catecholamines - Adrenaline, noradrenaline, dopamine, VMA and metanephrines<\/h1>\n<style>.oc-fiche-cta{margin:8px 0 34px;padding:22px 24px;border:1.5px solid rgba(50,60,82,.15);border-left:4px solid #FF611C;border-radius:12px;background:#F4F6F8;font-family:Poppins,sans-serif}.oc-fiche-cta-t{font-size:18px;font-weight:600;color:#323C52;margin:0 0 4px;line-height:1.35}.oc-fiche-cta-x{font-size:15px;color:#323C52;margin:0 0 14px;line-height:1.55}.oc-fiche-cta-b{display:flex;flex-wrap:wrap;gap:10px}.oc-fiche-cta-b a{display:inline-flex;align-items:center;justify-content:center;min-height:44px;padding:10px 18px;border-radius:8px;font-size:14px;font-weight:600;text-decoration:none;box-sizing:border-box}.oc-fiche-cta-b .oc-p{background:#FF611C;color:#fff}.oc-fiche-cta-b .oc-p:hover{background:#E04E0C}.oc-fiche-cta-b .oc-s{background:#fff;color:#323C52;border:1.5px solid rgba(50,60,82,.25)}@media (max-width:600px){.co-wrap h1{font-size:24px;line-height:1.25;text-transform:none}.oc-fiche-cta{padding:18px 16px}.oc-fiche-cta-b a{flex:1 1 100%}body .co-wrap > .co-table,body .co-wrap > .co-table tbody,body .co-wrap > .co-table tr,body .co-wrap > .co-table td{display:block;width:100%;box-sizing:border-box}body .co-wrap > .co-table{min-width:0;table-layout:auto}body .co-wrap > .co-table thead{display:none}body .co-wrap > .co-table tr{margin:0 0 10px;border:1px solid rgba(77,101,119,.18);border-radius:8px;overflow:hidden}body .co-wrap > .co-table td{padding:9px 12px;border:0}body .co-wrap > .co-table td:first-child{font-weight:600;color:#323C52;background:rgba(77,101,119,.07)}#ocw{transform:scale(.8);transform-origin:bottom right}}<\/style><div class=\"oc-fiche-cta\" data-oc-cta=\"fiche-haut-lab\"><p class=\"oc-fiche-cta-t\">Conduct this analysis<\/p><p class=\"oc-fiche-cta-x\">Blood draws at our service locations in Quebec. A healthcare professional can also review your results with you.<\/p><div class=\"oc-fiche-cta-b\"><a class=\"oc-p\" href=\"https:\/\/cliniqueomicron.ca\/en\/medical-samples\/\">Blood sampling<\/a><a class=\"oc-s\" href=\"https:\/\/cliniqueomicron.ca\/en\/appointment\/\">Make an appointment<\/a><a class=\"oc-s\" href=\"tel:+15146063350\">514 606-3350<\/a><\/div><\/div>\n\n\n <div class=\"co-intro\">\n Catecholamines are a group of tyrosine-derived neuromediators and hormones - mainly adrenalin (epinephrine), noradrenalin (norepinephrine) and dopamine - synthesized by the chromaffin cells of the adrenal medulla (adrenalin at 80 %, noradrenalin at 20 %), by post-ganglionic sympathetic nerve endings (mainly noradrenalin), and by dopaminergic neurons of the central nervous system. Biological investigation of catecholamines is based on the determination of these molecules and their metabolites in 24-hour urine or plasma. The main urinary metabolites measured are metanephrines (direct metabolite of adrenalin and noradrenalin via catechol-O-methyltransferase - COMT) and vanylmandelic acid or VMA (common terminal metabolite after action of COMT and monoamine oxidase - MAO). Dopamine is eliminated in the form of its own metabolites - notably homovanillic acid (HVA). The main indication for urinary catecholamine assays is the detection and diagnosis of pheochromocytoma and secretory paraganglioma - rare tumors of the chromaffin cells of the adrenal medulla (pheo) or para-aortic sympathetic ganglia (paraganglioma) responsible for catecholamine hypersecretion, often paroxysmal secondary hypertension, and potentially fatal hypertensive crises if left undiagnosed. Neuroblastoma - a malignant tumor of the sympathetic nervous system in children - is another major indication, with a preferential elevation of urinary catecholamines (notably HVA and VMA) that serves both diagnostic and therapeutic purposes. Plasma fractionated (free) metanephrines are now recognized as the most sensitive first-line test for pheochromocytoma (sensitivity 97-99 %), with urinary fractionated metanephrines (sensitivity 90-97 %) as the alternative of choice; the determination of urinary free catecholamines (adrenalin, noradrenalin) is less sensitive but can provide additional information on the secretion profile.\n <\/div>\n\n <h2>Catecholamine biosynthesis and metabolism<\/h2>\n <ul class=\"co-list\">\n <li>Synthetic pathway (Blaschko cascade) : tyrosine (dietary amino acid or synthesized from phenylalanine) \u2192 DOPA (dihydroxyphenylalanine) by tyrosine hydroxylase (limiting enzyme, inhibited by feedback) \u2192 dopamine by DOPA decarboxylase (aromatic L-amino acid decarboxylase) \u2192 noradrenaline by dopamine beta-hydroxylase (DBH) in storage vesicles \u2192 adrenaline by phenylethanolamine N-methyltransferase (PNMT) - enzyme expressed only in the adrenal medulla, induced by glucocorticoids ; adrenalin biosynthesis therefore requires direct anatomical proximity between the adrenal cortex (glucocorticoids) and the adrenal medulla (chromaffin cells)<\/li>\n <li>Catabolism and measurable metabolites: catecholamines are metabolized by two main enzymes - catechol-O-methyltransferase (COMT) and monoamine oxidase (MAO); COMT (cytoplasmic, intracellular) converts adrenalin into metanephrine and noradrenalin into normetanephrine - this conversion occurs continuously within the tumor cells (chromaffins) of pheochromocytomas, independently of secretion episodes - which is why metanephrines are more stable and sensitive markers than free catecholamines; MAO (mitochondrial) degrades catecholamines to aldehydes \u2192 MHPG (3-methoxy-4-hydroxyphenylglycol) and VMA (vanylmandelic acid = terminal metabolite of adrenalin and noradrenalin); dopamine \u2192 HVA (homovanillic acid) via MAO + COMT<\/li>\n <li>Very short plasma half-life: adrenaline 1-2 minutes, noradrenaline 2-3 minutes \u2192 marked instability of free plasma catecholamines (sensitive to the stress of blood sampling, standing, smoking, caffeine) \u2192 justifies the superiority of metanephrines (stable intracellular metabolites with longer half-life) for the biological diagnosis of pheochromocytoma<\/li>\n <\/ul>\n\n <h2>24-hour urine reference values<\/h2>\n <table class=\"co-table\">\n <colgroup>\n <col style=\"width:230px;\">\n <col style=\"width:180px;\">\n <col>\n <\/colgroup>\n <thead>\n <tr>\n <th>Analyst<\/th>\n <th style=\"text-align:center;\">Adult normal values<\/th>\n <th>Remarks<\/th>\n <\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>Adrenaline (epinephrine)<\/td>\n <td style=\"text-align:center;\">< 100 nmol\/24 h<br><small>(< 18 \u00b5g\/24 h)<\/small><\/td>\n <td>Secreted almost exclusively by the adrenal medulla; isolated elevation highly suggestive of adrenal pheochromocytoma; values vary according to laboratory (HPLC or LC-MS\/MS method)<\/td>\n <\/tr>\n <tr>\n <td>Noradrenaline (norepinephrine)<\/td>\n <td style=\"text-align:center;\">< 570 nmol\/24 h<br><small>(< 97 \u00b5g\/24 h)<\/small><\/td>\n <td>Produced by the adrenal medulla and peripheral sympathetic endings; higher than basal adrenaline; preferential elevation in extra-adrenal paragangliomas and noradrenaline-secreting pheochromocytomas (SDHB mutated)<\/td>\n <\/tr>\n <tr>\n <td>Dopamine<\/td>\n <td style=\"text-align:center;\">< 3,000 nmol\/24 h<br><small>(< 460 \u00b5g\/24 h)<\/small><\/td>\n <td>Strongly influenced by diet (bananas, pineapples, nuts); elevated in neuroblastomas, dopaminergic pheochromocytomas (rare - SDHB\/SDHD mutations) and some head-neck paragangliomas; to be interpreted in conjunction with diet.<\/td>\n <\/tr>\n <tr>\n <td>Vanylmandelic acid (VMA)<\/td>\n <td style=\"text-align:center;\">< 35 \u00b5mol\/24 h<br><small>(< 7 mg\/24 h)<\/small><\/td>\n <td>Common terminal metabolite of adrenaline and noradrenaline; old colorimetric method (less specific - numerous dietary interferences) gradually replaced by LC-MS\/MS fractionated metanephrines in modern laboratories; still required in current practice for neuroblastoma<\/td>\n <\/tr>\n <tr>\n <td>Fractionated urinary metanephrine<\/td>\n <td style=\"text-align:center;\">< 1,200 nmol\/24 h<br><small>(< 220 \u00b5g\/24 h)<\/small><\/td>\n <td>Adrenalin metabolite - most specific marker of adrenal pheochromocytoma; determination by LC-MS\/MS (reference method); little influenced by stress or diet (stable intracellular metabolite)<\/td>\n <\/tr>\n <tr>\n <td>Fractionated urinary normetanephrine<\/td>\n <td style=\"text-align:center;\">< 3100 nmol\/24 h<br><small>(< 570 \u00b5g\/24 h)<\/small><\/td>\n <td>Noradrenaline metabolite - high in noradrenaline-dominant pheochromocytomas and paragangliomas; slightly more sensitive than metanephrine for the detection of extra-adrenal paragangliomas<\/td>\n <\/tr>\n <tr>\n <td>Homovanillic acid (HVA)<\/td>\n <td style=\"text-align:center;\">< 36 \u00b5mol\/24 h<br><small>(< 7 mg\/24 h)<\/small><\/td>\n <td>Terminal metabolite of dopamine; elevated in neuroblastomas (often associated with elevated VMA) and in dopaminergic pheochromocytomas (rare); influenced by diet rich in dopamine precursors<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n\n <div class=\"co-infobox\">\n <span class=\"ico\">\u2139\ufe0f<\/span>\n <span>Reference values vary from laboratory to laboratory and from analytical method to analytical method (fluorimetric HPLC, LC-MS\/MS - liquid chromatography coupled with tandem mass spectrometry). Results must always be interpreted in the light of the reference values specific to the laboratory carrying out the analysis. Today, LC-MS\/MS is the reference method for fractionated metanephrines - it offers the best analytical specificity with the least interference from drugs and food.<\/span>\n <\/div>\n\n <h2>Main causes of elevation<\/h2>\n <table class=\"co-table\">\n <colgroup>\n <col style=\"width:220px;\">\n <col>\n <\/colgroup>\n <thead>\n <tr>\n <th>Cause<\/th>\n <th>Mechanism and biological characteristics<\/th>\n <\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>Pheochromocytoma<\/td>\n <td>Chromaffin cell tumor of the adrenal medulla - secretes excess adrenaline and\/or noradrenaline; fractionated metanephrines elevated in > 95 % of cases; elevation typically > 3 to 4 times the upper limit of normal - highly suggestive of malignancy below this threshold; 10 % malignant, 10 % bilateral, 10 % extra-adrenal, 10 % familial (10 % rule - now outdated: 25-40 % associated with a germline mutation); mutations: SDHB (malignant paraganglioma), SDHD, VHL (Von Hippel-Lindau disease), NF1 (neurofibromatosis type 1), RET (NEM2A and NEM2B), MAX, TMEM127<\/td>\n <\/tr>\n <tr>\n <td>Secretory paraganglioma<\/td>\n <td>Extra-adrenal sympathetic ganglion tumor (para-aortic, vesical, thoracic) secreting mainly noradrenaline \u00b1 dopamine; normetanephrine preferentially elevated; head and neck paragangliomas (carotid, jugular, vagal) - non-secreting in 95 % of cases; SDHB associated with highest metastatic risk (30-40 %)<\/td>\n <\/tr>\n <tr>\n <td>Neuroblastoma<\/td>\n <td>Malignant tumor of the sympathetic nervous system in children ( 1 - usual; very high levels correlated with extension and prognosis; used for initial diagnosis and monitoring of response to treatment<\/td>\n <\/tr>\n <tr>\n <td>Acute stress and intense pain<\/td>\n <td>Physiological activation of the sympathoadrenal system - moderate elevations (generally < 2 times the normal limit) of free adrenaline and noradrenaline; fractionated metanephrines are little influenced by acute stress (continuous intracellular metabolism independent of secretion episodes); 24-hour urine collection during a calm period is recommended<\/td>\n <\/tr>\n <tr>\n <td>Chronic renal failure<\/td>\n <td>Accumulation of catecholamines and their metabolites through reduced renal clearance - interference with diagnostic thresholds; urinary catecholamine\/creatinine ratios or free plasma metanephrines are preferable in severe CKD (GFR < 30 mL\/min)<\/td>\n <\/tr>\n <tr>\n <td>Interfering drugs<\/td>\n <td>Antidepressants (tricyclics, SSRIs, SNRIs - particularly venlafaxine) \u2192 elevation of urinary normetanephrines; MAO inhibitors (MAOIs) \u2192 accumulation of catecholamines; labetalol (beta-blocker) \u2192 false-positive elevation of catecholamines by fluorimetric method (analytical interference - absent with LC-MS\/MS) ; buspirone, phenoxybenzamine, amphetamines, cocaine, levodopa (elevated dopamine and HVA); high-dose acetaminophen (paracetamol) \u2192 false-positive VMA by old colorimetric method<\/td>\n <\/tr>\n <tr>\n <td>Food interferences<\/td>\n <td>Bananas, pineapple, nuts, chocolate, vanilla, coffee, tea (catecholamines and VMA); avoid 3 days prior to urine collection if colorimetric VMA method - less interference with LC-MS\/MS; diet rich in tyrosine or phenylalanine \u2192 slight increase in precursors<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n\n <h2>Dosage indications and collection conditions<\/h2>\n <ul class=\"co-list\">\n <li>Main indications: suspected pheochromocytoma or secretory paraganglioma (paroxysmal hypertension in crises, classic Menard's triad: pulsatile headache + sweats + palpitations, resistant hypertension, discovery of an adrenal incidentaloma); at-risk family syndrome (NEM2, VHL, NF1, SDHx mutations) \u2192 periodic screening; neuroblastoma in children (diagnosis and follow-up); assessment of secondary hypertension in young subjects (< 40 years) or in cases of treatment-resistant hypertension.<\/li>\n <li>24-hour urine collection: collection in a container supplied by the laboratory containing an acid preservative (hydrochloric acid 6 N - maintains pH < 3 to stabilize catecholamines); measure total volume and note start and end time of collection; keep refrigerated during collection; note creatininuria (collection validation - normal 24h creatinine: 8-18 mmol\/24h in women, 10-22 mmol\/24h in men); avoid intense exercise and major stress during collection; stop interfering drugs 5 days before if medically possible (in consultation with prescribing physician)<\/li>\n <li>Free plasma metanephrines - first-line test: assay on blood sample after 30 minutes' rest in supine position in a calm environment (minimize sympathetic stress); sensitivity 97-99 % for pheochromocytoma; specificity 85-89 % (non-negligible false positive rate); slightly higher values in standing position and during stress \u2192 strict collection in basal conditions essential; recommended as initial test by ETA 2014 and Endocrine Society 2014 guides.<\/li>\n <li>Recommended diagnostic strategy: start with free plasma metanephrines or fractionated urinary metanephrines (LC-MS\/MS) depending on local availability; if result > 3 times the upper limit of normal \u2192 very high probability of pheochromocytoma \u2192 direct imaging (MRI\/adrenal scanner); if result 1 to 3 times limit \u2192 grey zone \u2192 repeat assay under better conditions (stop interfering drugs, minimal stress) or use pharmacological suppression test (clonidine - not routinely performed in Quebec); if normal result \u2192 pheochromocytoma very unlikely (VPN > 99 %)<\/li>\n <\/ul>\n\n <h2>Action to be taken according to results<\/h2>\n <table class=\"co-table\">\n <colgroup>\n <col style=\"width:240px;\">\n <col>\n <\/colgroup>\n <thead>\n <tr>\n <th>Results<\/th>\n <th>Recommended course of action<\/th>\n <\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>Normal metanephrines, typical background of pheochromocytoma<\/td>\n <td>Negative predictive value > 99 % - pheochromocytoma is highly unlikely; if strong clinical suspicion (typical Menard's triad + adrenal incidentaloma) \u2192 repeat assay or perform free plasma metanephrines; no adrenal imaging as first-line treatment if biological workup negative<\/td>\n <\/tr>\n <tr>\n <td>Moderate elevation (1-3 \u00d7 LN)<\/td>\n <td>Grey zone - exclude causes of false positives (drugs, stress, CKD); repeat assay under optimal conditions (no interferants for 5 days, calm collection, decubitus for plasma); endocrinology consultation recommended; clonidine suppression test may be considered in a specialized context.<\/td>\n <\/tr>\n <tr>\n <td>Clear elevation (> 3 \u00d7 LN)<\/td>\n <td>Very suggestive of pheochromocytoma or secretory paraganglioma - probability > 90 %; adrenal MRI or CT scan as first-line treatment (MRI preferred - better tissue characterization, no radiation) ; if imaging negative \u2192 extra-adrenal investigation (whole-body MRI + MIBG \u00b9\u00b2\u00b3I scan or PET-DOTA-TATE if SDHB mutated); urgent endocrinology consultation; medical preparation for surgery (alpha-blocker phenoxybenzamine 10-14 days pre-op + beta-blocker secondarily - never beta-blocker alone before alpha-blocker).<\/td>\n <\/tr>\n <tr>\n <td>High VMA and HVA in children<\/td>\n <td>Neuroblastoma until proven otherwise - emergency abdominal and thoracic CT scans, MIBG scintigraphy, osteomedullary biopsy, onco-pediatric consultations; amplitude of elevation correlates with tumor extension and prognosis; monitoring of markers during treatment to assess response<\/td>\n <\/tr>\n <tr>\n <td>Germline mutation SDHx \/ VHL \/ RET \/ NF1 identified<\/td>\n <td>Annual to biannual biochemical screening (urinary or plasma metanephrines) depending on the mutated gene; whole-body MRI imaging every 1 to 3 years; follow-up in a neuroendocrine tumour expert center; genetic screening of first-degree relatives.<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n\n <div class=\"co-urgence\">\n <div class=\"co-urgence-titre\">Paroxysmal hypertensive crisis - absolute emergency<\/div>\n <p>Dial <strong>911<\/strong> or go immediately to the emergency department in the event of a paroxysmal hypertensive crisis (BP > 180\/120 mmHg) accompanied by intense headache, profuse sweating, palpitations, chest pain or major anxiety - this picture may correspond to a massive catecholaminergic discharge from an undiagnosed pheochromocytoma. In an emergency, the crisis is treated with phentolamine IV or nicardipine IV (never beta-blockers alone as first-line treatment without a prior alpha-blocker - risk of major paradoxical vasoconstriction). A diagnosis of untreated pheochromocytoma exposes the patient to the risk of sudden death from arrhythmia or hemorrhagic stroke during any invasive procedure (surgery, childbirth, colonoscopy, intubation).<\/p>\n <\/div>\n\n <h2>Consult at Clinique Omicron<\/h2>\n <p>Les m\u00e9decins de Clinique Omicron prescrivent le dosage des cat\u00e9cholamines et m\u00e9tan\u00e9phrines urinaires, informent sur les conditions de recueil optimal, interpr\u00e8tent les r\u00e9sultats en contexte clinique et orientent vers l'endocrinologue ou le sp\u00e9cialiste en m\u00e9decine nucl\u00e9aire pour la prise en charge diagnostique et th\u00e9rapeutique des ph\u00e9ochromocytomes, paragangliomes et neuroblastomes. Des consultations sont disponibles dans nos points de service au Qu\u00e9bec ainsi qu'en t\u00e9l\u00e9m\u00e9decine. Pour prendre rendez-vous, <a href=\"https:\/\/cliniqueomicron.ca\/en\/appointment\/\" data-oc-cta=\"fiche-consulter\">Choose your online service<\/a>.<\/p>\n\n <p class=\"co-disclaimer\">The contents of this page are provided for information purposes only and do not replace the advice of a qualified healthcare professional. Reference values for catecholamines and their metabolites vary between laboratories and analytical methods - always refer to the reference values of the laboratory that performed the analysis.<\/p>\n<\/div>\n<\/body>\n<\/html>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Cat\u00e9cholamines urinaires (adr\u00e9naline, dopamine, VMA) : valeurs normales et interpr\u00e9tation | Clinique Omicron Endocrinologie & Biochimie clinique Cat\u00e9cholamines urinaires : Adr\u00e9naline, noradr\u00e9naline, dopamine, VMA et m\u00e9tan\u00e9phrines Les cat\u00e9cholamines sont un groupe de neurom\u00e9diateurs et d’hormones d\u00e9riv\u00e9s de la tyrosine, principalement l’adr\u00e9naline (\u00e9pin\u00e9phrine), la noradr\u00e9naline (nor\u00e9pin\u00e9phrine) et la dopamine, synth\u00e9tis\u00e9es par les cellules chromaffines de la… <a href=\"https:\/\/cliniqueomicron.ca\/en\/catecholamines-urinaires-adrenaline-dopamine-vma\/\" rel=\"bookmark\">Read More \"<span class=\"screen-reader-text\">Urinary catecholamines (adrenaline, dopamine, VMA): normal values and interpretation | Clinique Omicron<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"off","neve_meta_content_width":100,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","_themeisle_gutenberg_block_has_review":false,"_metasync_otto_title":"","_metasync_otto_description":"","_metasync_otto_keywords":"","_metasync_otto_canonical":"","_metasync_metakeywords":"","_metasync_otto_og_title":"Cat\u00e9cholamines urinaires | Brossard | Clinique Omicron","_metasync_otto_og_description":"Les cat\u00e9cholamines urinaires (adr\u00e9naline, noradr\u00e9naline, dopamine, VMA, m\u00e9tan\u00e9phrines) permettent de d\u00e9pister le ph\u00e9ochromocytome et le neuroblastome. 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