Epinephrine Urine Test: High and Low Levels + Normal Range

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.

What is Epinephrine?

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’s “fight or flight” response [1].

The effects of epinephrine include increased heart rate, 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 [1, 2, 3, 4].

Epinephrine belongs to a group of neurotransmitters called catecholamines, which also includes norepinephrine and dopamine [5].

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 [6].

Epinephrine Urine Test

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 [7].

Diagnosing Rare Tumors

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 [8, 9].

There are two ways to perform an epinephrine urine test.

In the 24-hour urine test, you must collect all the urine produced over a 24 hour period. This is the test normally used to diagnose tumors [10].

The second method is called a “spot” or “random” urine test. This kind of test uses a single urine sample that is obtained at a specific time [11].

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).

The random urine test is reported in units of mcg/g crt (micrograms per gram of creatinine, a waste product used to measure kidney function). These values reflect the amount of epinephrine detected in the urine.

Other Reasons for Testing

Some people believe that epinephrine urine tests can help identify certain adrenal conditions like chronic stress and adrenal fatigue [11].

However, little evidence currently supports testing for this reason. The problem is that epinephrine levels can vary wildly throughout the day, due to factors like stress, physical activity, and diet [11, 12].

Another issue is that urine tests do not accurately reflect the epinephrine levels in the brain or in other areas of the body. 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 [11].

Thus, epinephrine urine testing is not currently very useful outside of diagnosing adrenal tumors.

Normal Levels

Your epinephrine levels will naturally fluctuate throughout the day. Normal ranges can also vary slightly depending on the lab.

For the 24-hour urine test, values below 20 mcg/24h are considered normal [13].

For the random urine test, values below 19 mcg/g crt are considered normal [14].

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.

Limitations

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.

High Epinephrine Levels

Causes

Causes shown here are commonly associated with high epinephrine. Work with your doctor or other health care professional for an accurate diagnosis.

1) Stress

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 [15].

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 [15].

Both physical and mental stress will trigger this response. For example, being startled (mental stress) and playing sports (physical stress) can both increase epinephrine levels [15, 16, 17].

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 [16, 18, 12].

2) Exercise

Epinephrine plays a major role in adapting to exercise. And it makes sense: epinephrine promotes blood flow to the muscles and opens up the airways [19].

During exercise, epinephrine levels can increase by 1.5 to over 20 times [19]!

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 [19].

Exercise duration and intensity affect increases in epinephrine. In general, longer and more intense activity will cause a greater increase in epinephrine levels [19].

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 [19].

3) Low Blood Sugar

The body has several ways to prevent blood sugar (glucose) 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 secretion [20, 21].

In a study of 31 people, low glucose levels triggered epinephrine release in both diabetics and non-diabetics [22].

People with type 1 diabetes are especially dependant on epinephrine release to avoid dangerous drops in blood sugar (hypoglycemia) [12].

Interestingly, patients whose diabetes is better managed (defined as having HbA1c below 10%) have less dramatic increases in epinephrine [22].

4) Low Oxygen Supply

Low oxygen supply, also known as hypoxia, triggers an increase in epinephrine, which opens up the airways and increases breathing rate [23].

A great example of this process takes place during exercise. When a person reaches 30% of their VO₂ max (the maximum amount of oxygen a person can use) during exercise, their epinephrine levels start to increase [19].

Another example is in sleep 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 [24].

Other low-oxygen circumstances that may trigger epinephrine release include high altitudes and injuries to the heart, such as heart attacks or heart failure [25, 26].

5) Adrenal Gland Tumors

Catecholamine urine tests (including the epinephrine test) are primarily used to help diagnose tumors of the adrenal glands [27, 28].

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 [27, 28, 29].

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 [27, 28].

To compensate, doctors test for catecholamine metabolites as well. Tumors more consistently make these metabolites, so their levels are consistently elevated [27, 28].

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 [27].

The pattern is the same when diagnosing neuroblastoma: metabolites like metanephrine are better for detecting the disease than the catecholamines [28].

6) PTSD

Post-traumatic stress disorder (PTSD) 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 [30].

Research suggests that people affected by PTSD may have elevated catecholamines, including epinephrine [31].

In one study, people with PTSD had average epinephrine urine levels of about 23 mcg/24h, which is only slightly above normal. By comparison, the average epinephrine urine levels are much lower in other psychiatric disorders like depression and schizophrenia (13 and 15 ug/24h, respectively) [31].

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. But according to another study, the epinephrine levels of asymptomatic patients were lower than in people who still experienced symptoms [32, 33]

Why Trauma Doesn’t Always Lead to PTSD

Trauma doesn’t always lead to PTSD. According to one study, people who go through severe trauma but don’t develop PTSD have lower-than-normal urine levels of epinephrine [32].

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 [32].

According to their hypothesis, a surge in stress hormones can fixate a traumatic experience into long-term memory, forming a sort of “memory scar.” At the time of trauma, high-stress hormones target the hippocampus, the brain’s hub for memory and emotions. They tell the brain: “This is important, don’t forget it.” Lacking the signal from stress hormones, the researchers suggest, the bad memories may not stick around as much [34, 35].

Researchers are looking into therapies that might help people overcome PTSD by lowering stress hormones like epinephrine and norepinephrine [35, 36].

7) Eclampsia in Pregnancy

Eclampsia is a pregnancy complication whereby the expectant mother experiences seizures due to high blood pressure [37].

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. Levels returned to normal about 6 days after delivery [38, 39].

8) Smoking

Cigarettes can cause several hormones, including epinephrine, to spike just 15 minutes after smoking [40].

Smoking increased epinephrine levels in the urine by 50% in one small study of 15 people [41].

Gender may also be a factor. For instance, in a study of 70 smokers, epinephrine increased more in men than in women [42].

9) Coffee

Drinking coffee can raise epinephrine levels. In a study of 30 people, participants’ blood levels of epinephrine increased by about 260% after drinking coffee. According to another study, urine epinephrine levels follow the rise in blood levels [43, 44].

10) Drugs

A number of common medications can increase epinephrine levels in the urine, including:

• Corticosteroids, such as dexamethasone [45]
• Propranolol (Inderal) [46]
• ADHD medication (dextroamphetamine and methylphenidate/Ritalin) [47, 48, 49]
• Opioid painkillers [50]
• Drugs of abuse, especially stimulants such as ecstasy and cocaine [51, 52]

These are only a few examples. Your doctor will advise you on what medications to stop, if any, prior to testing.

Effects of High Epinephrine

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.

1) Immune System

Stress, both physical and mental, is closely tied to the immune system [53].

The body releases hormones, like epinephrine and cortisol, 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 [53].

This defense mechanism starts to malfunction if you constantly face stress. Chronic elevations in stress hormones may cause inflammation and weaken the immune system. Stress hormones can reduce the activity of natural killer (NK) cells, the number of lymphocytes, and the production of antibodies [53, 54].

On the other hand, stress increases inflammatory factors like interleukins 6 and 1b (IL-6 and IL-1b) [55].

High-stress hormones may also reduce the body’s response to vaccines and reactivate old, dormant viral infections [56, 57].

2) Heart Disease

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 [16].

However, constantly elevated levels of epinephrine may strain the heart. For example, long-term stress is linked to high blood pressure [16].

Increased levels of catecholamines like epinephrine may lead to stress cardiomyopathy, a condition that causes heart muscle overgrowth and weakness [58].

3) Cancer Growth

Stress and chronically elevated epinephrine levels are associated with worse cancer prognosis [59, 60].

One animal study found that rats with more epinephrine have faster leukemia progression [59].

On top of that, epinephrine causes cancer cells to be more resistant to apoptosis (cell death), according to a study on human ovarian cancer cells [60].

High levels of epinephrine can also increase oxidative stress and DNA damage. One cell study found that just 30 minutes of exposure to epinephrine can produce five times more DNA damage compared to unexposed cells. DNA damage can activate tumor-promoting genes and turn healthy cells into cancerous ones [61].

Ways to Decrease Epinephrine

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.

1) De-stress

It’s normal for your body to experience spikes in epinephrine throughout the day, depending on your activity [16].

However, long-term elevations of epinephrine can have harmful effects on health. The most common culprit behind chronically-high epinephrine is stress [16].

Finding ways to de-stress may help keep epinephrine, along with other stress hormones like cortisol, under control [16].

Relaxing activities can reduce stress and prevent the release of stress hormones. Proven stress-busting activities include meditation, yoga, spending time in nature, and listening to pleasant music [62, 63, 64, 65, 66].

Even just taking a break can help. A study of 55 people found that stressed caregivers of Alzheimer’s patients had their epinephrine levels dropped after taking 2 weeks off at home [67].

2) Smoking Cessation

Cigarette smoking can cause large increases of epinephrine in the urine. Quitting the habit can be a good way to improve epinephrine levels [41].

A small study of 17 cigarette smokers found that epinephrine levels dropped after just one day of not smoking [68].

3) Reduce Coffee

As mentioned previously, epinephrine levels can rise sharply after drinking coffee. If you’re concerned about high epinephrine, it’s probably a good idea to cut back on your caffeine consumption [43, 44].

4) Taurine

Taurine, a common ingredient in energy drinks, may also lower epinephrine. In a small study of 19 people, 6 g of a taurine supplement each day significantly lowered epinephrine levels. We recommend avoiding energy drinks and choosing a quality taurine supplement [69, 70].

5) Other

No clinical evidence supports the approaches listed below to reduce epinephrine. Below is a summary of the existing animal and cell-based research, which should guide further investigational efforts. However, the studies listed below should not be interpreted as supportive of any health benefit.

• EGCG is an antioxidant compound found in green tea with many reported health benefits. One study found that in animals, EGCG counteracted the epinephrine elevation caused by caffeine [71].
• Dietary antioxidants: dry olive leaf extract protected against the DNA damage caused by epinephrine in one cell-based study. In a rat study, tomato extract prevented damage to the heart caused by epinephrine [72, 73].

Low Epinephrine Levels

Causes

Causes shown here are commonly associated with low epinephrine. Work with your doctor or other health care professional for an accurate diagnosis.

1) Addison’s Disease

Addison’s disease is caused by damage to the adrenal glands, leaving them unable to produce enough hormones. This condition leads to reduced levels of many hormones, including epinephrine. Symptoms may include tiredness, muscle weakness, and darkening of the skin [74].

In a study of 19 people, patients with Addison’s had, on average, less than half the epinephrine of those without the condition [75].

2) ACTH Deficiency

Adrenocorticotropic hormone (ACTH) deficiency is another condition that prevents the adrenal glands from making sufficient amounts of epinephrine and other hormones. This can lead to symptoms like tiredness, muscle pain, and weight loss [76].

ACTH is normally responsible for stimulating the adrenal glands to release hormones. In ACTH deficiency, a dysfunctional pituitary gland doesn’t produce enough ACTH [76].

A study of 43 kids found that children with ACTH deficiency have only 10-20% of normal epinephrine levels. In another study, adults with ACTH deficiency also had much lower epinephrine levels in their urine [77, 45].

3) Dopamine Beta‐Hydroxylase Deficiency

Dopamine beta-hydroxylase deficiency is a very rare genetic disorder that leaves a person unable to produce any epinephrine or norepinephrine [78].

The condition is caused by mutations in the DBH gene and can lead to a variety of symptoms, including low blood pressure, sexual dysfunction, and drooping eyelids [78].

4) Kidney Dysfunction

Damage to the kidneys may affect the urine level of epinephrine.

One study investigated catecholamine levels in patients with kidney damage due to diabetes. They found that these patients also had significantly lower levels of epinephrine in the urine [79].

5) Metabolic Syndrome

A person is diagnosed with metabolic syndrome when they have some combination of obesity, high blood pressure, high blood sugar, and high cholesterol [80].

In a study of 577 people, those with metabolic syndrome had lower epinephrine in the urine. Those with more severe symptoms of metabolic syndrome had the lowest levels of epinephrine [81].

6) Alzheimer’s Disease

Damage to the hippocampus area of the brain is one of the early signs of Alzheimer’s disease. This area of the brain also helps control levels of catecholamines in the body [82].

People with Alzheimer’s-related dementia had lower levels of epinephrine, according to one study of 115 patients [82].

7) Parkinson’s Disease Medication

Parkinson’s disease involves the destruction of dopamine neurons in certain parts of the brain. Other catecholamines, like epinephrine, may also be altered [83].

An older study observed that 83 people with Parkinson’s disease had higher epinephrine levels in the urine. However, epinephrine rose only in people in their 50s and 60s. Once given dopamine (levodopa) medication, their levels dropped [83].

Other studies confirmed levodopa lowers epinephrine in the urine, but they failed to find epinephrine changes in untreated patients. Thus, Parkinson’s disease likely doesn’t impact epinephrine but levodopa does [84].

Effects

The health effects of chronically low epinephrine levels are not well understood. The body generally does a good job of producing epinephrine when needed, and it’s uncommon to have low levels.

The main causes of low epinephrine levels are problems with the adrenal and pituitary glands or genetic disorders, all of which are fairly rare. These diseases often cause deficiencies in other hormones, such as norepinephrine and cortisol, as well [74, 76, 78].

Some symptoms of conditions associated with low epinephrine include [74, 78]:

• Low blood pressure
• Low blood sugar
• Weight loss
• Difficulty exercising

The effects of low epinephrine can also be seen in people with chronic fatigue syndrome, a complex condition that can limit the amount of epinephrine that is released during exercise. This lack of epinephrine may worsen symptoms, such as fatigue, difficulty thinking, and muscle pain [85, 86].

Ways to Increase Epinephrine

The body naturally releases epinephrine in response to stressful situations: for example, when facing a physical threat, when startled, or when dealing with chronic stress [16].

As long as you don’t have some kind of adrenal disorder, you likely don’t have to worry about increasing your epinephrine levels – your body does all the work [16].

But you can help out by making sure to include phenylalanine and tyrosine-containing foods in your diet. Your body uses these amino acids to make epinephrine and other catecholamines [87].

Some foods that are rich in phenylalanine and tyrosine include [87, 88, 89]:

• Meat
• Fish
• Eggs
• Cheese
• Nuts

Caffeine also causes epinephrine levels to rise. One study found that coffee elevates epinephrine levels in the urine by 32% [90].

But be careful: epinephrine elevates blood pressure, and caffeine amplifies this effect [90].