Differential Responses of Urinary Epinephrine and Norepinephrine to 24-h Shift-Work Stressor in Physicians.

Claudia Boettcher,Graeme Eisenhofer,Klaus-Peter Zimmer,Grit Sommer,Stefan A Wudy,Mirko Peitzsch

doi:10.3389/fendo.2020.572461

Abstract

Multiple stressors, including 24-h-shifts characterise the working environment of physicians, influencing well-being, health and performance. We aimed to evaluate the effect of the stressor 24-h-shift on the adrenal medullary and sympathoneural system in physicians with the hypothesis that shift work might have different impacts on both systems. Twenty-two physicians collected two 12-h-urine samples (“daytime” and “nighttime”) during a 24-h shift (“on-duty”) and on a free weekend (“off-duty”), respectively. Urinary excretion rates per m2 body surface area were assessed for the catecholamines epinephrine, norepinephrine and their respective free O-methylated metabolites metanephrine and normetanephrine by LC-MS/MS-analysis. The stressor provoked differential responses of epinephrine and norepinephrine. Epinephrine excretion rates showed significant increases from off to on duty. The largest proportional change (off-duty to on-duty) for epinephrine was observed for nighttime (205%), the increase for daytime was 84%. An increase in norepinephrine from off to on duty was only visible for nighttime collections. For the catecholamine metabolites, normetanephrine paralleled norepinephrine and exhibited an increase in excretion from off to on duty during nighttime collections of 53% whereas there was no change during daytime collections (3%). In conclusion: Whilst the 24-h-shift-work stressor in physicians activates the sympatho-adrenomedullary system, represented by epinephrine, the sympathoneural response through norepinephrine reflects mainly an ambulatory position during working hours.

Highlights

Over past decades there has been enlarging awareness about the importance of working conditions and association with work-related “stress” or stressors with adverse health outcomes
We aimed to evaluate the effect of the stressor “24-h shift” on the adrenal medullary and sympathoneural system in physicians by measuring urinary outputs of catecholamines and metanephrines
Research studies involving stress and catecholamines are often conducted under laboratory conditions exposing probands to one defined stimulus or stressor at a time

Summary

Introduction

Over past decades there has been enlarging awareness about the importance of working conditions and association with work-related “stress” or stressors with adverse health outcomes. Numerous scientific studies demonstrate the impact of an environment full of multiple stressors on Catecholamine-Responses to 24-h-Shifts the well-being of medical doctors in different subspecialties [1,2,3,4,5,6,7]. One of the main stressors recognised for physicians to be physically challenging and associated with impaired performance witch influences work-life-balance is shift work or being on call [8,9,10,11,12]. Stressor exposure alters activities of different effector systems: besides the hypothalamic-pituitary-adrenocortical system, the sympathoadrenal system is an important mediator of stress-related responses according to separate functions of the adrenomedullary hormonal and sympathetic neuronal systems. Whilst the adrenal medulla is the major source of circulating epinephrine (synonym: adrenaline), stimulation of the sympathetic nervous system leads to discharge of the locally acting neurotransmitter, norepinephrine (synonym: noradrenaline), from sympathetic nerve endings [13]

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