Total Metanephrines, 24-Hour Urine
The combined amount of metanephrine and normetanephrine in your urine over 24 hours. Doctors use it to look into adrenal gland tumors.
AI-verified against cited sources. Awaiting expert reviewLOINC 2609-6
Check your result
The usual range for Total metanephrines depends on sex. Choose female or male above to see where you stand.
Nothing you type here leaves your browser.
What it is
Total metanephrines is the combined amount of metanephrine and normetanephrine in a 24-hour urine collection. Metanephrine comes from epinephrine (adrenaline) and normetanephrine comes from norepinephrine. Some labs print the total as a third line under the two separate results. Older tests could only measure the combined total, and the separate results can give more detail.
Why it matters
Doctors mostly use this test when they are looking into rare tumors of the adrenal glands or nearby nerve tissue, called pheochromocytoma and paraganglioma. These tumors can release extra adrenaline-type hormones and cause spells of high blood pressure, headache, sweating and a pounding heartbeat. Because these tumors are rare, most mildly raised results turn out to have another cause. People with high blood pressure often have slightly higher results than people without it.
If it’s low
A total below your lab's range is less often useful for this test than a high one. The most common reason is a collection that missed some urine, which makes the total look smaller than it really was.
Common causes
- A collection that was incomplete or shorter than 24 hours
- Medicines that block the body's production of adrenaline-type hormones, such as metyrosine
What can help
- Check that all the urine was collected and handed in, with the start time, end time and total volume written down
- Ask your clinician whether the collection looks complete
If it’s high
A total above your lab's range means more of these hormone breakdown products than usual passed into your urine. Most of the time the cause is not a tumor. Medicines, caffeine, smoking, hard exercise, stress, illness, high blood pressure and imperfect collections are more common reasons. Mayo Clinic Laboratories notes that totals up to 1,300 µg/24 h can be seen in people with high blood pressure who do not have a tumor. It treats totals above 1,300 µg/24 h (about twice the upper limit) as a reason to look further. Your clinician can put your number in context.
Common causes
- Medicines such as tricyclic antidepressants, SNRI antidepressants, MAO inhibitors, labetalol, sotalol, decongestants and stimulants
- Caffeine and tobacco
- Hard exercise, emotional or physical stress, or a serious illness
- High blood pressure itself, which can raise results slightly
- A collection that did not follow the lab's instructions
- Rarely, a tumor of the adrenal gland or nearby nerve tissue that makes adrenaline-type hormones
What can help
- Bring a list of every medicine, supplement and stimulant you use, including cold remedies, caffeine and tobacco, to your visit
- Ask which of them could affect this test and whether anything should change before a repeat. Don't stop any medicine on your own
- Ask your lab for written collection instructions and follow them, including the right container and any limits on caffeine or exercise
Usual ranges
What labs print as the reference range, by who was tested. Ranges differ a little between labs, so the range on your own report is the one your result is judged against.
The usual range depends on sex and age. Choose women or men to see the one that applies.
- Men, 18–29190–583 µg/24 h
Source: Mayo Clinic Laboratories
- Men, 30–39200–614 µg/24 h
Source: Mayo Clinic Laboratories
- Men, 40–49211–646 µg/24 h
Source: Mayo Clinic Laboratories
- Men, 50–59222–680 µg/24 h
Source: Mayo Clinic Laboratories
- Men, 60–69233–716 µg/24 h
Source: Mayo Clinic Laboratories
- Men, 70+246–753 µg/24 h
Source: Mayo Clinic Laboratories
- Women, 18–29142–510 µg/24 h
Source: Mayo Clinic Laboratories
- Women, 30–39149–535 µg/24 h
Source: Mayo Clinic Laboratories
- Women, 40–49156–561 µg/24 h
Source: Mayo Clinic Laboratories
- Women, 50–59164–588 µg/24 h
Source: Mayo Clinic Laboratories
- Women, 60–69171–616 µg/24 h
Source: Mayo Clinic Laboratories
- Women, 70+180–646 µg/24 h
Source: Mayo Clinic Laboratories
See Total metanephrines by age and sex, with the U.S. survey numbers where they exist.
What can affect your result
- Age and sex: Mayo's adult limits rise with age and are lower in women
- Medicines, caffeine, tobacco, hard exercise and stress around the collection
- A full, correctly timed 24-hour collection in the container and preservative your lab provides
- Blood pressure: people with high blood pressure often have slightly higher results
- Kidney function: reduced kidney function changes how much of these substances reaches the urine, so urine results are harder to interpret and doctors sometimes rely on a blood test instead
- The lab and method: older color-based tests and newer mass spectrometry tests do not give the same numbers
- Tricyclic antidepressants, SNRI antidepressants, MAO inhibitors, labetalol, sotalol, decongestants, stimulants and levodopa can raise results.
- Caffeine, tobacco and strenuous exercise during the collection can raise results.
- A collection that is incomplete, or runs longer than 24 hours, changes the total. Labs differ on preservatives: Mayo prefers boric acid or acetic acid, while Quest rejects urine collected with boric acid. Use the container and instructions from the lab that will run your test.
- Older color-based (Pisano) methods that measured only the total were disturbed by many drugs. Mass spectrometry (LC-MS/MS) is not, according to Mayo.
Reflects what your body made over the 24 hours collected.
When to talk to a clinician
Talk with your clinician about any result your lab flags, especially one that is above 1,300 µg/24 h or about twice the upper limit, or if you also have repeated spells of pounding heartbeat, severe headache and sweating with high blood pressure. If you feel unwell, for example with chest pain, trouble breathing, confusion or fainting, call 911 or your local emergency number.
Questions you could ask
- Why was this test ordered for me?
- Is there anything I should avoid before a repeat collection?
- Could any of my medicines, caffeine, tobacco or recent stress explain this result?
- Which part is higher, metanephrine or normetanephrine, and does that matter?
- Was my collection complete and done the way the lab asked?
- Could my collection have been incomplete?
Questions people ask
Why does my report show a total and two separate results?
The total adds metanephrine and normetanephrine together. The two parts show which one is raised, which can matter because everyday causes tend to raise normetanephrine more than metanephrine. Ask your clinician how they read the pieces.
What is the 1,300 number I see on some reports?
Mayo Clinic Laboratories notes that totals up to 1,300 µg/24 h can be seen in people with high blood pressure who do not have a tumor. Above that, which is about twice the upper limit, clinicians usually look further. Your own lab's wording may differ.
Can I convert my total to nmol/24 h?
Not with one factor, because the total is two different molecules. Convert each part on its own, multiplying µg/24 h by 5.07 for metanephrine and by 5.46 for normetanephrine, then add them.
Show the science and sources
For clinicians and researchers
Total metanephrines is the sum of metanephrine and normetanephrine. Quest lists 'Metanephrine, Normetanephrine, Total Metanephrines' as the contents of its fractionated 24-hour test, and Mayo reports total metanephrines as a separate result with its own age- and sex-specific interval. Older assays measured only the total with a spectrophotometric (Pisano) reaction that was disturbed by diatrizoate, chlorpromazine, hydrazine derivatives, imipramine, MAO inhibitors, methyldopa, phenacetin, ephedrine and epinephrine; LC-MS/MS avoids these. Mayo's interpretive text sets hypertensive limits of 1,300 µg/24 h for the total, 400 for metanephrine and 900 for normetanephrine. Totals of 1,300 or lower occur in hypertensive patients without a tumor, and totals above 1,300 (about twice the upper limit of normal) warrant further clinical investigation. Below 1,300, further work-up may still be indicated if either fraction exceeds its hypertensive limit. A total hides which fraction is raised, and drug and sympathetic effects mostly raise normetanephrine, so the fractions are read individually. Per-day results assume a complete 24-hour collection.
LOINC 2609-6 (primary), 104630-9. Specimen: urine-24h.
Sources
- Metanephrines, Fractionated, 24 Hour, Urine (test METAF), Mayo Clinic Laboratories
- Metanephrines, Fractionated, LC/MS/MS, 24-Hour Urine (test 14962), Quest Diagnostics
- Pheochromocytoma and Paraganglioma: An Endocrine Society Clinical Practice Guideline, Journal of Clinical Endocrinology & Metabolism (2014)
- Pitfalls in the Diagnostic Evaluation of Pheochromocytomas, Journal of the Endocrine Society (2024)
AI-verified against cited sources. Awaiting expert review. Last reviewed 2026-10-03. How we build and check these pages.