What happens when you have too much norepinephrine in your system?

Norepinephrine, also known as noradrenaline, is a stress hormone and neurotransmitter that is released by the sympathetic nervous system. It plays an important role in the body’s “fight or flight” response by increasing heart rate, blood pressure, and blood sugar levels. However, having too much norepinephrine circulating in your system can cause a range of symptoms and health issues.

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What is norepinephrine?

Norepinephrine is classified as a catecholamine hormone and neurotransmitter. It is produced in the adrenal glands and certain brain nerves. When the body experiences stress or danger, the sympathetic nervous system signals the adrenal gland to release norepinephrine. This results in a boost of energy and focus so you can respond to the threat.

Norepinephrine increases arousal and alertness in the following ways:

Increases heart rate and blood pressure
Triggers the release of glucose from energy stores

Redirects blood flow from non-essential organs to the muscles and brain
Dilates the airways to improve breathing
Constricts blood vessels to reduce bleeding in case of an injury

Increases mental focus and concentration

This response is vital for dealing with genuine threats and danger. However, norepinephrine can also be released in response to chronic stressors like a demanding job, financial pressures, or traumatic experiences.

What causes too much norepinephrine?

There are several potential causes of elevated norepinephrine levels, including:

Stress – Both acute and chronic stress can trigger an excessive norepinephrine release.
Certain medical conditions – Such as pheochromocytoma (adrenal gland tumor), congestive heart failure, and Parkinson’s disease.
Nerve damage – From diabetes or amyloidosis can disrupt norepinephrine reuptake.

Drug side effects – Cocaine, amphetamines, tricyclic antidepressants, thyroid medications.
Drug withdrawal – Particularly from sedatives like alcohol or benzodiazepines.
Genetic factors – Having variants of certain genes can affect norepinephrine signaling.

Hormonal changes – Such as high thyroid hormone or low estrogen levels.

In some cases, no specific cause is found, and the excess norepinephrine is categorized as essential hypertension.

Symptoms of too much norepinephrine

Some signs and symptoms that may occur with elevated norepinephrine levels include:

High blood pressure – This can damage blood vessels over time and increase stroke risk.
Rapid or irregular heartbeat – Palpitations caused by norepinephrine-induced arrhythmias.
Headaches – Particularly migraines, cluster headaches, and sinus pain.

Dizziness – From the impact of norepinephrine on heart rate and blood pressure.
Cold hands and feet – Norepinephrine redirects blood flow away from the skin and extremities.
Pale skin – Vasoconstriction reduces blood flow to the skin.

Chest pain – Which may feel like tightness or discomfort.
Shortness of breath – Difficulty breathing from constricted airways and elevated blood pressure.
Blurred vision – Norepinephrine reduces blood flow to the optical nerve.

Nausea – From the influence of norepinephrine on the gut.
Stomach pain – Abdominal discomfort is common.
Diarrhea – Due to stimulation of the gastrointestinal tract.

Frequent urination – Pressure on the bladder from high blood pressure.
Anxiety or agitation – Norepinephrine boosts arousal and vigilance.
Trouble sleeping – Excess norepinephrine can cause insomnia.

Loss of appetite – Decreased hunger signals from norepinephrine’s metabolic effects.
Weight loss – From reduced appetite and increased metabolism.

Keep in mind that many conditions can produce these nonspecific symptoms. Lab tests of blood or urine norepinephrine levels are needed to confirm if someone truly has excess amounts.

Long term complications

Having chronically elevated norepinephrine can cause damage over time. Potential long term consequences include:

Hypertension – High blood pressure often results and can lead to cardiovascular disease.
Heart attack and stroke – Risk is increased from hypertension and constricted blood vessels.

Aneurysms – Weakened blood vessel walls may bulge or rupture.
Kidney problems – The kidneys can become impaired or fail over time.
Headaches – Migraines and tension headaches may become frequent and severe.

Cognitive changes – Such as trouble concentrating, memory issues, anxiety, and confusion.
Adrenal burnout – The adrenals may become depleted from pumping out too much norepinephrine.
Weight loss – From a suppressed appetite and increased metabolic rate.

Psychosis – In very high amounts, norepinephrine can trigger psychotic symptoms like hallucinations and paranoia.

The risks are higher in certain groups, like the elderly and those with existing medical problems. Getting excess norepinephrine under control is crucial for preventing permanent damage.

Diagnosing high norepinephrine

If symptoms suggest you may have elevated norepinephrine levels, your doctor can use tests to investigate further:

Plasma and urinary catecholamines – Measures norepinephrine and related hormones in the blood or urine. This confirms if levels are higher than normal.
Vanillylmandelic acid (VMA) – Tests urinary VMA, a metabolite of norepinephrine. VMA is elevated with excess norepinephrine production.
EKG – Looks for arrhythmias, an enlarged heart, or other cardiac abnormalities.

Blood pressure monitoring – Tracks blood pressure over a period of time.
Imaging tests – CT or MRI scans check the adrenal glands and elsewhere for tumors.
Genetic testing – Checks for gene variants that influence norepinephrine signaling.

Testing norepinephrine levels directly can be tricky. Norepinephrine is unstable and metabolizes quickly. Levels can vary widely during the day and in response to stress. Often, looking at metabolites or clinical signs is more useful for diagnosis.

Normal vs. high norepinephrine levels

Normal plasma norepinephrine reference ranges are:

Standing: 100-500 picograms/mL

Supine (laying down): 200-600 picograms/mL

Anything above 600 pg/mL is generally considered elevated. Useful ranges for 24-hour urine norepinephrine are:

Normal: 15-80 micrograms/24 hours

Grey area: 80-100 mcg/24 hrs
Elevated: greater than 100 mcg/24 hrs

However, as mentioned, there is significant individual variation throughout the day. Mildly high lab results alone don’t always equate to a medical problem. The clinical picture is important.

Treatment for excess norepinephrine

Treatment aims to reduce norepinephrine levels back to normal and prevent complications. Steps may include:

Addressing contributing factors – Such as discontinuing medications that raise norepinephrine or controlling an underlying condition like hyperthyroidism.
Stress management – Using relaxation techniques, counseling, and lifestyle changes to control stress.

Blood pressure medications – Such as beta-blockers and alpha-blockers to lower blood pressure.
Central alpha-agonists – Drugs like clonidine suppress norepinephrine signaling in the brain.
Surgical tumor removal – For pheochromocytoma and other norepinephrine-secreting tumors.

In many cases, getting stress under control combined with antihypertensive drugs can get norepinephrine back to normal. Severe high blood pressure may require multiple medications. Any underlying disease causing the excess norepinephrine also needs proper treatment.

Lifestyle changes

Adopting a healthy lifestyle can assist with normalizing norepinephrine levels. Recommendations include:

Relaxation practices – Like yoga, meditation, deep breathing, nature sounds.

Moderate exercise – Such as walking, swimming, cycling. But avoid exhaustive exercise.
Balanced diet – Eat whole foods low in sugar and processed carbs.
Adequate sleep – Get 7-9 hours per night.

Healthy social connections – Spend time with supportive friends and family.
Nature exposure – Spending time outdoors can reduce stress.
Therapy – Work through sources of chronic stress or trauma.

Massage – May help lower norepinephrine levels.
Time management – Don’t take on too many responsibilities.
Avoid stimulants – Like caffeine, tobacco, and illicit drugs.

Learning to manage life demands and engage the parasympathetic “rest and digest” nervous system can prevent sympathetic overdrive and norepinephrine spikes.

Risks of leaving high norepinephrine untreated

Allowing excess norepinephrine to go untreated can lead to severe medical consequences:

Uncontrolled hypertension – Greatly raising the risks of stroke, heart attack, kidney failure, and dementia.

Cardiac arrhythmias – Abnormal heart rhythms that may be life-threatening.
Heart failure – The heart muscle weakens and can’t pump blood properly.
Aneurysm – A weakened blood vessel bulging or rupture that can cause severe bleeding.

Worsened anxiety and panic – Excess norepinephrine fuels anxiety symptoms.
Adrenal crisis – Complete adrenal burnout with fatigue, low blood pressure, dehydration, and shock.
Stroke – Impaired blood flow to the brain from hypertension or vasoconstriction.

In rare cases, extremely high norepinephrine levels can even be fatal. Seeking prompt medical attention for unexplained signs of excess norepinephrine is important.

Preventing high norepinephrine

You may be able to reduce your risk of developing high norepinephrine levels by:

Managing stress properly through healthy outlets.

Having regular medical check-ups to monitor blood pressure.
Following doctor’s orders for any condition that could raise norepinephrine.
Avoiding stimulant or addictive substances.

Engaging in relaxing, low-impact activities.
Taking time to recover from stressful events.
Building healthy social and community connections.

While some cases can’t be prevented fully, keeping stress within a healthy range can stop norepinephrine surges before they start.

What should you ask your doctor about excess norepinephrine?

Questions to ask your doctor if you suspect excess norepinephrine include:

What tests can you do to check my norepinephrine levels?

Could any of my medications be raising norepinephrine?
Do I need to see an endocrinologist or cardiologist?
Could this be related to a tumor or other medical condition?

What is causing my norepinephrine to be elevated?
Will medication be needed to lower my blood pressure?
Could counseling or cognitive behavioral therapy help reduce my stress?

What lifestyle changes do you recommend to get my norepinephrine down?
How often should I have follow-up testing done?
What are the risks if my high norepinephrine goes untreated?

Being involved in your care and asking the right questions is key to successfully diagnosing and managing elevated norepinephrine levels.

Takeaway

Norepinephrine is vital for the body’s short-term stress response. However, chronically high levels can increase the risk for significant medical problems. Getting excess norepinephrine under control requires identifying the cause, making lifestyle changes to control stress, and using medications if needed. With proper treatment under a doctor’s care, norepinephrine can return to normal safe ranges.