High Catecholamine Levels (Dopamine, Adrenaline and Noradrenaline) May Be a Sign of Cancer

Catecholamines, produced by the brain, nerve tissue and adrenal glands, are hormones. Responsible for the body’s fight-or-flight response, catecholamines are released in response to emotional or physical stress. The main catecholamines include dopamine, adrenaline and noradrenaline.

Unusually high or low secretion of catecholamines may indicate serious underlying medical problems and can cause various health problems.

In this article, we explain how catecholamines work, when they can lead to health problems and when to see a doctor.

What Are Catecholamines and What Are Their Functions?

Catecholamines are hormones that also function as neurotransmitters, important chemicals facilitating communication between neurons or between a neuron and another cell. They are produced in the brain, nerve tissues and the adrenal glands located above the kidneys.

Dopamine

Dopamine, a chemical naturally produced in the human body, enables signals to travel through the nervous system. It helps regulate biological processes such as movement, emotion, memory and pleasure / the brain’s reward mechanism.

Adrenaline (Epinephrine)

Secreted by the inner parts of the adrenal glands, this neurotransmitter is responsible for the body’s fight-or-flight response. Under stress, adrenaline is released, allowing blood to flow to the muscles, heart and lungs.

Noradrenaline (Norepinephrine)

Synthesized from dopamine by an enzyme produced in the body, norepinephrine is released into the blood from the adrenal glands. This neurotransmitter helps the body respond to stress, increasing heart rate and blood pressure. It is also associated with mood regulation and the ability to concentrate.

What Causes Abnormal Catecholamine Levels?

Catecholamine levels that are very low or very high sometimes indicate underlying health problems. The main reason doctors test these levels is to check for certain conditions, such as a neuroendocrine tumor or neuroblastoma, among other tumors whose presence is being investigated.

Neuroendocrine Tumors

The neuroendocrine system consists of endocrine (hormone-producing) cells and nerve cells, and neuroendocrine tumors develop from cells in the hormonal and nervous systems. These tumors produce large amounts of catecholamines.

Pheochromocytomas are neuroendocrine tumors in the adrenal glands. Approximately 80-85% of pheochromocytomas grow in the inner layer of the adrenal glands, while 15-20% grow outside this area.

Symptoms of pheochromocytoma include:

• High blood pressure
• Palpitations
• Anxiety
• Tremor
• Excessive sweating
• Pale skin
• Tingling in the fingers and toes
• Blurred vision
• Severe headache
• Abdominal pain
• Constipation
• Weight loss
• High blood sugar
• Psychiatric disorders

Although usually benign, some pheochromocytomas can continue growing without treatment, with worsening symptoms damaging the kidneys and heart. Tumor growth also increases the risk of stroke and heart attack.

Neuroblastoma

Neuroblastoma is a cancer arising from specialized nerve cells called neuroblasts. It most often develops in the adrenal gland or nerve tissue extending along the spinal cord and causes increased catecholamine levels.

In children, neuroblastoma is the most common cancer, accounting for 6% of all childhood cancers, and it rarely occurs in people over age 10.

Symptoms of neuroblastoma are listed below:

• Abdominal swelling
• Watery diarrhea
• Anemia
• Bluish skin
• Blue or purple discoloration around the eyes
• Swollen eyes
• Small pupils
• Drooping eyelid
• Fever
• Inability to produce sweat
• High blood pressure
• Bone pain
• Low blood cell counts
• Paralysis

Tests Used to Determine Catecholamine Levels

To test a person’s catecholamine levels, the doctor requests a blood or urine test. A person having a urine test must collect their urine in a bottle over 24 hours. The hospital supplies a special bottle containing a small amount of acid to help preserve the urine. It is extremely important to keep it in a cool place.

After initial tests establish the catecholamine level, further tests may be requested if necessary. Pheochromocytoma tests can give false-positive results. Evaluation must therefore also consider factors such as the patient’s physical condition, medication use, diet and emotional state. If a tumor is suspected, magnetic resonance imaging (MRI) or computed tomography (CT) may be requested. If imaging confirms a tumor, a biopsy may be requested to determine its type.

Symptoms of Abnormal Catecholamine Levels

High or low catecholamine levels may cause various symptoms. Symptoms caused by increased levels of the main catecholamines are listed below.

Chronically elevated dopamine levels may be associated with conditions such as Costello syndrome, leukemia, Menkes syndrome and aromatic L-amino acid decarboxylase deficiency. Scientists also associate dopamine deficiency with neurodegenerative diseases such as Parkinson’s.

Low adrenaline levels may make it difficult to respond appropriately to stressful situations.

Low noradrenaline levels may lead to lethargy or lack of energy, low blood pressure on standing, attention deficit hyperactivity disorder, impaired concentration and depression.

The medications taken, such as paracetamol, acetaminophen, aspirin, blood-pressure and heart medications, as well as caffeine, alcohol, nicotine and foods and drinks such as bananas, pineapple and peppers, may alter catecholamine levels. Before testing, the doctor should therefore be informed about the medications being used, and consumption of the foods and drinks should be stopped 24 hours before providing a urine test.

Treatment Methods

Treatment is determined by the condition causing low or high catecholamine levels.

Common treatments for patients diagnosed with pheochromocytoma include surgery, radiation therapy, chemotherapy, ablation using very hot or cold substances to target and destroy abnormal cells, cancer-targeted drug therapy, and embolization to destroy the tumor by blocking blood flow in the adrenal gland.

People diagnosed with neuroblastoma may receive one or more treatments such as surgery, radiation therapy, chemotherapy, targeted therapies, immunotherapy and iodine 131-MIBG therapy, in which radioactive iodine is injected into the bloodstream to kill cancer cells.

In most cases, pheochromocytomas are benign and are not expected to cause metastasis; they do not tend to recur after surgical removal. By contrast, neuroblastoma’s response to treatment depends on the tumor’s risk level. Factors such as tumor stage, growth rate, genetic differences and the person’s age are important.

Summary

People with symptoms such as persistent high blood pressure, a rapid or irregular heartbeat, tremor, excessive sweating or severe headache should see a specialist doctor as soon as possible. Determining catecholamine levels through blood or urine tests helps establish whether further testing and treatment are necessary.