Epinephrine, also known as adrenaline, is usually associated with thrillseekers and provides incredible strength during times of crisis. What can be learned from testing epinephrine levels in the urine? Find out what results are considered normal and the effects of having too much or too little epinephrine.<\/p>\n
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Epinephrine, also called adrenaline, is a hormone and neurotransmitter. It plays an important role in the sympathetic nervous system, which is responsible for the body\u2019s \u201cfight or flight<\/strong>\u201d response [R<\/a>].<\/p>\n The effects of epinephrine include increased heart rate<\/a>, breathing rate, and blood flow to the muscles, to name a few. For this reason, it is also used as a medication for several conditions, such as cardiac arrest, serious allergic reactions, and asthma [R<\/a>, R<\/a>, R<\/a>, R<\/a>].<\/p>\n Epinephrine belongs to a group of neurotransmitters called catecholamines<\/strong>, which also includes norepinephrine<\/a> and dopamine<\/a> [R<\/a>].<\/p>\n The adrenal glands make most of the epinephrine in the body, but small amounts are also produced in other tissues, like some neurons and the kidneys [R<\/a>].<\/p>\n You can have your epinephrine levels checked by performing a urine test. Doctors will typically check the levels of all your catecholamines (epinephrine, norepinephrine, and dopamine) in the same test [R<\/a>].<\/p>\n This test is primarily used to help diagnose pheochromocytoma and neuroblastoma, two rare types of cancerous tumors. These tumors affect the adrenal gland, causing it to release too many catecholamines [R<\/a>, R<\/a>].<\/p>\n There are two ways to perform an epinephrine urine test.<\/p>\n In the 24-hour urine test<\/strong>, you must collect all the urine produced over a 24 hour period. This is the test normally used to diagnose tumors [R<\/a>].<\/p>\n The second method is called a \u201cspot\u201d or \u201crandom\u201d urine test<\/strong>. This kind of test uses a single urine sample that is obtained at a specific time [R<\/a>].<\/p>\n Results for the 24-hour test are reported back as a number in units of mcg\/24h (micrograms in a twenty-four-hour period or ug\/24h).<\/p>\n The random urine test is reported in units of mcg\/g crt (micrograms per gram of creatinine<\/a>, a waste product used to measure kidney function). These values reflect the amount of epinephrine detected in the urine.<\/p>\n Some people believe that epinephrine urine tests can help identify certain adrenal conditions like chronic stress<\/a> and adrenal fatigue<\/a> [R<\/a>].<\/p>\n However, little evidence currently supports testing for this reason<\/strong>. The problem is that epinephrine levels can vary wildly throughout the day<\/strong>, due to factors like stress, physical activity, and diet [R<\/a>, R<\/a>].<\/p>\n Another issue is that urine tests do not accurately reflect the epinephrine levels in the brain or in other areas of the body<\/strong>. In fact, much of the epinephrine found in the urine is made (and soon after excreted) by the kidneys, making it difficult to apply these results to the rest of the body [R<\/a>].<\/p>\n Thus, epinephrine urine testing is not currently very useful outside of diagnosing adrenal tumors.<\/p>\n Your epinephrine levels will naturally fluctuate throughout the day. Normal ranges can also vary slightly depending on the lab.<\/p>\n For the 24-hour urine test, values below 20 mcg\/24h are considered normal<\/strong> [R<\/a>].<\/p>\n For the random urine test, values below 19 mcg\/g crt are considered normal<\/strong> [R<\/a>].<\/p>\n Your body should produce some epinephrine throughout the day, but the optimal lower limit is unknown and there are no known health conditions associated with lower epinephrine levels.<\/p>\n The epinephrine urine test is uncommon and typically performed only to check for rare types of tumors. For this reason, few studies have investigated its extended implications. Due to the unclear lower limit, test results are usually considered normal as long as they are below a certain level.<\/p>\n Causes shown here are commonly associated with high epinephrine. Work with your doctor or other health care professional for an accurate diagnosis.<\/p>\n Epinephrine levels naturally shoot up during stressful moments. This is because the body is hardwired to quickly respond to perceived threats by activating the fight or flight response [R<\/a>].<\/p>\n This spike in epinephrine increases heart rate, breathing rate, and blood flow to the muscles, allowing for quick movement. These effects also provide the thrilling rush that adrenaline junkies look for [R<\/a>].<\/p>\n Both physical and mental stress will trigger this response<\/strong>. For example, being startled (mental stress) and playing sports (physical stress) can both increase epinephrine levels [R<\/a>, R<\/a>, R<\/a>].<\/p>\n Chronic stressors, such as job-related stress, can lead to constantly elevated levels of epinephrine. This, in turn, can lead to stress-related illnesses such as heart disease and diabetes<\/strong> [R<\/a>, R<\/a>, R<\/a>].<\/p>\n Epinephrine plays a major role in adapting to exercise<\/a>. And it makes sense: epinephrine promotes blood flow to the muscles and opens up the airways [R<\/a>].<\/p>\n During exercise, epinephrine levels can increase by 1.5 to over 20 times <\/strong>[R<\/a>]!<\/p>\n Some studies show that men experience a greater spike in epinephrine during exercise than women. Age is also a factor; older people release less epinephrine in response to exercise [R<\/a>].<\/p>\n Exercise duration and intensity affect increases in epinephrine. In general, longer and more intense activity will cause a greater increase in epinephrine levels<\/strong> [R<\/a>].<\/p>\n Interestingly enough, training experience is a significant factor as well. For example, trained athletes experience greater increases in epinephrine compared to untrained people, even when performing the same exercise [R<\/a>].<\/p>\n The body has several ways to prevent blood sugar (glucose<\/a>) levels from dipping too low. One of these mechanisms is the release of epinephrine into the blood. Epinephrine stimulates glucose production in the liver, while also reducing insulin<\/a> secretion [R<\/a>, R<\/a>].<\/p>\n In a study of 31 people, low glucose levels triggered epinephrine release in both diabetics and non-diabetics<\/strong> [R<\/a>].<\/p>\n People with type 1 diabetes are especially dependant on epinephrine release to avoid dangerous drops in blood sugar (hypoglycemia) [R<\/a>].<\/p>\n Interestingly, patients whose diabetes is better managed (defined as having HbA1c<\/a> below 10%) have less dramatic increases in epinephrine [R<\/a>].<\/p>\n Low oxygen supply, also known as hypoxia<\/a>, triggers an increase in epinephrine, which opens up the airways and increases breathing rate [R<\/a>].<\/p>\n A great example of this process takes place during exercise. When a person reaches 30% of their VO2<\/sub> max (the maximum amount of oxygen a person can use) during exercise, their epinephrine levels start to increase<\/strong> [R<\/a>].<\/p>\n Another example is in sleep<\/a> apnea, a condition that interrupts breathing during sleep. A study in 96 children with sleep apnea found that those with more severe breathing symptoms have higher levels of epinephrine in their urine<\/strong> [R<\/a>].<\/p>\n Other low-oxygen circumstances that may trigger epinephrine release include high altitudes and injuries to the heart, such as heart attacks or heart failure [R<\/a>, R<\/a>].<\/p>\n Catecholamine urine tests (including the epinephrine test) are primarily used to help diagnose tumors of the adrenal glands [R<\/a>, R<\/a>].<\/p>\n Pheochromocytoma and neuroblastoma are two rare types of cancerous tumors that cause the adrenal gland to release too much epinephrine. One study found that the average urine epinephrine level in people with pheochromocytoma was about 167 mcg\/24h: over 8 times the normal value<\/strong> [R<\/a>, R<\/a>, R<\/a>].<\/p>\n However, in these kinds of tumors, the release of catecholamines is not consistent. A urine test may miss a diagnosis if the tumor is not releasing catecholamines near the time of testing<\/strong> [R<\/a>, R<\/a>].<\/p>\n To compensate, doctors test for catecholamine metabolites as well. Tumors more consistently make these metabolites, so their levels are consistently elevated [R<\/a>, R<\/a>].<\/p>\n For example, according to one study, the epinephrine tests accurately identified pheochromocytoma in about 79% to 91% of cases. Metanephrine tests (a metabolite of epinephrine) were more sensitive, picking up 96% to 97% of these tumors [R<\/a>].<\/p>\n The pattern is the same when diagnosing neuroblastoma: metabolites like metanephrine are better for detecting the disease than the catecholamines [R<\/a>].<\/p>\n Post-traumatic stress disorder (PTSD<\/a>) can develop as a result of any traumatic event, such as a car accident or a war-related experience. Chronic stressors, like childhood neglect or domestic violence, can also lead to PTSD [R<\/a>].<\/p>\n Research suggests that people affected by PTSD may have elevated catecholamines, including epinephrine [R<\/a>].<\/p>\n In one study, people with PTSD had average epinephrine urine levels of about 23 mcg\/24h, which is only slightly above normal<\/strong>. By comparison, the average epinephrine urine levels are much lower in other psychiatric disorders like depression<\/a> and schizophrenia (13 and 15 ug\/24h, respectively) [R<\/a>].<\/p>\n The PTSD-related rise in epinephrine may be persistent. A 10-year study of 292 people discovered that people who no longer felt PTSD symptoms still had higher epinephrine levels years later<\/strong>. But according to another study, the epinephrine levels of asymptomatic patients were lower than in people who still experienced symptoms [R<\/a>, R<\/a>]<\/p>\n Trauma doesn\u2019t always lead to PTSD. According to one study, people who go through severe trauma but don\u2019t develop PTSD have lower-than-normal urine levels of epinephrine<\/strong> [R<\/a>].<\/p>\n Some researchers have suggested that lower epinephrine may reduce the importance of the traumatic event in the brain, thus preventing PTSD in a subset of people [R<\/a>].<\/p>\n According to their hypothesis, a surge in stress hormones can fixate a traumatic experience into long-term memory, forming a sort of \u201cmemory scar.\u201d At the time of trauma, high-stress hormones target the hippocampus, the brain\u2019s hub for memory and emotions. They tell the brain: \u201cThis is important, don\u2019t forget it.\u201d Lacking the signal from stress hormones, the researchers suggest, the bad memories may not stick around as much [R<\/a>, R<\/a>].<\/p>\n Researchers are looking into therapies that might help people overcome PTSD by lowering stress hormones like epinephrine and norepinephrine [R<\/a>, R<\/a>].<\/p>\n Eclampsia is a pregnancy complication whereby the expectant mother experiences seizures due to high blood pressure [R<\/a>].<\/p>\n Epinephrine levels may increase during eclampsia and worsen the seizures. In one study of 36 pregnant women, those with eclampsia had much higher epinephrine upon hospital admission<\/strong>. Levels returned to normal about 6 days after delivery [R<\/a>, R<\/a>].<\/p>\n Cigarettes can cause several hormones, including epinephrine, to spike just 15 minutes after smoking [R<\/a>].<\/p>\n Smoking increased epinephrine levels in the urine by 50%<\/strong> in one small study of 15 people [R<\/a>].<\/p>\n Gender may also be a factor. For instance, in a study of 70 smokers, epinephrine increased more in men than in women [R<\/a>].<\/p>\n Drinking coffee<\/a> can raise epinephrine levels. In a study of 30 people, participants\u2019 blood levels of epinephrine increased by about 260% after drinking coffee<\/strong>. According to another study, urine epinephrine levels follow the rise in blood levels [R<\/a>, R<\/a>].<\/p>\n A number of common medications can increase epinephrine levels in the urine, including:<\/p>\n These are only a few examples. Your doctor will advise you on what medications to stop, if any, prior to testing.<\/p>\n High epinephrine is associated with a number of potentially harmful health effects. If you believe that chronic stress or other conditions are causing you to have high epinephrine, talk to your doctor about your options for stress reduction and to rule out any underlying conditions.<\/p>\n Stress, both physical and mental, is closely tied to the immune system [R<\/a>].<\/p>\n The body releases hormones, like epinephrine and cortisol<\/a>, in response to stressful situations. Among other functions, these stress hormones activate the immune system. They are meant to protect the body from infection and enhance wound healing, in case you get injured [R<\/a>].<\/p>\n This defense mechanism starts to malfunction if you constantly face stress. Chronic elevations in stress hormones may cause inflammation and weaken the immune system<\/strong>. Stress hormones can reduce the activity of natural killer (NK) cells<\/a>, the number of lymphocytes<\/a>, and the production of antibodies [R<\/a>, R<\/a>].<\/p>\n On the other hand, stress increases inflammatory factors like interleukins 6 and 1b (IL-6<\/a> and IL-1b<\/a>) [R<\/a>].<\/p>\n High-stress hormones may also reduce the body\u2019s response to vaccines and reactivate old, dormant viral infections [R<\/a>, R<\/a>].<\/p>\n Epinephrine causes the heart to pump faster in times of stress. This response is useful because it increases blood flow to the brain and muscles and allows for quick action [R<\/a>].<\/p>\n However, constantly elevated levels of epinephrine may strain the heart. For example, long-term stress is linked to high blood pressure<\/strong> [R<\/a>].<\/p>\n Increased levels of catecholamines like epinephrine may lead to stress cardiomyopathy<\/strong>, a condition that causes heart muscle overgrowth and weakness [R<\/a>].<\/p>\n Stress and chronically elevated epinephrine levels are associated with worse cancer prognosis [R<\/a>, R<\/a>].<\/p>\n One animal study found that rats with more epinephrine have faster leukemia progression<\/strong> [R<\/a>].<\/p>\n On top of that, epinephrine causes cancer cells to be more resistant to apoptosis (cell death)<\/strong>, according to a study on human ovarian cancer cells [R<\/a>].<\/p>\n High levels of epinephrine can also increase oxidative stress<\/a> and DNA damage. One cell study found that just 30 minutes of exposure to epinephrine can produce five times more DNA damage<\/strong> compared to unexposed cells. DNA damage can activate tumor-promoting genes and turn healthy cells into cancerous ones [R<\/a>].<\/p>\n Epinephrine from stress may be naturally reduced by following certain lifestyle, diet, or supplement strategies; however, if you have a high epinephrine test result, these strategies may not be appropriate. Talk to your doctor before making significant changes, and never use these strategies in place of something your doctor recommends.<\/p>\n It\u2019s normal for your body to experience spikes in epinephrine throughout the day, depending on your activity [R<\/a>].<\/p>\n However, long-term elevations of epinephrine can have harmful effects on health. The most common culprit behind chronically-high epinephrine is stress [Epinephrine Urine Test<\/strong><\/span><\/h2>\n
Diagnosing Rare Tumors<\/strong><\/span><\/h3>\n
Other Reasons for Testing<\/strong><\/span><\/h3>\n
Normal Levels<\/strong><\/span><\/h3>\n
Limitations<\/strong><\/span><\/h3>\n
High Epinephrine Levels<\/strong><\/span><\/h2>\n
Causes<\/strong><\/span><\/h3>\n
1) Stress<\/strong><\/h4>\n
2) Exercise<\/strong><\/h4>\n
3) Low Blood Sugar<\/strong><\/h4>\n
4) Low Oxygen Supply<\/strong><\/h4>\n
5) Adrenal Gland Tumors<\/strong><\/h4>\n
6) PTSD<\/strong><\/h4>\n
Why Trauma Doesn\u2019t Always Lead to PTSD<\/strong><\/h5>\n
7) Eclampsia in Pregnancy<\/strong><\/h4>\n
8) Smoking<\/strong><\/h4>\n
9) Coffee<\/strong><\/h4>\n
10) Drugs<\/strong><\/h4>\n
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Effects of High Epinephrine<\/strong><\/span><\/h3>\n
1) Immune System<\/strong><\/h4>\n
2) Heart Disease<\/strong><\/h4>\n
3) Cancer Growth<\/strong><\/h4>\n
Ways to Decrease Epinephrine<\/strong><\/span><\/h3>\n
1) De-stress<\/strong><\/h4>\n