Get your Health question answered in 3 easy steps

163 Doctors Online
Doctor Image
MD
Dr. Andrew Rynne

Family Physician

Exp 18 years

I will be looking into your question and guiding you through the process. Please write your question below.

What does this urine test showing epinephrine levels indicate?

Answered by
Dr.
Dr. Karen Steinberg

Internal Medicine Specialist

Practicing since :1981

Answered : 824 Questions

default
Posted on Tue, 19 Aug 2014 in General Health
Question: Symptoms: heart palpitations, at times racing heart, MUSCLE TIGHTNESS,muscle pain, muscle fatigue, especially in shoulders, neck and forearms,headaches, dizziness, lightheaded at times, sweats at times, anxiety and nervousness, feel shaky and hand tremor.
Had urine test done. Results Epinephrine-30.39 pg/gCr range 3.36-6.06 Norepinephrine -142.61pg/gCr range 28.07-42.11 Dopamine 375.22 pg/gCr range 139.1-208.7. Symptoms increased greatly when tried Cymbalta. Do I need to see a neurologist or endocrinologist?
doctor
Answered by Dr. Karen Steinberg 4 hours later
Brief Answer:
See an endocrinologist

Detailed Answer:
Hi XXXXXXX thank you for using Healthcare Magic. Your results and symptoms are consistent with a pheochromocytoma, which is a tumor of the adrenal gland. The adrenal gland produces a variety of hormones, including stress hormones (eg, cortisol), and another part of it produces epinephrine, dopamine, and norepinephrine. These latter act as "flight or fight" hormones and create symptoms such as you are describing.

Pheochromocytoma can be associated with other endocrine tumors or may just be solitary. An endocrinologist would know what other tests to check. He or she may also know specific medicines that will help with the overproduction of these hormones while you are having an investigation for the definite diagnosis. Ultimately you are going to need imaging studies of your adrenal glands and possibly surgery.

For now I recommend you get in to an endocrinologist very soon. Pheochromocytoma can cause sudden high increases in blood pressure that can be dangerous. Was it your private doctor who ordered the urine test? Ask that doctor to advise you on the next steps you must take. He or she may want to initiate further studies while you are getting the referral. You also need to keep a close eye on your blood pressure.

Hope this answers your query. If you have further questions, I would be happy to answer them.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
default
Follow up: Dr. Karen Steinberg 1 hour later
I generally see a nurse practitioner.Tests were done from online lab. urine test. Pain management doctor had prescribed Cymbalta to try for the muscle pain issue. After the reaction to the Cymbalta-same symptoms but much worse I looked into the ingredients and noticed the norepinephrine reuptake inhibitor. Which I was not familiar with. Did some research and started thinking I should probably look at the adrenals.
Thinking she might think i was crazy I found the online lab to test the adrenal hormones. I know I have a 4-5 cm cyst on my left kidney. Could that possibly be the source of the excess hormone? She is wanting to send me to neurologist for the muscle issues and I was thinking I should be seeing a endocrinologist at this point?
doctor
Answered by Dr. Karen Steinberg 37 minutes later
Brief Answer:
Would see the endocrinologist first

Detailed Answer:
The more urgent problem is the possible pheochromocytoma. The muscle symptoms may be a separate issue or could be related. The endocrinologist would be better suited to make this determination.

The adrenal glands sit atop the kidneys. Possibly the cyst is located nearby and is actually in the adrenal gland. Or it could be some ectopic adrenal tissue in the kidney. This obviously deserves further evaluation with more imaging studies.

Good call on your part. Adrenal hormone problems are uncommon and often missed. You could talk to the nurse practitioner, inform her of the results, and ask for her advice and a referral. But get an appointment with an endocrinologist soon. Hope this helps.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
premium_optimized

The User accepted the expert's answer

Share on
Question is related to
Diseases and Conditions ,  
Drug/Medication ,  
Medical Topics ,  

Recent questions on Muscle pain

doctor1 MD

I have tested positive for ana 3 times in last 3 yrs. have had GI problems,muscle pain so bad I could'nt hold up phone, chronic fatigue,weight loss,stabbing pain in left kidney area. Every MRI, Colonoscopy, many other tests.In past 3 yrs. nothing else has shown up in blood work and I've been pretty healthy for 1 year now.Gained some weight back. Up until about 2 months ago in about 2 weeks I lost 10 lbs. and have lost a few more since then. I'm 41 yrs. old 5'7" and weigh less than I did in high school. I used to weigh 125-135, now I'm down to 110lbs. having chest pain, nausea, headaches, fatigue,diahrhea and nausea,Stomach pain,burning in back, Skin feels itchy,blood pressures been up and down, large bruising on outer left thigh.
Blood tests are coming back abnormal low wbc, high bilirubin,high mch,high auto Eosinophil,
low Auto neutrophil absolute. Any idea what it could be and what kind of Dr. should I see?
Sincerely,
Samantha

doctor1 MD

hello sir i have had throid for years intially levels had been 0-4.5 ; 5.4, 6.5, 9.1, 5.8 as various periods of time i was given medicine thyronorm 25 mcg. levels were ok then . but a year back my levels were fine so i stopped medicine . now my level is borderline 4.3. but i have had symtoms of thyrois fr years with or without medication like... Fatigue Muscle pain Muscle stiffness      Poor exercise tolerance Abnormal coldness Difficult menstrual cycles Irritability      Anxiety Insomnia Feel fatigued when you awaken Frequent urination Headaches - migraine or other Poor memory and concentration Afternoon fatigue Shortness of breath Dry skin or hair Pale or puffy skin Dry mucous membranes Low blood pressure Thick tongue Heat intolerance what should i do ?

doctor1 MD

I am 48 yrs old ,male .In 2007 angioplastry has been done and fitted with a one medicated stent.I am put on medicines as follows
1) PROLOMET XT 50 mg ( METOPROLOL SUSTAINED RELEASED ) MORNING
2) REMISTAR 1.25 mg ( RAMIPRIL ) MORNING
3) PLAGRIL 75 mg (CLOPIDOGRIL ) AFTERNOON
4) ECOSPRIN 150 mg (ASPIRIN )
5) TONACT EZ 10 mg ( ATORVASTATIN + EZETAMIDE )

Now i want to know that how much time i will have to continue the medicines
Does whisky drinking (60 to 90 ml ) help in any way
whole day I feel some type of body pain specially my calf muscles pains a lot
Pl advice for any addition or deduction or any type of change in medicines since I have been taking the same medicines for the last 3 years and some how it might have acllmatized in the body

doctor1 MD

I was diagnosed with Hashimoto's thyroiditis about 7 months ago. Despite fixing some period problems I was having and finally having an explanation for my thyroid problems, I'm still tired all the time, have bouts of insomnia, mood swings, migraine headaches, extreme brain fog and forgetfulness, acne, and muscle pain and spasms. I was first made aware of my thyroid issues at 16 years old, I'm now 22. I've been treated for iron definency anemia since age 11 and am currently on 45 mg of iron a day. I was diagnosed with a mitral valve prolapse which disappeared after getting treatment for the thyroid. My questions are... I've heard that since Hashimoto's is an auto-immune problem that other diseases can be assoiciated with it, what do I need to be tested for, if any thing? What type of things can I do to lose weight?
                                                                 

doctor1 MD

Can I take viagra whilst on prescriptions for ramipril 2.5mg, atorvastatin 20mg and omeprazole 20mg I have had haemochromatosis for 6 years Apart from that I’m healthy and run 60km on average per week including competitive races I have been...

doctor1 MD

I have a pain in the lower back area on the right side above the belt area and on the right side of my body next to the lower back. Have any suggestions? I have had these symptoms for almost 2 months

doctor1 MD

Hello Doc, Request your advice here please Medical history 1. Bronchitis asthma 2. Thalassemia Minor 3. Severe Iron deficiency anemia 4. Shoulder pain , muscle pain in shoulder has supraspinatus tear Recently diagnosed Blood pressure and has been...