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High Norepinephrine,High Catecholamines
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High Norepinephrine,High Catecholamines

Wednesday my Endo said i have an adrenal tumor.

Norepinephrine,Pl-  (0-399) mine was 1042
Catecholamine,TOT,PL-  (0-699)  mine was 1189

My thyroid was still out of whack-

TSH- 0.179  Hyperthyroid
Free T4- 2.34 high
T3- 191

He lowered my synthroid to 100mcg's

They made me do a 24 urine test,will get results next wednesday.

Is this pheochromocytoma or Neuroblastoma?
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Avatar_dr_f_tn
Hi,
High catecholamine levels seem to suggest a diagnosis of pheochromocytoma. The 24-hr urine catecholamine levels may provide further confirmation.
All the best!
13 Comments
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787406_tn?1339206783
How do they determine where it is, and whether it is cancer or not?

Also,after the 24 hr urine results what are the next steps they should take?
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Avatar_dr_f_tn
Hi,

Pheochromocytoma is diagnosed based on the plasma and urine levels of catecholamines. Iodine-131 meta-iodobenzylguanidine (I131 MIBG) imaging is useful for localization of the lesion and to determine any other areas of spread. Less than 10% of pheochromocytomas are malignant (cancer). CTscans/MRI of the abdomen and chest are done to rule out distant spread. A PET scan may also be useful. Treatment of this tumor is surgical resection. Before surgery, drugs to control the hypertension and volume loss need to be administered. The resected specimen can be microscopically examined to determine if it is cancerous or not.

All the best and God bless!
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787406_tn?1339206783
I got the urine Metanephrines back they were:

Total Urine Volume- 1500 (ML)
Normetanephrine,UR- 200 (undefined UG/L)
Normetanephrine,U,24H- 300 (110-1050 UG/24HR)
Metanephrine,UR- 81 (Undefined UG/L)
Metanaphrine,U,24HR-122(35-460 UG/24H

Catecholamines,Fractionated,Plasma were:

Norepinephrine- 1042 High (0-399 PG/ML)
Epinephrine,PL- 10 (0-99 PG/ML)
Dopamine,PL- 137 (0-142 PG/ML)
Catecholamines,TOT,PL- 1189 High (0-642 PG/ML)

TSH- 0.093 Low (0.450-4.50 UIU/ML)  3 weeks ago it was 0.170  3wks before that-1.95
T4Free- 2.10 High 0.61-1.76 NG/DL) 3 weeks before it was 2.34 High
PTH,intact- 22 (15-65 PG/ML)



Endo told me its just stress. I would like to know what your thoughts are about these test,everything I have read on the net about these test say that the plasma is more reliable than the 24 HR urine because you may not be having an episode at that period of time. I had a total Thyroidectomy (with papillary cancer and De Quervain's thyroiditis,difficult surgery and i am having problems with vocal cords and throat) on March 27th.

I talked to my Cardiologist office today and they said i am having Tachycardia and heart changes which he will explain to me next wednesday morning.

I am having so many symptoms right now, heat intolerance,sweats,night sweats,blurred vision,diarrhea,frequent bowel movements,low blood pressure,abdominal pain,headaches,weightloss,side and back pain,clammy skin,feet bone pain,hair loss,chest pain, and a boil.

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Avatar_dr_f_tn
Hi,

You initially mentioned that your endocrinologist had said that you have an adrenal tumor. Did you undergo any abdominal imaging? Or was the adrenal tumor a presumption based on the high levels of catecholamines? If an adrenal mass was detected on imaging and the plasma shows high levels of catecholamines, pheochromocytoma is a likely possibility. Other causes of raised levels of plasma catecholamines include hypoglycemia, stress, various drugs including thyroid hormone supplements, methyldopa, dopamine agonists etc. Pheochromocytoma is associated with a high blood pressure. The symptoms you have described can occur in states of thyroid hormone excess too.
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787406_tn?1339206783
The adrenal tumor was a presumption on my Endo's part because the norepinephrine and the Catecholamines were high. No imaging has been done. I am on 100 mcg's of Synthroid,my levels keep dropping even though he has lowered the dose 5 times since my total Thyroidectomy in 12 weeks ago. The only drugs i am on is Synthroid,nexium,estradiol,and vitamin D. I do have hypoglycemia but have never been treated for it or had problems with it. At the time of the test i was not under any stress.

Could new nodules that have formed on the front of my throat cause the test to be high?
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Avatar_dr_f_tn
Hi,
You need to get the nodules checked by your doctor. An abdominal imaging may also be indicated. Both hypoglycemia and thyroid hormone excess are stressors which can cause an increased release of catecholamines.
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787406_tn?1339206783
My doctor told me it was just stress and is not looking into it any further. My TSH levels keep dropping despite dosage being lowered. My TSH is 0.093 low and my T4Free is 2.10 High. He dropped my dosage to 100mcg's. @ weeks later i am dealing with hyperthyroid symptoms again-frequent bowel movements,stomach cramps,heat intolerance and etc.. This is getting so annoying.
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Avatar_dr_f_tn
Hi,
Sorry, we missed your post amongst all the others. Your doses may need further reduction if you are having symptoms of thyroid hormone excess and your blood levels are high. Since when are you taking the hormone supplements?
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787406_tn?1339206783
I have been on Synthroid since May 5th,he has me on a 100mcg dose but it still seems to much,i go back to him tomorrow to get the results of my labwork.
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Avatar_dr_f_tn
Hi,
Why were you started on the Synthyroid? Have you undergone any surgery for the thyroid? What were the thyroid hormone levels before you were started on the supplements?
All the best
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787406_tn?1339206783
I had a total thyroidectomy on march 27th,2009. Papillary cancer. My Endo was going to do treatment but he let my TSH get to 150 before he decided to change his mind. Thats when he started me on the Synthroid.

Yesterday he lowere my dosage again to 75mcg's because my TSH was 0.187 and T4Free was normal-1.34
M.D. Anderson wants my TSH around 0.2 to 0.5 to suppress the cancer.

He also told me yesterday that he thought i had Post Traumatic Stress Syndrome,because of the difficult surgery and the thyroid levels not being right. I am currently have bad feet pain when i walk,rib pain,spine pain and frequent bowel movements and stomach cramps every 3 days.
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Avatar_dr_f_tn
Hi,
Thyroid hormone supplements are given after total thyroidectomy both for maintaining physiological levels of these hormones in the body and for suppressing the TSH which stimulates growth of thyroid cancer cells. Therefore the drugs have been prescribed for you. Probably a dose of 100 mcg was high for you and was causing adverse effects. Since your dose has now been lowered, you can wait for sometime to see if your symptoms are being releived. If you are feeling stressed or anxious you may try some relaxation techniques. Consult your doctor again if you do not feel well in a couple of weeks.
All the best
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