What does this urine test showing epinephrine levels indicate?

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
Answered by
Dr.
Dr. Karen Steinberg

Internal Medicine Specialist

Practicing since :1981

Answered : 824 Questions

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

Hi, i have got severe pain in my muscles and joints and lower back pain and when i experience this pain i am very tired. To releave the pain i use...

doctor1 MD

32 yrs old male, height 5.6 weight 88 habbits - smoker ( daily 3 or 4) drinks - occ. once in monthmost of the time Veggy thrice in a month having...

doctor1 MD

Sir, I have suffering from strong left calve muscle pain from last evening. Pain remains the same what I suffered yesterday while pushing my car...

doctor1 MD

i had doctors say my gallbladder needed to be taking out over 5 days in the hospital they changed their mind was on antibotics got better for a...

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...

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...

doctor1 MD

Hello Doc, Request your advice here please Medical history 1. Bronchitis asthma 2. Thalassemia Minor 3. Severe Iron deficiency anemia 4. Shoulder...

Get personalised answers from verified doctor in minutes across 80+ specialties

146 Doctors Online

By proceeding, I accept the Terms and Conditions

HCM Blog Instant Access to Doctors
HCM Blog Questions Answered
HCM Blog Satisfaction
backtotop2