Pheochromocytoma is a rare tumor of the adrenal glands that causes dangerously high blood pressure and severe symptoms. It is caused by excessive production of catecholamines (epinephrine, norepinephrine, and dopamine) from tumor cells in the adrenal medulla. The Catecholamines, Fractionated, Plasma test is the most important test for diagnosis because it directly measures these elevated stress hormones in the blood.
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Pheochromocytoma is caused by abnormal tumor growth in the chromaffin cells of the adrenal medulla, which produces excessive amounts of catecholamines (epinephrine, norepinephrine, and dopamine). While most cases occur sporadically without a clear cause, about 30-40% are associated with genetic mutations including Multiple Endocrine Neoplasia type 2 (MEN2), Von Hippel-Lindau disease (VHL), and neurofibromatosis type 1 (NF1). These tumors continuously or episodically release stress hormones into the bloodstream, causing sudden and severe symptoms including dangerous blood pressure spikes that can lead to stroke or heart attack if untreated.
The Catecholamines, Fractionated, Plasma test is the most important test for pheochromocytoma because it directly measures the three key stress hormones (epinephrine, norepinephrine, and dopamine) that these tumors overproduce. This blood test captures elevated hormone levels in real-time, providing the biochemical evidence needed to confirm the diagnosis. The fractionated measurement is particularly valuable because it shows which specific catecholamines are elevated, helping your doctor understand the tumor's activity pattern. Many doctors also recommend testing plasma or urine metanephrines (breakdown products of catecholamines) as a complementary test, but the direct measurement of catecholamines remains the gold standard for initial diagnosis.
You should get tested if you experience sudden episodes of severe headaches, rapid heartbeat, excessive sweating, and dangerously high blood pressure that comes and goes unpredictably. Testing is especially important if you have a family history of pheochromocytoma or genetic conditions like MEN2, VHL, or NF1, or if you have persistent anxiety or panic-like symptoms that do not respond to typical treatments. You should also consider testing if imaging studies have identified an adrenal mass or if you experience severe blood pressure spikes during surgery or medical procedures, as these can be life-threatening situations that require immediate diagnosis.
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What this means
Your norepinephrine level is elevated above the optimal range, which may indicate excess stress hormone production. While this can sometimes occur during periods of high stress or anxiety, persistently elevated levels may suggest a hormone-producing tumor or other medical condition that requires further evaluation.
Recommended actions
Discuss these results with your doctor, especially if you have symptoms like rapid heartbeat or high blood pressure
Your doctor may recommend imaging tests to check for hormone-producing tumors
Avoid stimulants like caffeine and ensure adequate rest before any repeat testing
Follow up with additional testing as recommended by your healthcare provider
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