Metanephrine and normetanephrine are breakdown products (metabolites) of the catecholamines epinephrine (adrenaline) and norepinephrine. This test measures the amounts of metanephrine and normetanephrine that are released into the urine over a 24-hour period.
Catecholamines are produced by the adrenal glands (as hormones), small triangular organs located on top of each kidney, and by cells of the sympathetic nervous system (called neurotransmitter substances or neurotransmitters). The primary catecholamines are dopamine, epinephrine (adrenaline), and norepinephrine. Catecholamines are released in response to physical or emotional stress. They help transmit nerve impulses in the brain, increase glucose and fatty acid release for energy, dilate small air passages in the lungs called bronchioles, and dilate the pupils. Norepinephrine also constricts blood vessels, which increases blood pressure, and epinephrine increases heart rate and the rate at which the body uses energy (metabolism).
After completing their actions, the catecholamines are broken down to form inactive compounds. Epinephrine breaks down into metanephrine and vanillylmandelic acid (VMA), and norepinephrine becomes normetanephrine and VMA. Both the hormones and their metabolites are eliminated from the body in the urine.
Catecholamines and their breakdown products are normally present in the urine in small fluctuating amounts that increase appreciably during and shortly after a stressful situation.
However, rare tumors of the adrenal gland called pheochromocytomas and rare tumors outside the adrenal glands called paragangliomas can produce large amounts of catecholamines and their metabolites, resulting in greatly increased concentrations in both the blood and urine. (These syndromes are often grouped together and abbreviated as PPGL). This can cause persistent or episodic periods of hypertension, which may lead to severe headaches. Other symptoms include heart palpitations, sweating, nausea, anxiety, and tingling in the hands and feet.
Pheochromocytomas and paragangliomas are rare. While a few are cancerous, most are benign and do not spread beyond their original location. Left untreated, however, these tumors may continue to grow and the symptoms may worsen. Over time, the hypertension caused by the excess hormones may cause kidney damage, heart disease, and raise the risk of a stroke or heart attack.
Although they are rare, it is important to diagnose and treat these tumors because they cause a potentially curable form of hypertension. In most cases, the tumors can be surgically removed and/or treated to eliminate or significantly reduce the amount of catecholamines being produced and to reduce or eliminate associated symptoms and complications.
What does it mean if your Normetanephrine (24hr Urine) result is too high?
Elevated levels of metanephrine and normetanephrine when you have signs and symptoms suggest the presence of a tumor. Generally, two times the upper limit of normal is considered positive for total metanephrine. If levels are elevated after you have been treated for one of these tumors, it may be an indication that the treatment was not fully effective or that the tumor is recurring and appropriate follow up is needed.
The test for metanephrines is very sensitive and false positives do occur. The test is affected by stress, drugs, smoking, and various foods. If you have only moderately elevated metanephrines, then your healthcare provider may re-evaluate your medications, diet, and stress level to look for interfering substances or conditions. Once these are resolved, you may be tested again to determine whether the metanephrines are still elevated.
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