Test Code PMET Metanephrines, Fractionated, Free, Plasma
Additional Codes
CNE Order Code: MET-Frac
Reporting Name
Metanephrines, Fract., Free, PUseful For
Screening test for presumptive diagnosis of catecholamine-secreting pheochromocytomas or paragangliomas
Performing Laboratory
Mayo Clinic Laboratories in RochesterSpecimen Type
Plasma EDTASpecimen Required
Patient Preparation: Use of an Epi-pen within the last 7 days may produce inaccurate results.
Collection Container/Tube: Lavender top (EDTA)
Submission Container/Tube: Plastic vial
Specimen Volume: 1 mL
Collection Instructions: Centrifuge and aliquot plasma into a plastic vial within 2 hours of collection.
Specimen Minimum Volume
0.3 mL
Specimen Stability Information
Specimen Type | Temperature | Time | Special Container |
---|---|---|---|
Plasma EDTA | Frozen (preferred) | 28 days | |
Refrigerated | 14 days | ||
Ambient | 7 days |
Reference Values
METANEPHRINE, FREE
<0.50 nmol/L
NORMETANEPHRINE, FREE
<0.90 nmol/L
Day(s) Performed
Monday through Saturday
CPT Code Information
83835
LOINC Code Information
Test ID | Test Order Name | Order LOINC Value |
---|---|---|
PMET | Metanephrines, Fract., Free, P | 57772-6 |
Result ID | Test Result Name | Result LOINC Value |
---|---|---|
10140 | Normetanephrine, Free | 40851-8 |
10139 | Metanephrine, Free | 49700-8 |
Interpretation
In the normal population, plasma metanephrine and normetanephrine levels are low, but in patients with pheochromocytoma or paragangliomas, the concentrations may be significantly elevated. This is due to the relatively long half-life of these compounds, ongoing secretion by the tumors and, to a lesser degree, peripheral conversion of tumor-secreted catecholamines into metanephrines.
Measurement of plasma free metanephrines appears to be the best test for excluding pheochromocytoma. The test's sensitivity approaches 100%, making it extremely unlikely that individuals with normal plasma metanephrine and normetanephrine levels suffer from pheochromocytoma or paraganglioma.(1,2)
Due to the low prevalence of pheochromocytomas and related tumors (<1:100,000), it is recommended to confirm elevated plasma free metanephrines with a second, different testing strategy in order to avoid large numbers of false-positive test results.(3) The recommended second-line test is measurement of fractionated 24-hour urinary metanephrines (METAF / Metanephrines, Fractionated, 24 Hour, Urine). In most cases this strategy will suffice in confirming or excluding the diagnosis. Occasionally, it will be necessary to extend this approach if there is a very high clinical index of suspicion or if test results are nonconclusive. In these cases, repeat plasma and urinary metanephrines testing, additional measurement of plasma or urinary catecholamines, or imaging procedures might be indicated.
Elevated results are reported with appropriate comments.
Report Available
2 to 5 daysReject Due To
Gross hemolysis | Reject |
Gross lipemia | OK |
Gross icterus | OK |
Method Name
Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)
Forms
If not ordering electronically, complete, print, and send 1 of the following forms with the specimen:
-General Request (T239)
-Oncology Test Request (T729)