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Test ID ORXNA Orexin-A/Hypocretin-1, Spinal Fluid

Ordering Guidance

Orexin-A (hypocretin-1) deficiency is the hallmark of narcolepsy type 1. The diagnostic criteria for type 1 narcolepsy include the presence of cataplexy and/or measured cerebrospinal fluid orexin-A/hypocretin-1 concentrations less than or equal to 110 pg/mL. Alternative testing for narcolepsy type 1 includes mean latency of 8 minutes in the clinical multiple sleep latency test, with evidence of sleep-onset rapid eye movement periods and cataplexy.

Specimen Required

Patient Preparation: Patient should not have recently received radioisotopes, either therapeutically or diagnostically, due to potential assay interference.

Collection Container/Tube: Sterile vial

Submission Container/Tube: Plain vial with no additives

Specimen Volume: 1.5 mL

Pediatric Volume: 0.5 mL minimum volume

Collection Instructions:

1. Obtain aliquot from second collection vial (preferred, not required).

2. Hemolyzed specimens will give false-positive results. Specimens should be centrifuged to remove any red cells prior to shipping.

Useful For

Aiding in the diagnosis and differentiation of type 1 narcolepsy from other causes of hypersomnolence


This assay is not intended for use as a screening test.

Method Name

Radioimmunoassay (RIA)

Reporting Name

Orexin-A/Hypocretin-1, CSF

Specimen Type


Specimen Minimum Volume

0.5 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
CSF Frozen 120 days

Reference Values

Normal individuals should be >200 pg/mL


Previous literature has defined cerebrospinal fluid orexin-A/hypocretin-1 concentrations of 110 pg/mL or below as being consistent with narcolepsy type 1-(Mignot E: Arch Neurol 2002:59;1553-1562). Concentrations between 111 to 200 pg/mL are considered intermediate and have limited diagnostic utility for narcolepsy, as they may be representative of other neurological disorders. Concentrations above 200 pg/mL are considered normal.

Day(s) Performed

Twice monthly (Second and fourth Monday)

Report Available

3 to 32 days

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Test Classification

This test was developed, and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information


LOINC Code Information

Test ID Test Order Name Order LOINC Value
ORXNA Orexin-A/Hypocretin-1, CSF 91670-0


Result ID Test Result Name Result LOINC Value
604230 Orexin-A/Hypocretin-1, CSF 91670-0


If not ordering electronically, complete, print, and send a Neurology Specialty Testing Client Test Request (T732) with the specimen.