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Adrenaline and noradrenaline in urine
Last reviewed: 05.07.2025
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Reference values (norm) for adrenaline excretion in urine are up to 20 mcg/day; norepinephrine - up to 90 mcg/day.
With normal renal function, the study of urinary catecholamine excretion is considered an adequate method for assessing the state of the sympathoadrenal system. Urine is collected for 24 hours. Before collecting urine for catecholamine testing, certain foods should be excluded from the diet: bananas, pineapples, cheese, strong tea, and foods containing vanillin. Tetracycline antibiotics, quinidine, reserpine, diazepam, chlordiazepoxide, imipramine, adrenergic blockers, and monoamine oxidase inhibitors should not be taken. The patient should be given complete physical and emotional rest. During stress or mild hypoglycemia, the concentration of adrenaline in the plasma increases tenfold.
Increased excretion of catecholamines in urine is observed in diseases associated with pain syndrome, poor sleep, anxiety; during hypertensive crises, in the acute period of myocardial infarction, during attacks of angina pectoris; with hepatitis and cirrhosis of the liver; exacerbation of gastric ulcer and duodenal ulcer; during attacks of bronchial asthma; after the administration of insulin, ACTH and cortisone; during flights in pilots and passengers.
In pheochromocytoma, the content of catecholamines in the urine increases tens of times. In some patients, the excretion of norepinephrine reaches 1000 mcg/day, adrenaline - more than 750 mcg/day. The sensitivity of determining adrenaline in urine for diagnosing pheochromocytoma is 82%, specificity is 95%; norepinephrine - 89-100% and 98%, respectively.
Pheochromocytoma can be diagnosed in almost 95% of patients by combined determination of catecholamines and vanillylmandelic acid in urine (or determination of adrenaline and noradrenaline metabolism products). Separate determination of adrenaline and noradrenaline in urine allows obtaining approximate data on the possible localization of the tumor. If the tumor originates from the adrenal medulla, then more than 20% of the catecholamines excreted in urine will be adrenaline. With predominant excretion of noradrenaline, extra-adrenal localization of the tumor is possible.
In neuroblastoma and ganglioneuroblastoma, the concentration of norepinephrine in the urine is usually significantly increased, while the content of adrenaline remains within normal values. Neuroblastoma is characterized by increased excretion of cystathionine (an intermediate product of methionine catabolism).
If the chromaffin tissue tumor is benign, after its surgical removal, arterial pressure and excretion of catecholamines are normalized in 95% of patients with crisis course and in 65% of patients with persistent arterial hypertension. The absence of a decrease in the level of catecholamines in the urine indicates the presence of additional tumor tissue.
A decrease in the concentration of catecholamines in urine is observed with a decrease in the filtration capacity of the kidneys; collagenoses; acute leukemia, especially in children, due to the degeneration of chromaffin tissue.
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