Although free and conjugated dopamine (DA) constitute most of the plasma and urine catecholamine pool, the diagnostic significance of DA estimation for the evaluation of illness is not clear. We evaluated the clinical utility of DA estimation by measuring free and conjugated DA in patients with various illness. Patients with adrenal insufficiency did not show decreases in DA concentrations but did demonstrate reductions in free and conjugated plasma adrenaline (Ad). Patients with established stage of essential hypertension exhibited decreased plasma concentrations of free and conjugated DA, although they were hyperadrenergic. In patients with chronic renal insufficiency and failure, the free DA concentration in the urine decreased depending on the severity of renal impairment. Conversely, plasma concentrations of conjugated DA are higher in patients with chronic renal failure than in normal subjects. The high plasma concentrations of conjugated DA decreased dramatically following hemodialysis and renal transplantation. Urinary free DA excretion increased markedly following renal transplantation. In conclusion, the estimation of the free and conjugated DA in plasma and urine is clinically useful for the diagnosis of adrenal insufficiency, essential hypertension, and renal insufficiency and failure. It also can be used to monitor the effectiveness of hemodialysis and renal transplantation. (Hypertens Res 1995; 18 Suppl. I: S87-S92) Key Words: free dopamine, conjugated dopamine, adrenal insufficiency, essential hypertension, renal transplantationWe have developed methods to measure free and conjugated catecholamines in clinical samples as a routine laboratory exam using HPLC and have tried to estimate the clinical utility of free and conjugated dopamine (DA) as a diagnostic aid (1). Previous investigators (2-7) have reported trace amounts of free DA in the plasma in various illness, but the values of free DA were variable in each study. Some studies (2-4) have reported relatively low free DA concentrations in the plasma, near the detection limits of the assay, while other studies (5, 6) have found relatively high concentrations of free DA in the plasma. Similarly, the plasma concentrations of conjugated DA were variable (2-7). We have already reported the wide individual variations and circadian rhythm of free and conjugated DA concentrations in healthy volunteers (8).The total DA, including the free and conjugated forms constitutes the majority (approximately 60-70%) of total circulating catecholamines including DA, noradrenaline (NA) and adrenaline (Ad) (Fig. 1). The physiological and pathological roles of plasma free NA and Ad are well-known. Although large amounts of DA exist in the circulation, the pathophysiological roles of free and conjugated DA are not clear. Moreover, it has been reported that conjugated DA can be converted directly into free DA,. Therefore, it is important to measure the free and conjugated DA independently when evaluating the pathophysiological significance of DA in the plasma. Although...