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What do my lab test results indicate?

Answered by
Dr. Shehzad Topiwala


Practicing since :2001

Answered : 1663 Questions

Posted on Tue, 20 Sep 2016 in Thyroid Problem and Hormonal Problems
Question: If someone has a slight elevation in plasma normetanephrine and slight elevation in urine metanephrine should it be explored further or it considered insignificant?

I had been having intermittent episodes of shortness of breath for a year and rapid heart rate for months. I have random episodes where I begin to take deep breaths or feel short of breath, sometimes at rest, but always when walking up an incline or stairs. Recently I began to have random episodes where it feels like I drank a ton of coffee. I either get really angry or emotional and cry. I feel like I have little control of my emotions, feel crazy and and feel like I could snap during these attacks. Sometimes I feel like my blood sugar is low, or feel lightheaded, have palpitations, get mild tremors or gasp for breaths. Sometimes I feel really cold and I'll shiver or my hands are ice cold. Then during attacks I feel so hot and flushed. It can be so intense and then it is gone in less than 20 min or less. Sometimes after the episodes I will become so tired, like I just really really exerted myself and I feel like I could fall asleep immediately. When I lay flat I feel better. Other times after an attack I feel worn out, weak, or like I am going to pass out or that my blood pressure or heart rate are low. Family has told me that my color looks off or I look pale when it happens. I guess a Pheo is ruled out, but my other questions are:

1. Is there something that could cause symptoms similar to a pheo?
2. Can any endocrine problems cause the sensation of shortness of breath or feeling the need to take deep breaths?

By the way, I have seen a psychiatrist multiple times because it presents similar to an anxiety attack and he did not believe this was a psychiatric thing and encouraged me to see an endocrinologist. My CBC, metabolic profile , and thyroid levels are normal.
Answered by Dr. Shehzad Topiwala 1 hour later
Brief Answer:

Detailed Answer:
Sorry to learn about your bothersome symptoms.

I see you have mildly raised (nor)metanephrines. The correct way to go about this is to start with a blood test for

Plasma Free Metanephrines

Fasting is not required for this test and so it can be done at any time of the day.

If this is high then confirmation should be sought by performing a

24 hour urine test for Fractionated Catecholamines and Metanephrines and Creatinine
When I see someone like you in my practice, I typically also order the following blood tests in addition to a detailed physical examination:

HbA1c (Glycosylated Hemoglobin = your last 3 months' glucose average). Also known by other names such as GlycoHemoglobin or Glycated Hemoglobin or A1c
25 hydroxy Vitamin D levels (ideal range 40 to 60 ng/ml = 100 to 150 nmol/liter)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Shehzad Topiwala 43 minutes later
I had those tests done. The results are below.
My A1C was 4.9 last year
Vitamin D was 27 pg/mL

Metanephrine     0.29 nmol/L     0.00 - 0.49 nmol/L
Normetanephrine     0.95 nmol/L     0.00 - 0.89 nmol/L

Urine Test
Hours Collected     24 hr     hr
Total Volume     2025 mL     mL
Metanephrine, Urine - per volume     84 ug/L     ug/L
Normetanephrine, Urine - per volume     186 ug/L     ug/L
Metanephrine, Urine - per 24h     170 ug/d     39 - 143 ug/d
Metanephrine, Urine - ratio to CRT     140 ug/g CRT     0 - 300 ug/g CRT
Normetanephrine, Urine - per 24h     377 ug/d     109 - 393 ug/d
Normetanephrine, Urine - ratio to CRT     310 ug/g CRT     0 - 400 ug/g CRT
Metanephrines, Urine Interpretation     

Component     Your Value     Standard Range
Hours Collected     24 hr     hr
Total Volume     2025 mL     mL
Epinephrine, Urine - per volume     4 ug/L     ug/L
Norepinephrine, Urine - per volume     22 ug/L     ug/L
Dopamine, Urine - per volume     74 ug/L     ug/L
Epinephrine, Urine - ratio to CRT     7 ug/g CRT     0 - 20 ug/g CRT
Epinephrine, Urine - per 24h     8 ug/d     1 - 7 ug/d

REFERENCE INTERVAL: Epinephrine, Urine - ug/d

Access complete set of age- and/or gender-specific reference
intervals for this test in the ARUP Laboratory Test Directory
Norepinephrine, Urine - ratio to CRT     37 ug/g CRT     0 - 45 ug/g CRT
Norepinephrine, Urine - per 24h     45 ug/d     16 - 71 ug/d
REFERENCE INTERVAL: Norepinephrine, Urine - ug/d

Access complete set of age- and/or gender-specific reference
intervals for this test in the ARUP Laboratory Test Directory
Dopamine, Urine - ratio to CRT     123 ug/g CRT     0 - 250 ug/g CRT
Dopamine, Urine - per 24h     150 ug/d     77 - 324 ug/d

This all started after getting iron infusions and had multple symptoms over months. i've been to so many doctors and they dont know what to do so they send me to another doctor. It feels hopeless. There has to be a doctor that can figure this out. Or maybe I just have to learn to live like this.So these tests are not impressive but could they help determine what the next step be and can hormone excretion effect breathing patterns or the sensation of shortness of breath?
Answered by Dr. Shehzad Topiwala 2 hours later
Brief Answer:
Follow up

Detailed Answer:
1 I have reviewed the above results. None of them direct and strongly indicate the possibility of pheochromocytoma.
However a correct diagnosis requires the opportunity to examine the patient so you must see an endocrinologist in-person.

2 Hormones can affect breathing if they are abnormal in some cases. For example a severely abnormal thyroid can result in breathing difficulty. You have stated your thyroid levels were checked and that they were normal

3 The low vitamin D levels needs to be replaced. Request your doctor to consider prescribing vitamin D supplements
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Shehzad Topiwala 12 hours later
Other than thyroid how could hormones affect breathing? I would like to research more, but I don't even know what to research, that's why I came here. I have seen so many different specialists and I am wondering if I should even bother going to an endocrinologist because my tests are not that abnormal. The shortness of breath is very random, but very bothersome. The only reason I thought about endocrine was because I feel like I have random episodes that seem like an "exaggerated flight or fight" response and thought it could be hormone related. Also is there any way that iron can affect hormone levels?
Answered by Dr. Shehzad Topiwala 5 hours later
Brief Answer:
Second follow up

Detailed Answer:
Yes indeed. Examples include excess Growth hormone and deficient cortisol.

You will benefit considerably by consulting an endocrinologist in-person
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

The User accepted the expert's answer

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