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Absence of urinary epinephrine, plasma insulin?

Discussion in 'Diagnostic Guidelines and Laboratory Testing' started by A.B., May 26, 2013.

  1. A.B.

    A.B. Senior Member

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    I'm curious if these findings can tell me something about my metabolism. I'm unable to interpret them.

    During a 24-hour urinary catecholamine test, the morning urine had <0.003 mg/L epinephrine, ie. below detection limit.
    The 24-hour value for epinephrine was the same.

    Similarly, a morning blood insulin test showed <2 uUI/mL Insulin, ie. below detection limit. The reference bounds are 4-25.
  2. A.B.

    A.B. Senior Member

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    Is there nobody that can help me with this?
  3. LaurieL

    LaurieL Senior Member

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    The following normal values are the amount of the substance found in the urine over a 24-hour period:
    • Dopamine: 65 - 400 micrograms (mcg)/24 hours
    • Epinephrine: 0.5 - 20 mcg/24 hours
    • Metanephrine: 24 - 96 mcg/24 hours (some laboratories give the range as 140 - 785 mcg/24-hours)
    • Norepinephrine: 15 - 80 mcg/24 hours
    • Normetanephrine: 75 - 375 mcg/24 hours
    • Total urine catecholamines: 14 - 110 mcg/24 hours
    • VMA: 2 - 7 milligrams (mg)/24 hours
    I know high values are associated with pheochromocytoma, and neuroendocrine tumors. I am not aware of what the interpretation might be from 0.03 (yours) to 0.05 (lab parameter), and whether it is negligable.. Nor did you give any of the other values listed above, so I have no direction there either.
    The catacholamines (epinephrine, dopamine, and nor-epi) should be broken down into their respective metabolites, so I am swayed to (I am not a professional) interpret your epinephrine levels as within the low end parameter without the other results. See below...
    • Dopamine becomes homovanillic acid (HVA)
    • Norepinephrine becomes normetanephrine and vanillylmandelic acid (VMA)
    • Epinephrine becomes metanephrine and VMA
    With whom did you have this 24hour urinary test done through?
    LaurieL
    Valentijn likes this.
  4. rlc

    rlc Senior Member

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    Hi A.B. I can't find a good explaination for your low epinephrine levels, however you said

    Low insulin levels are caused by the diseases listed here http://en.diagnosispro.com/differential_diagnosis-for/insulin-level-lab-decreased/10406-153.html I would recomend getting your doctor to make sure that you don't have any of these diseases.

    Hope this helps

    All the best
    A.B. likes this.
  5. A.B.

    A.B. Senior Member

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    Here is the full test:

    Epinephrine: < 0.003 mg/L
    Epinephrine / 24h: ,, ,, mg/24h

    Norepinephrine: 0.020 mg/L
    Norepinephrine / 24h: 0.050 mg/24h

    Dopamine: 0.088 mg/L
    Dopamine / 24h: 0.220 mg/24h


    My GP ordered this test.
  6. roxie60

    roxie60 Senior Member

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    Did your GP offer any insight on the results?
  7. LaurieL

    LaurieL Senior Member

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    What about the metabolites?
  8. A.B.

    A.B. Senior Member

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    They were not measured.
  9. LaurieL

    LaurieL Senior Member

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    Hmmm....interesting. Have you had the snp's panel or the detox panel? What was your ordering docs "reason" for having this test done? You may have to look at the test results, and get the ordering code, its usually circled on the requisition or results page at the top. I am curious as to what code he used, as this will tell me quite a bit. Additionally, what is the history leading up to this and your symptoms? I know, lots of questions, but I don't have enough info, to even feel comfortable in offering you a non-professional observation.

    ** With the additional info you have provided as to your test results, I am now swayed to think that these may not be normal.
  10. taniaaust1

    taniaaust1 Senior Member

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    Your 24-hour urinary catecholamine test may not have been done properly, with that test there should be a certain amount of preservative in the bottle in which you are putting the urine into. Ive found that many places dont know how to do these well, I had mine done 4 times as they said doctors gave me wrong urine bottles with wrong amounts of acid etc etc. It isnt a commonly done test and hence often stuffed up with the person given not the right bottle with the right fluid at the bottom. I had two different clinics screw up my test (or the lab got it wrong) but anyway.. lab blamed the clinics.
    ........

    My own insulin tests.. I note that the lab range is from 0 upwards for a fasting insulin test with various amounts on the range after eatting. Your test may not be anything to worry about but as the other said do check into it more diseases related to low insulin.

    Thou I suspect it isnt an isssue as Insulin is produced to keep glucose down.. if your insulin wasnt being produced, wouldnt then a person have their glucose going up too much so show issues there??? (Im a lay person but just using my logic here).

    edit.. more info.. I just remembered something my specialist who specialises in insulin issues told me in the past. He said many insulin tests come out incorrect as they often arent handled correctly .."spun" and they need to be (centrifuged??) just after being taken and if the the test is left too long without that being done, the insulin breaks down (so I assume then the level will appear lower then it really is).
    He's actually got a web page on the proper handling of insulin tests online (you may find it if you do a search for Dr Allan Gale and also use the term "pandoras box" (he says insulin issues is the pandoras box of medical conditions as high insulin can cause so many different issues to occur).

    Ive found the insulin tests cause they arent all that commonly done either, many places dont know much about those either, even some of the places who take the blood for them. (I once had one blood place start argueing with me over what my insulin specialist doctor wanted done as they werent aware of much about those tests).

    anyway.. I think both of your tests may be screwups based on my own experiences with those two tests in the past (thou my insulin one was done as part of a 2hr GTT test with insulin included which is the best way to check for insulin issues)
  11. A.B.

    A.B. Senior Member

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    I'm not familiar with these tests. The only genetic testing I've done was for celiac disease, and showed that I carry http://en.wikipedia.org/wiki/HLA_DR3-DQ2

    I don't live in the US, I only see a "request number" on the paper which is probably not what you're asking for.

    The history is long-standing undiagnosed chronic fatigue which worsened in recent years, as well as the appearance of postprandial hypoglycemia which must be controlled by eating every three hours.

    The insulin test was part of a glucose curve to rule out diabetes. I'm not sure what the reason behind the urinary catecholamine test was, but I'm assuming pheochromocytoma.

    The low insulin value is interesting because I can get symptoms of hypoglycemia with blood glucose values above the clinical threshold for hypoglycemia. It could be that I'm very sensitive to insulin.

    Besides poor glucose control, I have a tendency towards mildly elevated monocytes in CBCs, borderline low-normal cortisol, borderline normal-high ACTH, low vitamin D and iron and albumin, thyroglobulin antibodies. I also have empty sella turcica aka flattened pituitary gland. I do seem to have the hallmark symptom of CFS, post-exertional malaise. I also feel that the symptoms associated with low thyroid and adrenal function match my symptoms closely.

    Aside from the Tg antibodies no clearly pathological abnormalities have emerged during the many lab tests that I've done and I feel the lab tests don't reflect how sick I am.

    The Tg antibodies are a recent discovery so it's not yet clear to what extent the thyroid is affected and to what extent appropriate treatment will help.
  12. LaurieL

    LaurieL Senior Member

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    Do you have your glucose levels? I would like those too, please.

    Low insulin levels are associated with Diabetes Type I, and hyperglycemia. So what you are telling me is that you have high glucose and low insulin? Or normal glucose, which when it falls, you experience hypoglycemia, and low insulin levels? And by hypoglycemia, what do you experience as a result?

    And yes, the request number or requisition number is what I was looking for. Although I am unfamiliar with where you are. I am proficient in ordering requisition numbers in the US only. What these numbers mean in the US system, is that they are a code for insurance companies and other physicians in which denotes the condition, and there for reason, for ordering the test. These numbers are standard throughout the US, I am unsure of other nations. But I could find out.

    I also wanted to comment again on the catecholamine testing. I have also heard they are quite unreliable. A better testing panel would be by Metametrix (blood). They do the metabolites, amino acids, etc. Also the urine testing as well. I believe it used to be Great Plains Lab. I am unsure about where you are. Also a stool test as well will give you some more info, as some metabolites are preferentially excreted in the bile, and thus stool. It will also give you info on the microbial status of your gut as well.

    The SNP testing, is genetic testing. Usually those with Type I Diabetes, have genetic mutations in which predispose them to insulin issues. Some of us, many, have done genetic testing either through Yasko or 23andme. In the beginning for me, the reasoning for having it done, was to identify problems in methylation, but the reasoning has now expanded into other pertinent mutations, in which contribute to ill-health. I didn't want pharma, but I did want to supplement these mutations through nutrition and supplements. Having the mutations, and trying to figure out which ones are being expressed, and then supplementing those have been a long haul. Definately worth it. So you may want to consider this as well. None of these test are cheap, except for the genetic testing through 23andme. I am unsure if they perform international testing. And of course, some SNP's are not tested in which Yasko does. There is a solution to everything, it will just depend on your own personal situation.

    I am coming off a brutal work week. Night!!

    LaurieL
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  13. A.B.

    A.B. Senior Member

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    My morning glucose is always within the norm (fasting blood glucose of 80 mg/dl or values close to that, I don't remember at the moment).

    A glucose curve was performed in the morning alongside the insulin test to rule out diabetes. Blood glucose was within the norm, not too high, not too low, and no symptoms.

    I never have low glucose in the morning. It only starts getting unstable later during the day, 2-3 hours after meals. The probability of low glucose pretty much follows a reverse cortisol curve, with meals obviously preventing low values.

    A glucose curve performed during the afternoon had me going down to 45 mg/dl with obvious symptoms of hypoglycemia.

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