The essentials

A catecholamines test measures epinephrine (adrenaline), norepinephrine and dopamine, or their breakdown products, the metanephrines, in blood or 24-hour urine. It looks for rare hormone-making tumors: pheochromocytoma and paraganglioma in adults, neuroblastoma in children. Metanephrines are now the first-line test. A mildly high result is common and usually comes from stress, posture, food or medicines, not a tumor.

What is a catecholamines test and what does it measure?

Catecholamines are hormones made by your adrenal glands. The three main ones are dopamine, norepinephrine and epinephrine (adrenaline)[1].

Urine testing is more common, because blood levels change quickly and rise with the stress of the needle[1].

The body breaks catecholamines down into metanephrine and normetanephrine (the "metanephrines"), and into vanillylmandelic acid (VMA); a 24-hour urine report may list these too[3]. The Endocrine Society found the metanephrines more accurate than the parent hormones for finding tumors, which is why they are now the first-line tests[4].

How do I read my catecholamines result, line by line?

A fictitious 24-hour urine report from an adult with spells of headache and sweating:

Fictitious example of a lab report (United States format, 24-hour urine)
TestResultReference rangeFlag
Urine volume, 24 h1,850 mL--
Norepinephrine, 24 h urine148 mcg/24 h14-120 mcg/24 hH
Epinephrine, 24 h urine9 mcg/24 h1-14 mcg/24 h-
Dopamine, 24 h urine302 mcg/24 h71-485 mcg/24 h-
Normetanephrine, 24 h urine410 mcg/24 h75-375 mcg/24 hH
Metanephrine, 24 h urine58 mcg/24 h24-96 mcg/24 h-
  1. Urine volume: checks that a full day was collected; missed urine makes values falsely low.
  2. Norepinephrine 148 (H): slightly above the range. Stress, heavy exercise, coffee and many medicines can push it up[3].
  3. Normetanephrine 410 (H): just above the upper limit, and far from double it. Doctors weigh how far above the limit, and in how many values, with your symptoms and medicines[4][5].
  4. Other lines: within range (MedlinePlus ranges[3]; your laboratory's range prevails).

An H next to a catecholamine or metanephrine line? BloodSense explains each line of your complete report and helps you prepare your questions.

Get my report explained

Why would a doctor order a catecholamines test?

  • Spells of symptoms in adults: high blood pressure that does not improve with treatment, severe headaches, sweating, a rapid heartbeat, anxiety or tingling in the arms and legs[1].
  • An adrenal mass found by chance on a scan: nearly 5% are pheochromocytomas[4].
  • Inherited risk: carriers of a linked gene change, or people with a personal or family history, are tested regularly[5]. At least one third of people with these tumors have such a gene change[4].
  • Children: bone pain, a lump in the belly, weight loss or unusual eye movements can lead to urine testing for neuroblastoma[1].

These tumors are rare. They are found in about 0.2% to 0.6% of people with high blood pressure seen in general clinics[4]. European hypertension experts advise against testing everyone with ordinary high blood pressure[5].

Catecholamines or metanephrines: which test is best?

The Endocrine Society guideline recommends starting with plasma metanephrines (unbound form) or urinary fractionated metanephrines, measured by liquid chromatography[4]. Urine metanephrines miss fewer tumors than urine catecholamines or VMA[4].

In a study of 2,056 people tested for these tumors, plasma metanephrines detected 97.9% of them, against 93.4% for urinary metanephrines in unbound form[6]. Both tests were positive in about 6 of every 100 people without a tumor (specificity 94.2%)[6]. The blood test did better in people at high risk[6].

Catecholamine tests are still used, for example urine tests in children with a suspected neuroblastoma[1], and a 24-hour urine report often lists catecholamines and metanephrines together[3].

What are normal catecholamine and metanephrine levels?

Ranges differ with the method, the sample, the unit and age.

Examples of adult reference ranges (your laboratory's range prevails)
TestRangeSource
Epinephrine, blood0-140 pg/mLMedlinePlus[2]
Norepinephrine, blood70-1,700 pg/mLMedlinePlus[2]
Norepinephrine, 24 h urine14-120 mcg/24 hMedlinePlus[3]
Normetanephrine, 24 h urine75-375 mcg/24 hMedlinePlus[3]
Metanephrine, 24 h urine24-96 mcg/24 h (some labs: 140-785)MedlinePlus[3]
Normetanephrine, plasma0.0-0.89 nmol/LARUP Laboratories[8]
Metanephrine, plasma0.0-0.49 nmol/LARUP Laboratories[8]

Normetanephrine rises with age. In a study of supine blood samples, its upper limit went from 0.47 nmol/L in children and teenagers to 1.05 nmol/L after 60[7].

What does a high catecholamine level mean?

  • Common Stress, pain or heavy exercise before or during the test[1][2]. Acute anxiety can also raise levels[3].
  • Common Caffeine, nicotine and alcohol, and foods such as bananas, chocolate, citrus fruits and vanilla[1][2].
  • Common Medicines. For catecholamines: acetaminophen, albuterol, levodopa, pseudoephedrine and tricyclic antidepressants, among others[2]. For metanephrines: antidepressants, MAO inhibitors and phenoxybenzamine raise normetanephrine markedly[5].
  • Possible A blood sample taken sitting up. Experts advise drawing blood after at least 20 minutes lying down and comparing with ranges set in the same position[4][5].
  • Rare Pheochromocytoma or paraganglioma, tumors of the adrenal gland or nearby nerve tissue[1][4].
  • Rare Neuroblastoma, ganglioneuroma or ganglioneuroblastoma, mostly in infants and children[1][3].

The size of the rise matters. A plasma metanephrine more than twice the upper limit, or a rise in two or more metanephrines, makes a tumor likely and leads to a scan[5]. For a small rise, a repeat test after removing interfering medicines, or a clonidine suppression test, helps sort true from false results[5]. A normal metanephrine result makes these tumors very unlikely[5].

What does a low catecholamine level mean?

A low result is usually not a concern. Clonidine and MAO inhibitors can lower blood catecholamines[2], and an incomplete 24-hour collection can make urine values falsely low. The blood test is also sometimes used to investigate multiple system atrophy, a rare nervous system disorder[2].

How should I prepare for a catecholamines test?

  • For two to three days before, avoid caffeine, alcohol, tobacco, bananas, citrus fruits, vanilla, stress and vigorous exercise, unless your lab says otherwise[1].
  • List every medicine and supplement. Never stop one on your own: your doctor decides[2][5].
  • Blood catecholamines: you will likely be asked to fast for about 10 hours[2]. Plasma metanephrines need no special diet, but an overnight fast is required when 3-methoxytyramine is included[5].
  • Ask whether you will lie down before the blood draw. At least 20 minutes of rest lying down is advised for plasma metanephrines[5].
  • 24-hour urine: discard the first morning urine and note the time, collect every void for 24 hours, keep the container in the fridge or on ice, and pass urine one last time at the end[1].

When should I see a doctor?

When to see a doctor

  • Emergency: call 911 for a sudden severe headache with very high blood pressure, chest pain, fainting, trouble breathing or confusion.
  • Within 24 to 48 hours for repeated spells of pounding headache, sweating and palpitations, or blood pressure far above your usual.
  • At your next appointment to discuss a high result, an adrenal mass seen on a scan, or a family history of these tumors.

Questions to ask your doctor

  1. Why was this test ordered, and was it catecholamines or metanephrines?
  2. How far above the upper limit is my result, and in which values?
  3. Could my medicines or the way the sample was taken explain it?
  4. Should the test be repeated lying down, or do I need a scan?

Frequently asked questions

Should I stop my blood pressure medicine before the test?

Only if your doctor tells you to. Experts say interrupting medicines is not usually needed and can be considered after a first positive result[5].

What happens after a clearly high result?

Usually imaging, often a CT scan. Genetic testing is then considered for every patient with a confirmed tumor[4].

Does a normal result rule out a tumor?

A normal metanephrine result virtually excludes these tumors, except for some very small ones and head and neck paragangliomas that release few hormones[5].

  1. MedlinePlus. Catecholamine tests. US National Library of Medicine. Updated August 21, 2024. medlineplus.gov (accessed October 26, 2026)
  2. MedlinePlus Medical Encyclopedia. Catecholamines - blood. Reviewed February 13, 2025. US National Library of Medicine. medlineplus.gov (accessed October 26, 2026)
  3. MedlinePlus Medical Encyclopedia. Catecholamines - urine. Reviewed July 1, 2025. US National Library of Medicine. medlineplus.gov (accessed October 26, 2026)
  4. Lenders JWM, Duh QY, Eisenhofer G, et al. Pheochromocytoma and paraganglioma: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2014;99(6):1915-1942. doi:10.1210/jc.2014-1498 (accessed October 26, 2026)
  5. Lenders JWM, Kerstens MN, Amar L, et al. Genetics, diagnosis, management and future directions of research of phaeochromocytoma and paraganglioma: a position statement and consensus of the Working Group on Endocrine Hypertension of the European Society of Hypertension. J Hypertens. 2020;38(8):1443-1456. doi:10.1097/HJH.0000000000002438 (accessed October 26, 2026)
  6. Eisenhofer G, Prejbisz A, Peitzsch M, et al. Biochemical diagnosis of chromaffin cell tumors in patients at high and low risk of disease [...]. Clin Chem. 2018;64(11):1646-1656. doi:10.1373/clinchem.2018.291369 (accessed October 26, 2026)
  7. Eisenhofer G, Lattke P, Herberg M, et al. Reference intervals for plasma [...] metanephrines with an age adjustment for normetanephrine for optimized laboratory testing of phaeochromocytoma. Ann Clin Biochem. 2013;50(Pt 1):62-69. doi:10.1258/acb.2012.012066 (accessed October 26, 2026)
  8. ARUP Laboratories. Metanephrines, plasma. Laboratory test directory, test 0050184. ltd.aruplab.com (accessed October 26, 2026)

This page is general information. It does not replace the advice of a doctor, who interprets your results with your symptoms, history and examination.