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HelpTest Code META3 Metanephrines with 3-Methoxytyramine, 24 Hour, Urine
Ordering Guidance
Necessary Information
24-Hour volume (in milliliters) is required.
Specimen Required
Patient Preparation: Tricyclic antidepressants, labetalol, and sotalol medications may elevate levels of metanephrines producing results that cannot be interpreted. If clinically feasible, it is optimal to discontinue these medications at least 1 week before collection. For advice on assessing the risk of removing patients from these medications and alternatives, consider consultation with a specialist in endocrinology or hypertension.
Supplies: Urine Tubes, 10 mL (T068)
Submission Container/Tube: Plastic urine tube
Specimen Volume: 10 mL
Collection Instructions:
1. Complete 24-hour urine collections are preferred, especially for patients with episodic hypertension; ideally the collection should begin at the onset of a "spell."
2. Add 10 g (pediatric: 3 g) of boric acid or 25 mL (pediatric: 15 mL) of 50% acetic acid as preservative at start of collection.
3. Collect urine for 24 hours.
Useful For
A first- and second-tier screening test for the presumptive diagnosis of catecholamine-secreting pheochromocytomas and paragangliomas
Profile Information
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| 3MT1 | 3-Methoxytyramine, U | Yes, (Order 3MT) | Yes |
| METAF | Metanephrines, Fractionated, 24h, U | Yes | Yes |
Special Instructions
Method Name
Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
Reporting Name
Metanephrines with 3-MT, 24h, USpecimen Type
UrineSpecimen Minimum Volume
4 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Urine | Refrigerated (preferred) | 28 days | |
| Frozen | 28 days | ||
| Ambient | 21 days |
Reference Values
3-Methoxytyramine:
Males: ≤306 mcg/24 h
Females: ≤242 mcg/24 h
METANEPHRINE
Males
Normotensives
3-8 years: 29-92 mcg/24 h
9-12 years: 59-188 mcg/24 h
13-17 years: 69-221 mcg/24 h
≥18 years: 44-261 mcg/24 h
Reference values have not been established for patients that are younger than 36 months.
Hypertensives: <400 mcg/24 h
Females
Normotensives
3-8 years: 18-144 mcg/24 h
9-12 years: 43-122 mcg/24 h
13-17 years: 33-185 mcg/24 h
≥18 years: 30-180 mcg/24 h
Reference values have not been established for patients that are younger than 36 months.
Hypertensives: <400 mcg/24 h
NORMETANEPHRINE
Males
Normotensives
3-8 years: 34-169 mcg/24 h
9-12 years: 84-422 mcg/24 h
13-17 years: 91-456 mcg/24 h
18-29 years: 103-390 mcg/24 h
30-39 years: 111-419 mcg/24 h
40-49 years: 119-451 mcg/24 h
50-59 years: 128-484 mcg/24 h
60-69 years: 138-521 mcg/24 h
≥70 years: 148-560 mcg/24 h
Reference values have not been established for patients that are younger than 36 months.
Hypertensives: <900 mcg/24 h
Females
Normotensives
3-8 years: 29-145 mcg/24 h
9-12 years: 55-277 mcg/24 h
13-17 years: 57-286 mcg/24 h
18-29 years: 103-390 mcg/24 h
30-39 years: 111-419 mcg/24 h
40-49 years: 119-451 mcg/24 h
50-59 years: 128-484 mcg/24 h
60-69 years: 138-521 mcg/24 h
≥70 years: 148-560 mcg/24 h
Reference values have not been established for patients that are younger than 36 months.
Hypertensives: <900 mcg/24 h
TOTAL METANEPHRINE
Males
Normotensives
3-8 years: 47-223 mcg/24 h
9-12 years: 201-528 mcg/24 h
13-17 years: 120-603 mcg/24 h
18-29 years: 190-583 mcg/24 h
30-39 years: 200-614 mcg/24 h
40-49 years: 211-646 mcg/24 h
50-59 years: 222-680 mcg/24 h
60-69 years: 233-716 mcg/24 h
≥70 years: 246-753 mcg/24 h
Reference values have not been established for patients that are younger than 36 months.
Hypertensives: <1300 mcg/24 h
Females
Normotensives
3-8 years: 57-210 mcg/24 h
9-12 years: 107-394 mcg/24 h
13-17 years: 113-414 mcg/24 h
18-29 years: 142-510 mcg/24 h
30-39 years: 149-535 mcg/24 h
40-49 years: 156-561 mcg/24 h
50-59 years: 164-555 mcg/24 h
60-69 years: 171-616 mcg/24 h
≥70 years: 180-646 mcg/24 h
Reference values have not been established for patients that are younger than 36 months.
Hypertensives: <1300 mcg/24 h
For International System of Units (SI) conversion for Reference Values, see www.mayocliniclabs.com/order-tests/si-unit-conversion.html
Interpretation
Further clinical investigation (eg, radiographic studies) and genetic studies might be warranted in patients whose 3-methoxytyramine (3MT), metanephrine, or normetanephrine are elevated or when there is a very high clinical index of suspicion.
Increased 3MT levels are found in patients with pheochromocytoma and dopamine-secreting tumors.
3MT levels of 306 mcg/24 h or less in male patients and 242 mcg/24 h or less in female patients can be detected in non-pheochromocytoma hypertensive patients.
Clinical Reference
1. Muskiet FA, Thomasson CG, Gerding AM, Fremouw-Ottevangers DC, Nagel GT, Wolthers BG. Determination of catecholamines and their 3-O-methylated metabolites in urine by mass fragmentography with use of deuterated internal standards. Clin Chem. 1979;25(3):453-460
2. Taylor RL, Singh RJ. Validation of liquid chromatography-tandem mass spectrometry method for analysis of urinary conjugated metanephrine and normetanephrine for screening of pheochromocytoma. Clin Chem. 2002;48(3):533-539.
3. Roden M, Raffesberg W, Raber W, et al. Quantification of unconjugated metanephrines in human plasma without interference by acetaminophen. Clin Chem. 2001;47(6):1061-1067
4. Sawka AM, Singh RJ, Young WF Jr. False positive biochemical testing for pheochromocytoma caused by surreptitious catecholamine addition to urine. The Endocrinologist. 2001;11(5):421-423
5. van Duinen N, Steenvoorden D, Kema IP, et al. Increased urinary excretion of 3-methoxytyramine in patients with head and neck paragangliomas. J Clin Endocrinol Metab. 2010;95(1):209-214
6. Le Jacques A, Abalain JH, Le Saos F, Carre JL. Interet du dosage urinaire de la 3-methoxytyramine dans le diagnostic des pheochromocytomes et paragangliomes: a propos de 28 cas [Significance of 3-methoxytyramine urine measurement in the diagnosis of pheochromocytomas and paragangliomas: about 28 patients]. Ann Biol Clin (Paris). 2011;69(5):555-559. doi:10.1684/abc.2011.0612
7. Lam L, Woollard GA, Teague L, Davidson JS. Clinical validation of urine 3-methoxytyramine as a biomarker of neuroblastoma and comparison with other catecholamine-related biomarkers. Ann Clin Biochem. 2017;54(2):264-272
8. Hirsch D, Grossman A, Nadler V, Alboim S, Tsvetov G. Pheochromocytoma: Positive predictive values of mildly elevated urinary fractionated metanephrines in a large cohort of community-dwelling patients. J Clin Hypertens (Greenwich). 2019;21(10):1527-1533. doi:10.1111/jch.13657
9. Gupta PK, Marwaha B. Pheochromocytoma. In: StatPearls [Internet]. StatPearls Publishing; 2024. Updated March 5, 2023. Accessed April 22, 2024. Available at www.ncbi.nlm.nih.gov/books/NBK589700
Day(s) Performed
Monday through Friday
Report Available
3 to 5 daysPerforming Laboratory
Mayo Clinic Laboratories in Rochester
Test Classification
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.CPT Code Information
82542
83835
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| META3 | Metanephrines with 3-MT, 24h, U | 101400-0 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 8552 | Metanephrine, U | 104629-1 |
| 609422 | 3-Methoxytyramine, U | 32618-1 |
| 21545 | Normetanephrine, U | 104631-7 |
| 83006 | Total Metanephrines, U | 104630-9 |
| TM50 | Collection Duration (h) | 13362-9 |
| VL48 | Volume (mL) | 3167-4 |
| 2434 | Comment | 48767-8 |