Metanephrines Fractionated, Urine

Abbrev Code:METNEF   
Order Code:LAB3610Order Name:Metanephrine Random or 24 HR Urine
Methodology:Quantitative High Performance Liquid Chromatography-Tandem Mass Spectrometry
CPT Codes: 83835 x1
Test Includes:Metanephrine and normetanephrine
Turnaround Time:Specimens are sent to the reference laboratory Mon-Sat; results are reported in 1-4 days.

For tests developed and validated by ARUP (previously referred to as Compliance Statement B, C or D). This test was developed and its performance characteristics determined by ARUP Laboratories. It has not been cleared or approved by the U.S. Food and Drug Administration. This test was performed in a CLIA certified laboratory and is intended for clinical purposes.

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Urine Collection Procedure

Collection Instructions

Specimen:Urine, 24 hour or random collection
Optimal Volume:Submit entire collection; analysis requires 2.5 mL
Container:3 L plastic jug
Alternate Containers: Plastic leakproof container, sterile
Collection Instructions:Refrigerate sample during collection. Adequate refrigeration is the most important aspect of specimen preservation. A pH lower than 2 may cause interference.
Patient Preparation:If possible, abstain from medications for 72 hours prior to collection.
Causes for Rejection:Room temperature specimen; specimens preserved with boric acid or acetic acid.

Processing and Shipping

Specimen Processing:
Mix collection well. Aliquot 4 mL, 2.5 mL minimum. Samples are stable refrigerated for 2 weeks. Record volume and collection. MUST RECORD VOLUME AND DURATION ON BATCH LIST AND TUBE.
Alternate options to allow for extended stability up to 1 month:
Option 1: Transfer a 4 mL, 2.5 mL minimum, aliquot to an ARUP Standard Transport Tube. Adjust pH to 2.0-4.0 with 6M HCl.
Option 2: Transfer a 4 mL, 2.5 minimum, aliquot to an ARUP Standard Transport Tube containing 20 mg sulfamic acid (ARUP Supply #48098), available online through eSupply using ARUP Connect™or contact ARUP Client Services at (800) 522-2787. 
Shipping Instructions:Ship on dry ice.
Stability:2 weeks refrigerated (unpreserved); 1 month (preserved); 1 month frozen
Test Performed at or Referral Lab Lab Sendouts  (ARUP)
Referral Lab number:2007996


Reference Range:
Age Male, µg/d
0-6 y Not established
7-12 y 45-273
13-17 y 56-298
18 y & older 55-320
Age Female, µg/d
0-6 y Not established
7-17 y 40-209
18 y & older 36-229
Age Male, µg/dL
0-6 y Not established
7-12 y 58-670
13-17 y 82-553
18-29 y 81-667
30 y & older 114-865
Age Female, µg/dL
0-6 y Not established
7-12 y 48-474
13-17 y 65-406
18 y & older 95-650
Limitations:A pH lower than 2 can cause assay interference.
The optimal specimen for this testing is a 24-hour urine collection. Per day calculations are not reported for patients younger than 18 years of age and for the following specimen types: a random collection, a collection with duration of less than 20 hours, a collection with duration of greater than 28 hours, or a collection with total volume less than 400 mL. Ratios to Creatinine may be useful for these evaluations.   Smaller increases in metanephrine and/or normetanephrine concentrations (less than two times the upper reference limit) usually are the result of physiological stimuli, drugs, or improper specimen collection. Essential hypertension is often associated with slight elevations (metanephrine less than 700 µg/d and normetanephrine less than 900 µg/d). Elevated concentrations may be due to intense physical activity, life-threatening illness, and drug interferences. Significant elevation of one or both metanephrines (three or more times the upper reference limit) is associated with an increased probability of a neuroendocrine tumor.  

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