What is methoxyadrenaline?
Methoxyadrenaline, also called metanephrine, is a stable breakdown product (metabolite) of adrenaline, which is one of the body's stress hormones. Methoxyadrenaline is formed when adrenaline is broken down in the body, mainly via the enzyme catechol-O-methyltransferase (COMT). Since methoxyadrenaline is more stable than adrenaline itself, the marker can provide a more reliable picture of adrenaline metabolism over time.
Analysis of methoxyadrenaline is used in healthcare, primarily in the investigation of pheochromocytoma, an uncommon tumor in the adrenal medulla that can produce stress hormones. The marker is particularly relevant when assessing whether the body has an overproduction with a clear connection to adrenaline, which can often cause attacks of symptoms.
Unlike adrenaline, which is often released in a pulsatile manner and can vary rapidly, methoxyadrenaline provides a more stable and diagnostically useful signal if there is increased adrenaline production.
The role of methoxyadrenaline in the body
Methoxyadrenaline has no hormonal effect of its own, but functions as a biomarker for how much adrenaline is produced and metabolized. Adrenaline is released primarily when the body's acute stress response ("fight-or-flight") is activated and affects, among other things, heart rate, blood pressure and blood sugar.
Once adrenaline has been released and exerted its effect, it is rapidly broken down and converted into more stable metabolites. Methoxyadrenaline is one of the most important of these and can therefore be used to assess the activity of the adrenaline system even when symptoms come in attacks and do not just happen to occur at the time of sampling.
Relationship to catecholamines and adrenal function
Adrenaline belongs to the group of catecholamines (stress hormones), which are mainly produced in the adrenal medulla. Catecholamines affect the body's rapid adaptation to stress, for example by increasing the heart's pumping ability, mobilizing energy and redistributing blood flow to muscles.
Methoxyadrenaline specifically reflects the metabolism of adrenaline and is therefore a more targeted marker compared to other catecholamine metabolites. In simplified terms, the relationship can be described as follows:
- Adrenaline > methoxyadrenaline (metanephrine).
This makes methoxyadrenaline particularly valuable when you want to identify conditions where adrenaline production is abnormally high, for example in pheochromocytoma with a clear adrenaline profile.
Symptoms of elevated methoxyadrenaline levels
Elevated methoxyadrenaline levels are not a diagnosis in themselves, but may indicate increased adrenaline production. This can cause symptoms that often occur in attacks and can vary in intensity:
- Heart palpitations or rapid pulse.
- Profuse sweating.
- Feeling of pressure or discomfort in the chest.
- Feeling of anxiety, anxiety or “inner stress.”
- Trembling or shaking.
- Increased blood pressure, sometimes in attacks.
- Headache.
Since symptoms can be intermittent, a stable metabolite such as methoxyadrenaline can be particularly useful for capturing overactivity even between attacks.
Why is methoxyadrenaline analyzed?
Methoxyadrenaline is primarily analyzed as part of an investigation for suspected pheochromocytoma. The test may be relevant for the following symptoms:
- Recurrent attacks with palpitations, sweating, and increased blood pressure.
- Suspicion of a stress hormone-producing tumor based on the clinical picture.
- Difficult-to-explain symptoms that resemble panic attacks but where a hormonal cause needs to be ruled out.
- Follow-up after treatment or surgery (in a specialist-led investigation).
Methoxyadrenaline is a more adrenaline-specific marker, which makes it particularly relevant when you want to understand whether the symptom picture is driven by adrenaline overproduction. Methoxyadrenaline is most often analyzed in free plasma as part of a methoxycatecholamine panel. Since stress, body position, caffeine, nicotine, physical activity and certain medications can affect the result, it is important to take the sample correctly, preferably after rest according to the sample collection instructions.
Elevated values do not automatically mean diagnosis, but should always be assessed by a doctor and can be followed up with additional tests and further investigation, such as imaging diagnostics, if necessary. The result should always be interpreted in relation to symptoms and the overall clinical picture.