Catecholamine Excretion Research Articles

Mediastinal paragangliomas related to SDHx gene mutations.

IntroductionParagangliomas (PGLs) related to hereditary syndromes are rare mediastinal tumors. Paragangliomas are caused by mutations in genes encoding subunits of succinate dehydrogenase enzyme (SDH).AimTo evaluate clinical, anatomical and functional characteristics of mediastinal paragangliomas related to SDHx gene mutations.Material and methodsRetrospective analysis of 75 patients with confirmed SDHx gene mutations (24 patients with SDHB, 5 SDHC, 46 with SDHD mutations) was performed. Patients underwent evaluation using computed tomography (CT), somatostatin receptor scintigraphy (SRS) (99mTc-[HYNIC,Tyr3]-octreotide), 123I mIBG scintigraphy and urinary excretion of total methoxycatecholamines.ResultsOut of 75 patients, 16 (21%) patients (1 SDHB, 15 SDHD mutations) had 17 PGLs localized in the mediastinum. Fourteen PGLs were localized in the middle mediastinum (intrapericardial) and 3 PGLs in the posterior mediastinum. The median diameter of paragangliomas measured on the axial slice was 24.3 mm (interquartile range (IQR): 14.7–36.6), and the median volume was 2.78 ml (IQR: 0.87–16.16). Twelve out of 16 patients (75%) underwent SRS, and 11 of them (92.3%) had pathological uptake of the radiotracer. Eleven (68.75%) out of 16 patients underwent 123 I mIBG, with only 3 positive results. Symptoms of catecholamine excretion were observed in 3 patients with PGLs localized in the posterior mediastinum. All PGLs were benign except in 1 patient with the SDHB mutation and PGL detected in the posterior mediastinum, who had a metastatic disease.ConclusionsMost mediastinal paragangliomas were related to SDHD gene mutations. They were asymptomatic, localized in the medial mediastinum, intrapericardially.

Creating a system of medical and psychological rehabilitation of extreme professions representatives (firemen-rescuers as a model)

Chumaeva Julia , Golikov а Vladislava, Nekhoroshkova Julia , Ogulenko Alexey , Shafran Leonid. Creating a system of medical and psychological rehabilitation of extreme professions representatives (firemen-rescuers as a model). Journal of Education , Health and Sport . 2015;5(8):1 9 7 - 209 . ISSN 2391-8306 . DOI 10.5281/zenodo.28064 http://dx.doi.org/10.5281/zenodo.28064 http://ojs.ukw.edu.pl/index.php/johs/article/view/2015%3B5%288%29%3A197-209 https://pbn.nauka.gov.pl/works/607738 Formerly Journal of Health Sciences. ISSN 1429-9623 / 2300-665X. Archives 2011–2014 http://journal.rsw.edu.pl/index.php/JHS/issue/archive Deklaracja. Specyfika i zawartośc merytoryczna czasopisma nie ulega zmianie. Zgodnie z informacją MNiSW z dnia 2 czerwca 2014 r., ze w roku 2014 nie bedzie przeprowadzana ocena czasopism naukowych; czasopismo o zmienionym tytule otrzymuje tyle samo punktow co na wykazie czasopism naukowych z dnia 31 grudnia 2014 r. The journal has had 5 points in Ministry of Science and Higher Education of Poland parametric evaluation. Part B item 1089. (31.12.2014). © The Author (s) 2015; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland and Radom University in Radom, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 05.06.2015. Revised 15.07.2015. Accepted: 12.08.2015. CREATING A SYSTEM OF MEDICAL AND PSYCHOLOGICAL REHABILITATION OF EXTREME PROFESSIONS REPRESENTATIVES (FIREMEN-RESCUERS AS A MODEL) Julia Chumaeva 1 , Vladislava Golikovа 1,2 , Julia Nekhoroshkova 1 , Alexey Ogulenko 1 , Leonid Shafran 1 1 Ukrainian Scientific and Research Institute of Transport Medicine, Odessa, Ukraine 2 Odessa National Maritime Academy, Odessa, Ukraine Abstract Background. Working conditions of representatives of extreme professions (firemen-rescuers are a good example), are connected with disregulations and disorders of physiologic functions, fatigue accumulation and disadaptation. The medical and psychological rehabilitation is an effective way for occupational health and reliability restoration. However, last one is characterized by an empirical approach and conducted by priority of medical component, that significantly reduces effectiveness of the undertaken measures. So, it is necessary to develop a system of combined medical and psychological rehabilitation (MPR). Materials and methods. In this progect MPR was carried out in 238 specialists of three professional groups: firemen-rescuers (146), fire-engine drivers (44) and inspectors of fire safety (48 - control). Psychophysiological examination included the computerized program “MORTEST”, variant “SPAS-14” performance, answers to the individual-typological questionnaire (ITQ) and Eysenck personal test (EPT). The levels of epinephrine (Е), norepinephrine (NЕ), dopamine (DА) and dioxyphenylalanine (DOPA) urinal excretion, the vanillylmandelic (VMA) and homovanillic acids (HVA) levels in urine were also defined. The survey is conducted three times: at the beginning, middle and the end of a 12-day rehabilitation course. Statistical data processing was carried out by common programs in Microsoft Excel. Results and discussion. The studies have shown that the attributes to identify individual-typological differences are indicators of extroversion-introversion and anxiety in tests ITO and EPT. The results were divided into three clusters: extroverts with low anxiety (52.9%); ambiverts with low (27.7%) and high anxiety (19.4%). Simultaneously it was assigned different types of SAS response in the rehabilitation process: basic or balanced, epinephrinic, norepinephrinic, and with low secretory activity. Low efficiency of rehabilitation measures occurred in 40.7 ± 5,1% of surveyed firefighters with epinephrinic response type and SAS functional exhaustion. The type of SAS response allocated 3 levels of stress in fire-rescuers: adequate to professional load, with the signs of hormonal and mediatorial dissociation, and dangerous - with the depletion of all links of SAS. Conclusion. According to the results of the performed researches it was developed a system of MPR, which allows to conduct a differentiated remediation of firemen-rescuers in the view of occupational features, individually-typological properties of the rehabilitants’ personality, the nature and degree of changes in the central nervous, autonomic and hormonal systems. The developed approaches included in the elaborated Methodical Guidelines, implemented in practice. Key words: extreme professions, firemen-rescuers, medical and psychological rehabilitation, psychophysiological assessment, psychological markers, catecholamines excretion, effective measures elaboration.

Contemporary Patterns of Formation of Suicidal Behavior in Patients with Depressive Disorders

Aims The research wasdesigned to study the contemporary patterns of suicidal behavior in patientswith depressive disorders. Objectives Itwas conducted comprehensive examination of 155 patients of both genders, aged 18–35 years with anestablished diagnosis of depressive disorders which contained various forms ofsuicidal behavior. Methods Hamilton Rating Scale for Depression (HRSD), the Montgomery–Asberg Depression Rating Scale and the Hospital Anxiety andDepression Scale, Biochemical tests. Results Symptoms of phobia andanxiety which correlated with affective disorders (dysthymia, recurrent depressive episode) and posttraumatic stress disorder in menpotentiated the risk of suicidal behavior. The results of biochemical tests showed that patients withsuicidal behavior have an increase of the concentration of serotonin in theblood, reducing the level of melatonin in the plasma and the decrease of therate of excretion of adrenaline and norepinephrine in the night and dayperiods. In patients with high levels of depression according to the Hamilton Rating Scale for Depressionand other scales of depression were found the maximum increase of the concentration of serotonin inthe blood and the lowest level of melatonin in the plasma. It can be concluded thatthe neuroendocrine regulation of suicidal behavior is triggered by a reductionof melatonin, which lead to a decrease of catecholamine excretion. Conclusions The present study allowed us todevelop a comprehensive pathogenetic based complex system of correction ofsuicidal behavior during the acute stress reactions, which includes thecombined use of medication and psychotherapy .

Endocrine Determinants of Changes in Insulin Sensitivity and Insulin Secretion during a Weight Cycle in Healthy Men

ObjectiveChanges in insulin sensitivity (IS) and insulin secretion occur with perturbations in energy balance and glycemic load (GL) of the diet that may precede the development of insulin resistance and hyperinsulinemia. Determinants of changes in IS and insulin secretion with weight cycling in non-obese healthy subjects remain unclear.MethodsIn a 6wk controlled 2-stage randomized dietary intervention 32 healthy men (26±4y, BMI: 24±2kg/m2) followed 1wk of overfeeding (OF), 3wks of caloric restriction (CR) containing either 50% or 65% carbohydrate (CHO) and 2wks of refeeding (RF) with the same amount of CHO but either low or high glycaemic index at ±50% energy requirement. Measures of IS (basal: HOMA-index, postprandial: Matsuda-ISI), insulin secretion (early: Stumvoll-index, total: tAUC-insulin/tAUC-glucose) and potential endocrine determinants (ghrelin, leptin, adiponectin, thyroid hormone levels, 24h-urinary catecholamine excretion) were assessed.ResultsIS improved and insulin secretion decreased due to CR and normalized upon RF. Weight loss-induced improvements in basal and postprandial IS were associated with decreases in leptin and increases in ghrelin levels, respectively (r = 0.36 and r = 0.62, p<0.05). Weight regain-induced decrease in postprandial IS correlated with increases in adiponectin, fT3, TSH, GL of the diet and a decrease in ghrelin levels (r-values between -0.40 and 0.83, p<0.05) whereas increases in early and total insulin secretion were associated with a decrease in leptin/adiponectin-ratio (r = -0.52 and r = -0.46, p<0.05) and a decrease in fT4 (r = -0.38, p<0.05 for total insulin secretion only). After controlling for GL associations between RF-induced decrease in postprandial IS and increases in fT3 and TSH levels were no longer significant.ConclusionWeight cycling induced changes in IS and insulin secretion were associated with changes in all measured hormones, except for catecholamine excretion. While leptin, adiponectin and ghrelin seem to be the major endocrine determinants of IS, leptin/adiponectin-ratio and fT4 levels may impact changes in insulin secretion with weight cycling.Trial RegistrationClinicalTrials.gov NCT01737034

Cardiorenal axis and arrhythmias: Will renal sympathetic denervation provide additive value to the therapeutic arsenal?

Disruption of sympathetic tone may result in the occurrence or maintenance of cardiac arrhythmias. Multiple arrhythmic therapies that intervene by influencing cardiac sympathetic tone are common in clinical practice. These vary from pharmaceutical (β-blockers, angiotensin-converting enzyme inhibitors, and calcium antagonists) to percutaneous/surgical (cardiac sympathetic denervation) interventions. In some patients, however, these therapies have insufficient prophylactic and therapeutic capabilities. A safe and effective additional therapy wherein sympathetic drive is further attenuated would be expedient. Recently, renal sympathetic denervation (RSD) has been subject of research for various sympathetic nervous system-related diseases. By its presumed afferent and efferent sympatholytic effects, RSD might indirectly attenuate sympathetic outflow via the brain to the heart but might also reduce systemic catecholamine excretion and might therefore reduce catecholamine-sensitive arrhythmias. RSD is subject of research for various sympathetically driven arrhythmias, both supraventricular and ventricular. In this review, we give an overview of the rationale behind RSD as potential therapy in mediating arrhythmias that are triggered by a disrupted sympathetic nervous system and discuss the presently available results from animal and human studies.

Catecholamine excretion in patients with eating disorders

To compare clinical features of eating disorders and parameters of monoamine metabolism. Authors examined 21 patients with eating disorders during 2008-2011 using clinical/psychopathological method. To evaluate the status of monoamine neuromediator system, urine levels of dopamine, noradrenalin and adrenaline excretion were measured using high-yield liquid chromatography with electrochemical detection. The reference group included 26 sex- and age-matched volunteers. The common patterns of the pathogenesis of compulsive urges of different origin were identified. The results indicate not only nonspecific changes in catecholamine systems of patients with eating disorders associated with different stress disorders but also demonstrate the pathogenetic correlations between dopaminergic activity and clinical symptoms of addiction.

Dealing with Pheochromocytoma during the First Trimester of Pregnancy.

Purpose. Pheochromocytoma in association with pregnancy is a very rare, without specific symptoms, life-threatening condition, increasing both maternal and fetal mortality up to 50%. The present paper illustrates the case of a pregnant woman, diagnosed with pheochromocytoma, aiming to demonstrate and discuss the difficulties that arouse during the diagnosis and the problems concerning the treatment. Patient. A 34-year-old woman, in the 9th week of pregnancy, complained for headache, sweating, and a feeling of heavy weight on the right renal area. A tumor of 10 cm diameter at the site of the right adrenal was found. Twenty-four-hour urine catecholamine and VMA excretion levels were well raised. Results. Multidisciplinary approach treated the patient conservatively. Surgical resection of the tumor was performed after the 14th week of pregnancy at the completion of organogenesis. Neither postoperative complications occurred nor hypertension relapse was recorded. The fetus was delivered without complications at the 36th week. Conclusions. There are no consensus and guidelines for treating pheochromocytoma during pregnancy, especially when it is diagnosed in the first trimester. The week of pregnancy and a multidisciplinary approach will determine whether the pregnancy should be continued or not, as well as the time and the approach of surgical treatment.

Wistar rats resistant to the hypertensive effects of ouabain exhibit enhanced cardiac vagal activity and elevated plasma levels of calcitonin gene-related peptide.

Ouabain is a cardiac glycoside produced in the adrenal glands and hypothalamus. It affects the function of all cells by binding to Na+/K+-ATPase. Several lines of evidence suggest that endogenous ouabain could be involved in the pathogenesis of essential (particularly, salt-sensitive) hypertension. However, information regarding the postulated hypertensive effect of the long-term administration of low-dose exogenous ouabain is inconsistent. This study was designed to help settle this controversy through the use of telemetric monitoring of arterial blood pressure and to elucidate the ouabain-induced alterations that could either promote or prevent hypertension. Ouabain (63 and 324 µg/kg/day) was administered subcutaneously to male Wistar rats. Radiotelemetry was used to monitor blood pressure, heart rate and measures of cardiovascular variability and baroreflex sensitivity. The continuous administration of ouabain for 3 months did not elevate arterial blood pressure. The low-frequency power of systolic pressure variability, urinary excretion of catecholamines, and cardiovascular response to restraint stress and a high-salt diet as well as the responsiveness to α1-adrenergic stimulation were all unaltered by ouabain administration, suggesting that the activity of the sympathetic nervous system was not increased. However, surrogate indices of cardiac vagal nerve activity based on heart rate variability were elevated. Molecular remodeling in mesenteric arteries that could support the development of hypertension (increased expression of the genes for the Na+/Ca2+ exchanger and Na+/K+-ATPase α2 isoform) was not evident. Instead, the plasma level of vasodilatory calcitonin gene-related peptide (CGRP) significantly rose from 55 (11, SD) in the control group to 89 (20, SD) pg/ml in the ouabain-treated rats (PTukey's = 18.10−5). These data show that long-term administration of exogenous ouabain does not necessarily cause hypertension in rodents. The augmented parasympathetic activity and elevated plasma level of CGRP could be linked to the missing hypertensive effect of ouabain administration.

The blood pressure-lowering effect of renal denervation is inversely related to kidney function

In renal denervation (RDN), a wide range in the blood pressure (BP)-lowering effect has been reported. On the basis of the current knowledge of pathophysiology, we hypothesized that the BP-lowering effect of RDN would be inversely related to kidney function. Second, we investigated whether direct and indirect variables of the renin-angiotensin-aldosterone system (RAAS) and the sympathetic nervous system (SNS) would be related as well. Sixty-seven patients from a prospective cohort of patients treated with RDN with completed 6 months follow-up were included. Data collected during routine standardized work-up before RDN were used: 24-h urine excretion of creatinine, albumin, sodium and catecholamines, plasma creatinine, renin activity and aldosterone, ambulatory BP-monitoring and a captopril challenge test. When considered well tolerated, antihypertensive drugs were stopped before these investigations. The BP-lowering was inversely related to estimated glomerular filtration rate (eGFR) in patients who stopped antihypertensive drugs prior to testing (ß: 0.46, P = 0.013). There was a positive relation between SBP at baseline and the BP-lowering effect of RDN (ß:-0.55 mmHg per mmHg, P < 0.001). Parameters related to the rennin-angiotensin system (aldosterone, captopril test) and the sympathetic nervous system (dipping pattern and catecholamines in urine) positively related to the BP-lowering effect of RDN. The present explorative study shows an inverse relation between the BP-lowering effect of RDN and eGFR. Second, we found relations between variables of the RAAS and SNS with the BP-lowering effect of RDN. The data complement current concepts on pathophysiology of sympathetic hyperactivity and hypertension and may give some insight in the wide range of the effect of RDN.

Development and validation of a specific and sensitive LC-MS/MS method for quantification of urinary catecholamines and application in biological variation studies.

Catecholamines are a class of biogenic amines that play an important role as neurotransmitters and hormones. We developed and validated a rapid, specific and sensitive LC-MS/MS method for quantitative determination of catecholamines in human urine. Linearity, specificity, sensitivity, precision, accuracy, matrix effect, carryover, analyte stability, method comparison and reference range were evaluated. The catecholamine measurements were not affected by 35 structurally-related drugs and metabolites. The outstanding specificity was achieved by use of a specific diphenylborate-based solid phase extraction and subsequent selective LC-MS/MS analysis. Excellent sensitivity, accuracy and precision (average intra-assay variations <2.9% and inter-assay variations <4.6%) were obtained. The method was successfully applied in the study of day-to-day biological within- and between-subject variations of 25 healthy people under free-living conditions over three consecutive days. We observed that catecholamine excretions for second morning sampling had least day-to-day within-subject variation and excellent reproducibility. This work is one of the rare studies on these topics and represents the first utilization of advanced LC-MS/MS technology. Additionally, we found significant correlations between spot and conventional 24h collections of human urine (n = 22, r > 0.853, p < 0.0001). These findings suggest that determining the catecholamine concentrations inthe second morning urine sample presents accurate, convenient and reliable measurement of catecholamine excretions. In addition, consistent and significant diurnal variations for norepinephrine and epinephrine excretions were observed during the three-day period, while dopamine did not exhibit a diurnal rhythm. The LC-MS/MS method presented here is rapid, sensitive and specific, which could be an advantage in clinical laboratories.

Effects of softness of bedding materials upon overnight excretion of urinary catecholamines and sleep quality in warm environmental conditions

The purpose of this study was to investigate whether, when subjects were living in a moderately warm environment: (1) the softness of clothing worn during the daytime could influence the subjects’ preference in the evening for the softness of clothing and a face towel; and (2) the softness of bedding materials could modulate their nocturnal body temperature, overnight urinary catecholamine excretion, and sleep quality. Six females were tested during the luteal phase of their menstrual cycles. The experiment was conducted over three consecutive days and nights in a climatic chamber controlled at 28 ± 0.2 °C and 50% RH during the evening (from 19:30 to 21:30 h) and at 29 ± 0.2 °C and 50% RH during the sleep period (from 22:30 to 07:00 h). The first night was for adaptation to the experimental chamber. Five different sets of clothing and bedding were used; these were identical except for the softness/hardness of the materials used (due to treatment with fabric softener or starch), and material softness decreased in the order: Type A (softest) > Type B > Type C > Type D > Type E (hardest). There were two phases to the experiment, conducted in random order. In one phase, subjects wore “soft type” (Type B) T-shirt and shorts in the daytime and, in the other phase, “hard type” (Type D/E) T-shirt and shorts. In both phases, subjects were asked at 21:30 h to select a T-shirt and a face towel which they felt would be most comfortable to use. At night, they slept on bedding (a mattress cover, a pillowcase and a covering blanket) which was of the same degree of softness as the T-shirt and shorts that had been worn in the daytime in that phase. Rectal temperature, skin temperatures at seven sites, and body movement were measured during sleep, an overnight urine sample was taken for measurement of urinary excretion of adrenaline and noradrenaline, and subjective sleep quality was assessed on being woken the following morning. The main results were as follows: (1) T-shirt preference in the evening showed large inter-individual variation but did not differ significantly between the two phases (when “hard type” or “soft type” clothing had been worn during the daytime). The preferred texture of the face towel was softer than that of the T-shirt, the difference in softness between the chosen face towel and T-shirt being significant (p < 0.05 and p < 0.10, respectively, when having worn “soft type” and “hard type” clothing in the daytime). (2) Rectal temperature and mean skin temperature were not significantly different when sleeping with “soft type” (Type B) and “hard type” (Type D/E) bedding materials. (3) Overnight secretions of urinary adrenaline and noradrenaline were significantly less with “soft type” than “hard type” (p < 0.01 and p < 0.05 for adrenaline and noradrenaline, respectively) bedding. (4) When sleeping with “soft type” bedding materials, five out of the six subjects showed less body movements during the sleep period and reported that they had slept better. These results suggest that, in a moderately warm environment, bedding materials with a softer texture might be more comfortable to the subject (due to less tactile stimulation of the skin, which results in neurophysiological relaxation) and provide them with better sleep quality.

Phenotype of SDHB mutation carriers in the Netherlands.

SDHB mutation carriers are predisposed to developing paragangliomas (PGLs). The objective of this study was to assess genotype-phenotype correlations of a Dutch cohort of SDHB mutation carriers and assess potential differences in clinical phenotypes related to specific SDHB founder mutations. Forty-seven consecutive SDHB mutation carriers were included. Initial screening consisted of measurement of 24 h urinary excretion of catecholamines and their metabolites in duplicate, repeated annually if initial biochemical screening was negative. Whole-body imaging studies with magnetic resonance imaging (MRI) or computed tomography (CT) and/or (123)I-MIBG scintigraphy were performed in case of catecholamine excess, and MRI or CT scans of thorax, abdomen and pelvis were performed every 2 years regardless of catecholamine levels. Repetitive head-and-neck MRI was performed at 2 year intervals. Mean follow-up was 3.6 ± 3.6 years. Twenty-seven persons (57 %) carried the SDHB c.423+1 G>A mutation and seven persons (15 %) the SDHB c.201-4429_287-933del (exon 3 deletion) mutation. No differences were found in the clinical phenotype of carriers of these two specific SDHB mutations. By end of follow-up, 49 % of SDHB mutation carriers displayed no biochemical or radiological evidence of manifest disease, i.e. they were unaffected carriers. Three persons (6 %) had been diagnosed with a pheochromocytoma (PCC), four with a sympathetic PGL (sPGL) (9 %), 18 with a HNPGL (38 %), and two persons (4 %) had developed a malignant paraganglioma, i.e. metastatic disease. In conclusion, the two main Dutch SDHB founder mutations do not differ in clinical expression and result in a relatively mild phenotype. Over one-third of SDHB mutation carriers develop HNPGL, with sPGL/PCC in only 15 % and malignancy in only 4 %.

Differential circadian catecholamine and cortisol responses between healthy women with and without a parental history of hypertension.

Previous studies suggest that otherwise healthy individuals who have a parental history of hypertension (PH+) have an accentuated reactive rise in catecholamines and cortisol to laboratory stressors as well as elevated plasma levels when compared with those with no parental history (PH-); however, few, if any, studies have evaluated whether parental history affects the responses of these hormones to changing environmental circumstances in everyday life. The purpose of this study was to compare urinary catecholamine (epinephrine and norepinephrine) and cortisol excretion and ambulatory blood pressures (BPs) across three daily microenvironments between women with and without a parental history of hypertension. The women in the study (PH+, N = 62, age = 35.2 ± 9.1; PH-, N = 72, age = 33.8 ± 10.0) worked in clerical, technical, or professional positions at a major medical center in New York City. Urinary hormone excretion rates and ambulatory BP were measured across three daily microenvironments: work (11 am to 3 p.m.), home (approximately 6 p.m. to 10 p.m.), and during sleep (approximately 10 p.m. to 6 a.m.). History group comparisons by microenvironment were made using repeated-measures ANCOVA and ANOVA analyses. The results show that epinephrine excretion among PH+ women was 36% higher than PH- women (P < 0.008) over the entire day and that nocturnal cortisol excretion was also greater among PH+ women (P < 0.045). PH+ women also had statistically significantly higher systolic (4 mm Hg higher; P < 0.01) and diastolic (2 mm Hg higher, P < 0.03) BP when compared with PH- women across all daily microenvironments. These findings suggest that there may be genetically linked mechanisms which elevate tonic epinephrine levels and nocturnal cortisol levels that contribute to elevating circadian BP.

Corrélation entre les dosages des dérivés methoxylés urinaires et l’index d’apnée-hypopnée dans une population d’hypertendus : étude pilote

AimsSleep disorders like obstructive sleep apnea in adults are associated with increased sympathetic activity, which induced high blood pressure and could be associated with resistant hypertension. Some studies have demonstrated that high urinary catecholamine levels in obstructive sleep apnea patients may be decreased with continuous positive airway pressure therapy. However, very few studies have demonstrated a correlation between apnea-hypopnea index and urinary catecholamine levels in hypertension patients. MethodsIn this pilot study, 20 hypertensive patients referred for hypertension work-up including night-time polygraphy and 24h urinary catecholamine dosage were included. ResultsMean age was 51±11 years (30–76), 68% were males. Diagnosis of obstructive sleep apnea was confirmed in 13 patients at the end of the work-up. Mean apnea-hypopnea index was 14±9 (2–32). The only urinary catecholamine parameter significantly increased in patients with obstructive sleep apnea was 24h urinary normetanephrine (1931±1285 vs 869±293nmol/24h; P<0.05). However, this difference was not significant when this parameter was adjusted to 24h urinary creatinine. We observed a significant positive correlation between AHI and 24h urinary normetanephine (r=0.486; P=0.035). ConclusionThis pilot study confirms an isolated elevation of 24h urinary normetanephrine in hypertensive patients with obstructive sleep apnea and shows a significant correlation between sleep disorders expressed by apnea-hypopnea index and urinary catecholamines excretion.

Excretion of catecholamines in children with obesity

The paper gives an analysis of the peculiarities in catecholamine (CA) urinary excretion in children and adolescents suffering from obesity in different age groups. Disorders in age-related dynamics of CA contents at the stages of puberty have been revealed both in boys and in girls with obesity due to activation of sympathoadrenal system (SAS) in 12-15 years. Persistent positive relationships between CA findings and the value of body mass index have been established in patients with obesity, in boys mainly due to dioxyphenilalanin (DOPA) and dophamin (DA), and in girls due to norepinephrine (NE) and epinephrine (EA). In girls with obesity, complicated with insulin resistance (IR), higher values of NE and E have been registered significantly more often. Growth of immunoreactive insulin and HOMA-IR index in obese boys is accompanied by an increased excretion of DA and NE. The data obtained, in general, are consistent with the findings of other researchers as regards SAS activation at early stages of puberty, which causes formation of other hormonal disorders and a rapid course of puberty in patients with obesity.

The urine catecholamine's excretion characteristics in preschool age children with deprivation

The urine catecholamine's excretion characteristics in preschool age children with deprivation

Functional Retroperitoneal Neuroblastoma and Ganglioneuroblastoma in Adults

ABSTRACTGanglioneuroblastoma and neuroblastoma are malignant catecholamine-secreting tumors arising from neural crest tissue. Thirty-eight cases of functional retroperitoneal extra-adrenal neuroblastoma and ganglioneuroblastoma in adults are reported in English literature. These tumors behave more aggressively in adults compared to children and have very poor prognosis. We report four adults who presented with retroperitoneal extraadrenal ganglioneuroblastoma and neuroblastoma between 2008 and 2012. Median age at presentation was 28.5 years (21-40 years). One patient was in late stages of pregnancy. Three patients presented with local pressure effects from the tumor and one patients manifested clinical features of catecholamine excess. Biochemical analysis showed raised urinary dopamine excretion in all our patients. Urinary noradrenaline and metanephrines were elevated in three cases. Computed tomography/magnetic resonance imaging/meta-iodobenzylguanidine (CT/MRI/MIBG) confirmed stage IIB disease in one patient, stage III disease one patient and stage IV in two cases. Preoperative biopsy confirmed diagnosis in two cases. Complete surgical resection was performed in patient with stage II B disease and partial surgical resection was feasible in other cases. Histological diagnosis was ganglioneuroblastoma in two cases and neuroblastoma in two cases. Meta-iodobenzylglunidine/radiotherapy and chemotherapy were used for residual disease. Urinary catecholamines and metanephrines normalized after complete tumor resection but remained elevated in residual disease. Survival for neuroblastoma was 15 and 21 months after the surgery and 29 months for ganglioneuroblastoma. One patient remains free of disease at 6 months. Functioning ganglioneuroblastoma and neuroblastoma are rare in adults and only one other case ganglioneuroblastoma in pregnancy is reported in the world literature. Measurement of plasma/urinary excretion of catecholamines and their precursors and metabolites is helpful for diagnosis of neuroblastoma and ganglioneuroblastoma. Due to late presentation surgical resection is unlikely to be curative. Three of our patients developed local recurrence of disease. Urinary/plasma assay are used for monitoring disease relapse. Long-term survival is unusual.

Plasma levels of free metanephrines and 3-methoxytyramine indicate a higher number of biochemically active HNPGL than 24-h urinary excretion rates of catecholamines and metabolites

A substantial number of patients with head and neck paragangliomas (HNPGLs) have biochemically active tumors, evidenced by increased urinary excretion of catecholamines and metabolites, including 3-methoxytyramine (3MT). It is unclear whether plasma levels of these parameters are more sensitive to detect biochemical activity in HNPGL patients than urinary excretion rates. To compare plasma free levels vs urinary excretion rates of deconjugated 3MT and combined metanephrines (MNs) in patients with HNPGL. We included 124 consecutive patients with HNPGL for screening of catecholamine excess by measurement of 24-h urinary excretion rates of deconjugated (nor)metanephrine, (nor)epinephrine, dopamine, vanillylmandelic acid, 3MT, and plasma free levels of (nor)metanephrine and 3MT. Plasma free 3MT levels were increased in 35 of the 124 patients (28%), whereas 24-h urinary excretion of deconjugated 3MT was increased in 30 patients (24%) (P=0.13). Plasma free MN levels were increased in seven patients (6%) and urinary deconjugated MN levels in six patients (5%) (P=1.00). Plasma free normetanephrine (NMN) levels were increased in seven patients (6%), and five patients had increased urinary excretion of deconjugated NMN (4%) (P=0.69). Plasma free combined MN levels (NMN, MN, and 3MT) were increased in 41 patients (33%), whereas 24-h urinary excretion rates of deconjugated combined MNs were increased in 33 patients (27%, P<0.05). The combined levels of free MNs and free 3MT in plasma indicate a higher number of biochemically active HNPGLs than the 24-h urinary excretion rates of these markers.

Pheochromocytoma/paraganglioma: clinical and genetic aspects

The present retrospective descriptive and analytical study included 167 patients divided into three groups. Two groups were comprised of the patients with genetically predetermined pheochromocytoma (type 2 MEN syndrome and von Hippel-Lindau disease respectively), the third croup consisted of the patients presenting with sporadic pheochromocytoma. The median age at which pheochromocytoma was diagnosed was 25 years in group 1, 18 years in group 2, and 47 years in group 3. Adrenalin-type secretion was predominated in group 1 in contrast to the noradrenalin-type and mixed-type secretion in the patients of groups 2 and 3 respectively. The patients of group 1 showed positive correlation between the tumour size and excretion of methylated catecholamines. 82% of these patients exhibited bilateral adrenal lesions and 58% suffered multifocal lesions; no cases of extra-adrenal localization of the tumour were documented. The extra-adrenal localization of pheochromocytomas was observed in 16.4% of the patients in group 2, where 6.6% of the patients had metastases. No metastases of pheochromocytoma were found in the patients of groups 1 and 3. It is concluded that the patients under the age of 40 presenting with bilateral and multicentral pheochromocytoma with the aggravated familial history need the genetic predetermination of the disease to be excluded taking into account syndromal symptoms. Examination for the detection of type 2 MEN is not required in the patients showing isolated normetanephrin excretion. Nor is the search for metastases of pheochromocytoma and its extra-adrenal localization is necessary in the patients presenting with type 2 MEN syndrome and/or exhibiting isolated metanephrin excretion.

Successful Management of a Catecholamine-Secreting Glomus Jugulare Tumor with Radiosurgery Alone

Secretory glomus jugulare tumors are often resected surgically to control the systemic effects of the catecholamines they produce. This involves complex skull base surgery, which carries significant risks and frequent morbidity. Stereotactic radiosurgery (SRS) is a recently recognized treatment for glomus jugulare tumors, though little is known about its use in secretory tumors. Case Report A young fit patient with a catecholamine-secreting glomus jugulare tumor was treated with SRS alone and over the following 37 months her urinary catecholamine excretion fell to near normal levels, and serial magnetic resonance imaging (MRI) confirmed a reduction in tumor volume. Discussion Radiosurgery is an accepted treatment for glomus jugulare tumors and is now readily available to skull base surgeons. In this case a catecholamine-secreting tumor was successfully controlled with radiosurgery alone. Further research and long-term follow-up will determine the role of this treatment in the nonsurgical management of secreting glomus jugulare tumors.