From the Guidelines
Elevated epinephrine levels from a blood draw can be caused by a rare adrenal tumor known as phaeochromocytoma, which secretes catecholamines, including epinephrine, as stated in the 2024 ESC guidelines for the management of elevated blood pressure and hypertension 1.
Possible Causes of Elevated Epinephrine
- Phaeochromocytoma or paraganglioma, as mentioned in the guidelines, is a significant cause, although it is present in less than 0.2% of patients with hypertension 1.
- Other factors not directly mentioned in the provided evidence but relevant in clinical practice include stress or anxiety during the blood collection process, physical exertion before the blood draw, certain medications, and other medical conditions.
Clinical Considerations
- Identifying and managing the underlying cause of elevated epinephrine levels is crucial, especially in cases of phaeochromocytoma, where surgical excision after adequate pharmacological preparation is necessary to prevent fatal events 1.
- The technique used during blood collection and the patient's preparation before the test can significantly impact the results, emphasizing the need for careful consideration of these factors in clinical practice.
- Given the potential for phaeochromocytoma to cause fatal events, it is essential to approach patients with elevated epinephrine levels with caution and thoroughly investigate the cause, prioritizing this rare but critical condition due to its significant impact on morbidity, mortality, and quality of life.
From the Research
Causes of Elevated Epinephrine Levels
Elevated epinephrine (adrenaline) levels from a blood draw can be caused by various factors, including:
- Pheochromocytoma, a rare endocrine tumor that secretes high levels of catecholamines, mainly epinephrine and norepinephrine 2, 3
- Hypertension, which can be sustained or paroxysmal, and is highly correlated with the dominantly secreted catecholamine and its plasma concentration 2
- Anxiety symptoms, although the correlation between plasma and urinary epinephrine levels and anxiety symptoms is not significant in patients with pheochromocytoma 4
- Stress, although the role of epinephrine in the production of somatic symptoms of mental stress is considered to be small 5
- Essential hypertension, which is associated with raised plasma catecholamine levels, particularly elevated epinephrine levels, and platelet activation 6
Associated Conditions
Elevated epinephrine levels can be associated with various conditions, including:
- Cardiovascular manifestations, such as hypertension, arrhythmia, hypotension, shock, myocardial ischemia, cardiomyopathy, aortic dissection, and peripheral ischemia 3
- Platelet activation, which can be stimulated by psychological stress and is associated with essential hypertension 6
- Somatic symptoms, such as changes in heart rate and peripheral blood pressure, although the correlation with epinephrine levels is weak 5