Medical Oncologist
CION Cancer Clinics
Metanephrine testing for paraganglioma, in plain language | CION Cancer Clinics
Metanephrines are the breakdown products of adrenaline and noradrenaline, and measuring them in blood or urine is the main screening test for a hormone-releasing paraganglioma or phaeochromocytoma. This page explains which test you may be offered, how to prepare so the result is reliable, why a raised result is often a false alarm, and why a normal one does not remove the need for scans. At CION Cancer Clinics, our oncologists plan screening and care for families with an inherited cancer syndrome, explained in plain words.
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Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed September 2026, next review due September 2027
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The short answer
What are metanephrines, and why are they measured?
Metanephrines are what adrenaline and noradrenaline break down into. Paragangliomas and phaeochromocytomas often make these hormones and break them down inside the tumour, so metanephrines leak into the blood steadily, even between attacks. Measuring them in blood or urine is the most reliable first test for a hormone-releasing tumour.
Why not measure adrenaline itself?
Adrenaline levels jump with fear, exercise, pain and even the needle prick. Tumours also release it in bursts, so a single reading can easily be normal or misleadingly high. Metanephrines are far steadier, which makes them better at telling a real tumour from an ordinary stressful morning.
What the test can and cannot find
It is very good at finding tumours that release hormones. Many head and neck paragangliomas, and some tumours linked to SDHB, release little or nothing. A normal result does not rule those out, which is why screening for gene carriers always pairs this test with scans.
The blood test and the scan answer different questions. Carriers need both.The tests you may be offered
Blood, urine, or both?
Your team chooses based on what the laboratory offers and what your gene tends to produce.
Blood metanephrines
Often called plasma free metanephrines. A single blood sample, ideally taken after you have been lying down quietly for about half an hour. It is the most sensitive test and the one most guidelines prefer.
Urine metanephrines
You collect every drop of urine for a full day and night in a container the laboratory gives you. It is a good choice when a lying-down blood sample cannot be arranged.
To get it right
- Throw away the first urine of the starting morning
- Collect everything after that, including the next morning's first
- Keep the container cool and return it promptly
Methoxytyramine
The breakdown product of dopamine. It can pick up tumours that make dopamine rather than adrenaline, which is more common with SDHB and head and neck tumours. Not every laboratory offers it yet.
Chromogranin A
A general marker sometimes added to the panel. It is less specific. Kidney problems and common acid-reducing tablets can raise it, so it is read alongside the other results, never on its own.
Not sure whether this applies to you?
Ask an oncologistBefore and after the sample
How do you prepare, and what happens next?
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Share your full medicine list
Certain antidepressants, some Parkinson's medicines, cold remedies with decongestants and some blood pressure medicines can push results up. Do not stop anything yourself. Your doctor will tell you what, if anything, to pause.
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Avoid the usual triggers beforehand
You will usually be asked to avoid coffee, tea, smoking and heavy exercise before the test, and often to fast overnight for the blood sample.
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The sample is taken
For blood, you lie down, a small tube is placed in a vein, and the sample is drawn after a rest. Sitting upright can raise results slightly, which is why position matters.
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The result is compared with the normal range
A result just above the upper limit is often a false alarm. A result several times higher is much more likely to mean a tumour.
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A raised result leads to a repeat or a scan
Borderline results are usually repeated under stricter conditions. Clearly raised results lead to imaging to find where the hormones are coming from.
On your lab report
The words you will see, in plain language
- Metanephrine
- The breakdown product of adrenaline. Raised mainly by tumours in the adrenal gland.
- Normetanephrine
- The breakdown product of noradrenaline. Often the one raised in SDH gene carriers.
- Methoxytyramine
- The breakdown product of dopamine. Useful for tumours that make little adrenaline.
- Plasma free metanephrines
- The blood version of the test. "Plasma" is simply the liquid part of the blood.
- Upper reference limit
- The top of the normal range for that laboratory. Different laboratories use slightly different ranges.
- False positive
- A raised result when no tumour is present. It is common with this test, and is why borderline results are repeated.
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One thing that cannot wait
If you carry one of these gene faults and suddenly get a severe headache with a pounding heart and heavy sweating, especially with chest pain, blurred vision or very high blood pressure, go to the nearest emergency department the same day. Tell them a paraganglioma or phaeochromocytoma is known or suspected. Some anti-sickness medicines and steroid injections can set off these attacks, so mention your gene result before any procedure.
Being straight with you
What this page cannot tell you
It cannot tell you what your own numbers mean. A result sits in the context of your gene, your medicines, how the sample was taken and your previous results. The endocrinologist or oncologist who ordered it is the right person to read it, ideally with your earlier reports beside them.
It cannot interpret your gene result
What your specific variant means is a question for the counsellor who ordered the test. That also decides how often you need this blood test, and when scans are added.
Who this does not apply to
Most people with high blood pressure do not need metanephrine testing. It is meant for people with symptoms that suggest a hormone-releasing tumour, people with an adrenal lump found on a scan, and carriers of a known gene fault. If none of those apply to you, your blood pressure is far more likely to have an ordinary cause.
Keep every result in one folder. A trend over years tells your doctor more than any single number.Commonly believed
Four things patients tell us about this test
"My metanephrines are normal, so I have no tumour."
You have no tumour releasing enough hormone to show up. Some tumours, especially in the head and neck, release very little. That is why carriers also have scans.
"A raised result means I definitely have a tumour."
Mildly raised results are often caused by medicines, stress or sitting upright during the sample. They are usually repeated before anyone orders a scan.
"I should stop my blood pressure tablets before the test."
Never stop them on your own. Stopping some medicines suddenly can be dangerous. Your doctor will say whether anything needs pausing, and for how long.
"I feel fine, so I can skip this year's test."
Many tumours found by screening cause no symptoms at all. Finding one while it is small and quiet usually makes treatment simpler and safer.
Questions we are asked
Common questions about metanephrine testing
Do I need to fast before the blood test?
An overnight fast is usually advised for the blood test, with water allowed. Avoid coffee, tea and smoking that morning. For the urine collection, fasting is not normally needed, but your laboratory may give extra food instructions.
How often do gene carriers need this test?
Usually once a year, alongside scans every few years. The exact schedule depends on your gene and age, and some children start in the early school years. Your counsellor and endocrinologist will set a schedule for you.
Can I give the sample at a lab near my home?
Sometimes. The lying-down blood sample needs a lab that can do it properly and send it to a laboratory that runs the test. Urine collections are easier to arrange locally. Ask your team which option gives reliable results where you live.
How long does the result take?
It depends on the laboratory, because not every centre runs this test in-house and some send samples away. Ask when the sample is taken, and how you will be told the result, so you are not left waiting without news.
What happens if my result is borderline?
Usually the test is repeated, with more careful attention to medicines, fasting and lying down beforehand. Most borderline results turn out normal on repeat. If they stay raised, a scan is arranged.
Can the test tell where the tumour is?
Not directly. The pattern of which breakdown product is raised gives clues. A raised metanephrine points towards the adrenal gland, while normetanephrine or methoxytyramine can suggest a tumour elsewhere. A scan is still needed to find it.
Is this test useful for head and neck tumours?
It is still done, because a hidden hormone-releasing tumour elsewhere must be ruled out before any surgery. But head and neck tumours themselves often give normal results, so they are found and followed mainly with MRI scans.
Is the test covered by insurance or government schemes?
Cover for screening tests varies between private policies and schemes such as Aarogyasri and Ayushman Bharat. It is more often covered when the test is part of treatment. Ask the billing desk before the sample is taken.
Your Specialists
Meet CION's oncologists. Bring your family history or genetic report to them.
Our medical oncologists see people with a strong family history of cancer, arrange genetic counselling and testing where it fits, and plan the checks that follow.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
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Sources
- GeneReviews (NCBI) — Hereditary Paraganglioma-Pheochromocytoma Syndromes
- MedlinePlus — Metanephrines Blood Test
- NHS — Phaeochromocytoma
- National Cancer Institute — Pheochromocytoma and Paraganglioma Treatment (PDQ) - Patient Version
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Hereditary paraganglioma and phaeochromocytoma explainedThe syndrome, the genes and the family pictureImaging surveillance and which scan whenThe scans that pair with this blood testLiving with a lifelong screening programmeKeeping up with yearly tests without it taking overWhy every phaeochromocytoma warrants genetic testingWhy the gene test comes first
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