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Dr. M, ideally, where do you like to see the fractionated catecholamine results fall within the lab ranges? Thank you.
@bulldogsandbruins 708 wrote:
fractionated catecholamine results fall within the lab ranges? Thank you.
ARUP Labs ranges (supine, 18 and older):
Epinephrine 10-200 pg/mL
Norepinephrine 80-520 pg/mL
Dopamine 0-20 pg/mLThe levels may be increased in conditions such as:
Stress
Pheochromocytoma
Ganglioneuroma
Neuroblastoma
HypoglycemiaThe levels may be decreased in conditions such as:
Postural hypotension
Diabetes or Insulin Resistance
Shy-Drager Syndrome
Familial DysautonomiaNorepinephrine is the most important value. When there is a patent connection between the sympathetic nervous system and the adrenal medulla, this can give a good measure of one’s stress level. Clinically, when I see a norepinephrine level between 275-1400, stress is high. Symptoms and signs such a person may exhibit include: insomnia, anxiety, irritability, impaired attention, hypertension, etc.
Epinephrine can give me an indication of whether or not the sympathetic nervous system and adrenal glands are connected. The sympathetic neuron that connects to the adrenal medulla connects via a serotonin signal – not norepinephrine as in the rest of the sympathetic nervous system. This serotonin signal is impaired in certain conditions including diabetes and insulin resistance. In this case, Epinephrine is low (e.g. < 20 pg/mL). This may then reduce norepinephrine signaling via the adrenal medulla versus the central nervous system via the Locus Ceruleus. Such a person, for example, may be very stressed, feels wired, but has low blood pressure and feels exhausted. It is as if the transmission was disconnected from the engine.
Dopamine, unfortunately, has turned out to be an unreliable signal to measure in plasma and urine. The problem is that the sympathetic neurons and ganglia (bundles of nerves along the sympathetic nervous system chain that parallels the spine, of which the adrenal medulla is one), all leak dopamine when they try and produce norepinephrine. Dopamine is a precursor to norepinephrine. Thus it turns out this cannot correlate with central nervous system dopamine signaling since most of it is leakage from norepinephrine neurons. This is also the case with urine dopamine tests.
An indirect test of dopamine signaling is a Prolactin level. When dopamine is low, Prolactin is released, and vice versa. The question I haven’t worked on yet is how much variation is there in Prolactin level between persons. If there is little variation, then Prolactin can be used to determine dopamine signaling. If there is a large variation, then it can’t be used as a screening test. It would then only useful for individual persons to see variation in Prolactin levels depending on manipulation of dopamine.
Thank you.
Does low dopamine with high norepinephrine suggest the low dopamine result is fairly accurate?
Do you boost epinephrine if it is low and norepinephrine is high?
@bulldogsandbruins 765 wrote:
Thank you.
Does low dopamine with high norepinephrine suggest the low dopamine result is fairly accurate?
Do you boost epinephrine if it is low and norepinephrine is high?
Low dopamine and high norepinephrine does not suggest a level of dopamine signaling in the nervous system. The dopamine is always accurate. The problem is where does it come from – central nervous system (the value desired) or body (not desired). Since much of dopamine is leakage from norepinephrine neurons, this makes central nervous system dopamine difficult to assess. I currently assess it based on the history and physical exam. Prolactin may help but I haven’t yet standardized it to behavior, it that is possible at all.
I would not generally not boost epinephrine if it is low. That would increase heart rate, blood pressure, anxiety, premature ejactulation, insomnia, etc. If there is a need to do this specifically and in a targetted fashion, such as if one has asthma in order to open the airway passages, then an artificial epinephrine/norepinephrine is given via inhalers.
@DrMariano 766 wrote:
The dopamine is always accurate. The problem is where does it come from – central nervous system (the value desired) or body (not desired). Since much of dopamine is leakage from norepinephrine neurons, this makes central nervous system dopamine difficult to assess. .
Thank you and last question.
Can a low dopamine reading be incorrect? OR Does this mean a low dopamine reading is correct however normal and high dopamine readings need further investigation?
@bulldogsandbruins 769 wrote:
Thank you and last question.
Can a low dopamine reading be incorrect? OR Does this mean a low dopamine reading is correct however normal and high dopamine readings need further investigation?
A high dopamine reading needs further investigation. It may mean the presence of a pheochromacytoma. But then, norepinephrine should be elevated as well. Generally, the levels have to be above 3 times normal to be concerned about this form of cancer.
If dopamine is very low, but norepinephrine is high, it does bring up the question of whether this central nervous system is low in dopamine signaling. The problem is that there is contamination to an unknown extent by dopamine from leakage from norepinephrine neurons.
Currently, there is no way to differentiate the source of dopamine, even via the use of dopamine’s metabolites.
What would it mean if plasma NE is high but urinary NE is low/normal? Are the urinary metabolites accurate and meaningful?
@leanguy 812 wrote:
What would it mean if plasma NE is high but urinary NE is low/normal? Are the urinary metabolites accurate and meaningful?
The tests for catecholamines are designed primarily to answer the question: Is there cancer, i.e. a pheochromocytoma?
When doing work to optimize signaling and health – mental and/or physical via medication, hormone, nutritional, or behavioral treatment, a different question is asked: What can be determine via these labs about behavior or function near physiologic limits?
Thus, the interpretation has to be recalibrated. We aren’t looking, for example, for norepinephrine at over three times the upper reference range. We are looking at lower levels then determining how they apply to what we see on exam of the patient.
When it comes to behavior, an important factor is to see if the test allows one to determine what central nervous system function is like. In our present case, dopamine levels do not tell us much about central nervous system function since so much of dopamine is interference from leakage from norepinephrine neurons. Norepinephrine levels, however, are useful.
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If plasma norepinephrine is high, yet urinary norepinephrine is lower, then I would ask the question: Has some of that norepinephrine been metabolized/destroyed in the process of forming urine? After all, the kidneys are a very active metabolic organ. The kidneys produce many enzymes which metabolize various substances. Like the liver, the kidneys function as a signal ender for some signals and a signal activator for others.
Urinary metabolites are accurate. They give you a consistent number. The question is not of accuracy. The question is whether or not the result is meaningful.
When it comes to urinary metabolites of the catecholamines, unfortunately, I have yet to see any meaning in them as it applies to behavior which is different from examining Norepinephrine, Dopamine, and Epinephrine directly. Both Monoamine Oxidase and Catechol-O-Methyltransferase are in the central nervous system AND body. Thus, the metabolites don’t tell where they come from. I’d love to have someone show me something different. Please, pretty please with sugar on it. 🙂
@DrMariano 813 wrote:
Urinary metabolites are accurate. They give you a consistent number. The question is not of accuracy. The question is whether or not the result is meaningful.
When it comes to urinary metabolites of the catecholamines, unfortunately, I have yet to see any meaning in them as it applies to behavior which is different from examining Norepinephrine, Dopamine, and Epinephrine directly. Both Monoamine Oxidase and Catechol-O-Methyltransferase are in the central nervous system AND body. Thus, the metabolites don’t tell where they come from. I’d love to have someone show me something different. Please, pretty please with sugar on it. 🙂
Dr. M to me urine levels dont help so much decide whether i had high norepinephrine or not, since suffering from irritable bowel syndrome, makes it difficult to excrete all the available urine. Somedays i do, someother days when there is heavier bowel continence this becomes a very inaccurate method. I did several urinetests and found really inconsistent results, (despite the fact that i new norepinephrine levels where ultra high – i couldnt watch tv for more than 2-3 minutes at that time, thats how stress i was)
Then i read about plasma catecholamine levels and found a lab in the other side of my ocuntry to measure them. They didnt do the tests correctly though since i was supposed to
-have them levels measured with a catheter installed rather than poking me every time
-didnt do all the necessary steps of testing (only did 2 out of 4). One measurement came after relaxing for someminutes laying down on a bed, the second after running on a threadmill with fast pace (i managed to run 5-6 minutes before collapsing-really docs where shocked they said i suffer from a strange type of sympatheticotonia)- and instead of taking the second measurement while on my feet after doing the threadmill run they made me lie down again????? (for what i didnt understand) and then 1 minute later they took the measurement. But my major problem back at that time was that i couldnt STAND or WALK. When i laid down i felt better i tried to explain they couldnt get the point. Experienced labs are crucial in helping you in such cases.Nevertheless plasma levels in both instances (lying and after exercise) where quite higher than the highest normal range.
I guess if i did the measurement after standing on my feet for 5 minutes or so (which was impossible to do due to exhaustion) the norepinephrine level would be shocking
*Lately though i have something different, and so surprised how my body changes. My last relapse, after drinking 1 cup of coffee 3 days in a row caused me to have very weak pulse when walking. That wasnt the case before. I suspect epinephrine or and norepinephrine values are low now, but wouldnt that affect my blood pressure more?? My pulse rate drops when i walk around or when i try to run and i feel dead exhausted. Maybe i exhausted my adrenal medullary signals.
Your writings are so accurate, i couldnt find these sort of issues anywhere else being discussed.
Have you read through hose twobooks in the past, i think they have very valuable regarding Brain, MEtabolism, Hormones and Chronic Fatigue.
-Hormones Brain and Behaviour
-Tuning the Brain- Principles and Practices of neurosomatic medicine
[url]http://www.infibeam.com/Books/info/Jay-A-Goldstein/Tuning-the-Brain-Principles-and-Practice-of/078902246X.html
[/url]@Shaolin 834 wrote:
*Lately though i have something different, and so surprised how my body changes. My last relapse, after drinking 1 cup of coffee 3 days in a row caused me to have very weak pulse when walking. That wasnt the case before. I suspect epinephrine or and norepinephrine values are low now, but wouldnt that affect my blood pressure more?? My pulse rate drops when i walk around or when i try to run and i feel dead exhausted. Maybe i exhausted my adrenal medullary signals.
It would be unusual for the heart rate to drop when exercising. I would wonder if the person having this problem should see a cardiologist to determine if their is a cardiac problem involved.
@bulldogsandbruins 880 wrote:
Where do you like to see serum Norepinephrine within the range?
Top, middle, bottom?
Under 275, preferably in the middle.
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