Catecholamines Research Articles

Endogenous systems involved in exercise-induced analgesia.

Exercise-induced analgesia is a phenomenon discussed worldwide. This effect began to be investigated in the early 1970s in healthy individuals and rodents during and after an acute or chronic session of running or swimming. Thereafter, studies found this effect was also induced by resistance exercises. Over the years, many studies have demonstrated the importance of exercise-induced analgesia in relieving pain caused by different conditions, such as fibromyalgia, low back pain, neuropathy, and osteoarthritis. This review aims to provide the reader with an in-depth description of the main endogenous systems, substances, neurotransmitters, receptors and enzymes that are thought to be involved in the analgesic effect induced by exercise. Many hypotheses have been proposed to elucidate the mechanisms responsible for exercise-induced analgesia. One of the most accepted hypotheses has been the activation of several endogenous systems described as analgesics. Studies have demonstrated that during and after exercise different endogenous systems are activated, which release substances or neurotransmitters, such as opioids, nitric oxide, serotonin, catecholamines and endocannabinoids, that may modulate the pain perception.

Probing catecholamine neurotransmitters based on iron-coordination surface-enhanced resonance Raman spectroscopy label

Catecholamine (CA) is neurotransmitters of the biological amines class which play an important role in organism. However, it is quite difficult to realize sensitive and selective detection of CA in complex system. Here, we employ surface-enhanced resonance Raman spectroscopy (SERRS) strategy, iron-nitrilotriacetic acid functionalized PVP-Au NPs (Au-Fe(NTA)) as Raman label for rapid and sensitive detection of CA containing dopamine (DA), norepinephrine (NE) or epinephrine (EP) in complex serum. The Au NPs is sufficient to provide Raman enhancement and Fe-NTA label can rapidly trap CA molecules adjoining gold core to form NTA-Fe-CA resonant structure, which can amplify the signals of CA. More important, we successfully distinguish these three CA molecules in serum since surface-enhanced Raman spectroscopy (SERS) technique can provide fingerprint identification. Furthermore, the SERS signals of Au-O band from PVP stabilized Au NPs can be utilized as a stable internal calibration standard for quantitative detection of target. Additionally, we continue to investigate the binding constants between different CA molecules and functionalized substrate to evaluate the corresponding adsorption property. This SERRS strategy is not only capable to offer exciting opportunities to selectively trap the analyte, but also strongly amplify the Raman signals of CA as well as achieve quantitative measurement.

Electrochemical Determination of Tyrosine and Tryptophan Using Ultraviolet Irradiated Tungsten Trioxide Nanoparticles

Amino acids are derived by the human body through the breakdown of proteins that enters in the form of diet in foods. Among 22 standard amino acids, L-Tyrosine (Tyr) and L-Tryptophan (Trp) play important roles in the biochemical, nutritional and clinical significance in mammalian systems. Tyrosine (4- hydroxyphenylalanine) is a non-essential amino acid because, under normal conditions, the body synthesizes sufficient quantities from phenylalanine. It acts as a precursor for catecholamine neurotransmitters and hormones such as L-dopa, dopamine, norepinephrine and epinephrine, melanin and thyroid hormones. Tryptophan (2S-2-amino-3-(1H-indol-3-yl) propanoic acid) is one of the essential amino acids which is commonly synthesized in plants and microorganism from shikimic acid. Trp acts as precursor for the indolamine neurotransmitters such as serotonin, melatonin and vitamin B6 niacin. Improper metabolism of both the aromatic amino acids leads to depression, Parkinson’s disease, sister chromatid exchange, hallucinations, schizophrenia, drowsiness and appetite suppression [1]. Therefore, the development of a simple and sensitive tool for the determination of amino acids in food products and pharmaceuticals is necessary to have great importance in life science research. Here, we report a simple method for the electrochemical determination of Tyr and Trp based on ultraviolet (UV) irradiated tungsten trioxide (WO3) nanoparticles modified glassy carbon electrode (GCE) without using surface mediators or promotors. Irradiation with appropriate sources such as gamma rays, swift heavy ion and low energy ion beam have been used as an efficient tool to improve its physic-chemical properties [2-5]. In addition to these fairly sophisticated tools, UV light irradiation can be considered as an alternative method due to its advantageous features like room temperature processes, creating defects in a controlled manner, easy to operate and long service life. Li et al., reported that the exposure of WO3 photoanodes to UV irradiation leads to improvements in photoelectrochemical activity towards the oxygen evolution reaction [6]. In the current work, WO3 nanoparticles were synthesized via UV irradiation with variant exposure time (2, 4, 6 and 8 hr) and characterized by powder XRD, FESEM, Raman, UV-Vis absorption and photoluminescence spectra. Optimally irradiated (4 hr) WO3 NPs exhibited reduced crystallite size with fragmented spherical particles and increased band gap energy due to induced oxygen defects and vacancies. Cyclic Voltammetry (CV) studies of UV-4 hr WO3/GCE showed an excellent electrocatalytic activity towards the oxidation of Tyr and Trp in phosphate buffer solution (PBS, pH 6.0) in the presence of several potentially interfering compounds. Differential pulse voltammetry (DPV) studies of the modified GCE exhibited linear response over a wide concentration range of 0.1 to 1100 µM (Tyr) and 0.1 to 1000 µM (Trp) with the lowest detection limit of 41 nM and 55 nM respectively for Tyr and Trp. Under optimum experimental conditions, influence of various interfering compounds was investigated by DPV method. A series of foreign species were added into 0.1 M PBS (pH 6.0) containing 2 µM Tyr and 5 µM Trp and the tolerance limit was found to be approximately ±2% relative error in the determination of Tyr and Trp. It was noted that 500-fold excess of ascorbic acid, uric acid, cysteine, Na+ and K+ ions and 50-fold excess of dopamine, serotonin, melatonin, epinephrine and norepinephrine had no significant effect on the response of the two analytes. These results indicate that the proposed electrode can act as a highly selective sensor for recognition of Tyr and Trp in aqueous solutions. The fabricated sensor was successfully applied to determine Tyr and Trp concentration in milk, curd and egg samples with satisfactory recoveries. Keywords: WO3 nanoparticles; Ultraviolet irradiation; Electrochemical sensor; Tyrosine; Tryptophan; Dairy products.

Does Fentanyl Cause Hypotension in Patients Undergoing Rapid Sequence Intubation in the ED

Opioids are sometimes given as pretreatment agents to mitigate the catecholamine release associated with laryngoscopy, although benefit from this

Glucoprivic sensitivity of hindbrain catecholamine neurons is astrocyte‐dependent

Hypoglycemia poses a threat to survival. Endocrine, metabolic, and behavioral counter‐regulatory responses (CRRs) act to correct blood glucose deficit. These responses require sensor, integrator, and effector elements to restore glucose homeostasis. Groups of hindbrain catecholamine (CA) neurons are essential for implementation of different CRRs which include activation of descending sympathetic pathways controlling epinephrine and glucagon release and ascending pathways controlling feeding behavior and glucocorticoids (3, 4). Hindbrain astrocytes respond to low glucose (1, 2, 5). Therefore, we postulated that CA neurons are activated by astrocytes during glucose deficit. To directly test the proposition that CA neuron responses to glucoprivic challenges are astrocyte dependent, we utilized male and female transgenic mice in which the calcium reporter construct (GCaMP5) was expressed selectively in tyrosine hydroxylase neurons (TH‐GCaMP5; TH+). We conducted live‐cell calcium imaging studies on tissue slices containing the nucleus of the solitary tract (NST) and the ventrolateral medulla (VLM); loci of glucoregulatory circuitry (4). Results show that hindbrain TH+ neurons are robustly activated by a glucoprivic challenge and that this response is dependent on functional astrocytes. Pretreatment of hindbrain slices with fluorocitrate (an astrocytic metabolic suppressor) abolished TH+ neuronal responses to glucoprivation, but not to glutamate stimulation. Pharmacologic results suggest that the astrocytic connection with TH+ neurons is purinergic via P2 receptors. Parallel imaging studies on hindbrain slices of NST from wild type C57BL/6J mice (astrocytes and neurons were prelabeled with a calcium reporter dye and an astrocytic vital dye) show that both cell types are activated by glucoprivation but astrocytes responded nearly a minute sooner than neurons. Pretreatment of these hindbrain slices with fluorocitrate eliminated both astrocytic and neuronal responses to glucoprivation; pretreatment with P2 antagonists only abolished neuronal responses to glucoprivation without interruption of astrocyte responses. These results support earlier work suggesting that the primary detection of glucoprivic signals by the hindbrain is mediated by astrocytes which utilize purinergic gliotransmission to activate critical effector neurons.Support or Funding InformationNIH NIDDK 108765, U54 GM 104940, ADA‐1‐15‐JF‐37,This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Whether catecholamines have beneficial effects on splanchnic perfusion

The majority of vasoactive agents in clinical use are catecholamines, which are major vasopressors and/or inotropes in shock.While the primary goal in treating shock is to maintain tissue perfusion and oxygenation.The question of the ideal vasoactive agent in a shock patient remains controversial and unanswered.This article focused on whether catecholamines, such as norepinephrine, dopamine, dobutamine, epinephrine, norepinephrinecombined withdobutamine or epinephrine, have beneficial effects on splanchnic perfusion. Key words: Catecholamines; Splanchnic perfusion; Shock; Vasopressors; Inotropes,

Selection, use and controversy of inotropic agents

Inotropic agents used widely in heart failure and shock.The mechanism, use and controversy of digitalis, catecholamines, phosphodiesterase inhibitors, calcium sensitizer and new inotropics are reviewed, in order to guide appropriate selection and application of inotropics in clinics. Key words: Positive inotropic agents; Heart failure; Shock,

Use of vasoactive agents in different shock

Circulatory failure recognition and treatment represents an important issue in critically ill infants and children.Improvement of cardiocirculatory disability and stabilization of hemodynamic is the key step.Hemodynamic variations among different types of shocks, such as hypovolemic, cardiogenic, distributive and obstructive shock, are different.When fluid administration fails to restore adequate arterial pressure and organ perfusion, vasoactive agents should be considered.The key to selecting among vasoactive agents is to consistent with the context of the goals of therapy.Despite the complex pathophysiology of shock, choose of right vasoactive agents for hemodynamic support of patients with shock can be guided by acknowledged pathological changes, mechanisms of vasoactive agents and current studies. Key words: Shock; Children; Vasoactive agents; Catecholamine drugs,

Paraganglioma of the urinary bladder

Paragangliomas are rare tumors, of neuroendocrine origin. These neoplasms are equivalent to extra-adrenal pheochromocytomas and their symptoms attributed to the secretion of catecholamines. When the urinary system is affected, the urinary bladder is implicated in the majority of the cases with the most specific symptom to be the hypertensive crisis during urination. Paragangliomas are considered benign, although in a small proportion of cases they may demonstrate aggressive biologic behavior. No distinct factors exist which distinguish these two groups; therefore, the follow-up of the patients with this rare tumor has to be close and long-term.

Catecholamine-Modulated Novel Surface-Exposed Adhesin LIC20035 of Leptospira spp. Binds Host Extracellular Matrix Components and Is Recognized by the Host during Infection.

In this study, the effect of the host stress hormone catecholamine on Leptospira gene transcripts encoding outer membrane proteins was investigated. There was no impact of catecholamine supplementation on the in vitro growth pattern of Leptospira interrogans; however, 7 genes out of 41 were differentially transcribed, and the effect was reversed to the basal level in the presence of the antagonist propranolol. Comprehensive analysis of one of the differentially regulated proteins, LIC20035 (in serovar Copenhageni)/LB047 (in serovar Lai) (due to catecholamine supplementation), revealed immunogenicity and ability to adhere to host extracellular matrices. Protease accessibility assay and phase partition of integral membrane proteins of Leptospira showed LIC20035/LB047 to be an outer membrane surface-exposed protein. The recombinant LIC20035 protein can be serologically detected using human/bovine sera positive for leptospirosis. Moreover, the recombinant LIC20035 can bind to diverse host extracellular matrices, with a higher affinity toward collagen and chondroitin sulfate.IMPORTANCE Leptospirosis is a neglected tropical disease of global importance. This study aimed to identify outer membrane proteins of pathogenic Leptospira responding to host chemical signals like catecholamines, with the potential to serve as virulence factors, new serodiagnostic antigens, and vaccine candidates. This study mimicked the plausible means by which Leptospira during infection and hormonal stress intercepts host catecholamines to disseminate in host tissues.

Simvastatin reduces adrenal catecholamine secretion evoked by stimulation of cholinergic nicotinic and angiotensinergic AT1 receptors.

We investigated the influence of simvastatin, a statin, on the secretion of catecholamines (CA) in rat adrenal glands, and clarified its action mechanism. Simvastatin suppressed acetylcholine (ACh)-evoked CA release in a dose- and time-dependent fashion. In the presence of simvastatin, CA secretion evoked by 1.1-dimethyl-4-phenyl piperazinium iodide (DMPP), angiotensin II, high K+, veratridine, and Bay-K-8644 was time-dependently inhibited. However, in the simultaneous presence of simvastatin and Nω-nitro-L-arginine methyl ester hydrochloride, CA secretion evoked by angiotensin II and DMPP recovered to control levels. Adrenal NO release was increased by simvastatin-treatment. Simvastatin-inhibited CA secretion was not affected by treatment with mevalonate. Pravastatin did not influence ACh-evoked CA secretion, while atorvastatin reduced it. In the simultaneous presence of simvastatin and fimasartan, ACh-induced CA release was markedly reduced compared to that of fimasartan-treatment alone. We present the first evidence that simvastatin reduces adrenal CA secretion induced by stimulation of nicotinic and AT1-receptors. Simvastatin-induced inhibition seems to involve reducing the influx of both Ca2+ and Na+ into adrenochromaffin cells, partly via the elevation of NO production by NO synthase activation, without inhibition of 3-hydroxy-methylglutaryl coenzyme A reductase. Co-administration of simvastatin and fimasartan may be clinically helpful for the treatment of cardiovascular diseases.

Robust Coatings via Catechol-Amine Codeposition: Mechanism, Kinetics, and Application.

Bioinspired polyphenol/polyamine codeposition has been demonstrated by the competence for surface modification; however, the reaction processes including mechanism and kinetics remain superficially understood. In this work, the catechol (CA)-amine reaction has been thoroughly investigated by using CA and two amines m-phenylenediamine and piperazine. We verify that both primary and secondary amines are prone to link with CA through Michael addition to form polyphenol/polyamine oligomers under aerobic and mild-alkaline conditions. Molecular simulations indicate that the Michael addition products are dominant for both aromatic and aliphatic amines with CA, which supports the durable chem- and phystability of the codeposited coatings. The aggregation kinetics of polyphenol/polyamine is provided for the first time, and the formed aggregates show high-adhesive properties, which can be deposited as the skin layers for high-performance nanofiltration membranes.

Potential of Sulphur-containing Amino Acids in the Prevention of Catecholamine-induced Arrhythmias.

Various physiological and pathological stimuli can hypersensitize the sympathetic nervous system resulting in a substantial release of catecholamines (CA) and consequent alterations in excitation-contraction coupling and excitation-transcription coupling. It has been shown that oxidation products of CA, rather than CA themselves, are responsible for such adaptation to a new equilibrium. While chronic, sustained accumulation of CA and their toxic products are associated with the depression in cardiac contractile force and remodeling, acute excessive release of CA can result in brief oxidative bursts and serious damage leading in lethal arrhythmias. In response to such oxidative stress, dysregulation of ion homeostasis, activation of neurohumoral system, immune and inflammatory responses, are augmented. These events are inter-related, and as a complex promote electrical instability. Likewise, remodeling occurring after the loss of cardiomyocytes, induces the development of a proarrhythmogenic environment. Thus, CA oxidation products may be involved in triggering arrhythmias as a result of both changes in cardiac cell automaticity and conduction velocity. In contrast, sulphur-containing amino acids (S-AA), in particular taurine and its precursor cysteine have been shown to modulate redox state of the heart. However, the multiple anti-oxidant properties of S-AA are unlikely to be exclusively responsible for their anti-arrhythmic action. They also possess additional cytoprotective effects which can stabilize electrical activity of the heart. It is concluded that specific S-AA may attenuate deleterious effects of supraphysiological levels of CA and this could serve as an important mechanism for the treatment and/or prevention of arrhythmogenesis.

Premature aging in behavior and immune functions in tyrosine hydroxylase haploinsufficient female mice. A longitudinal study

Aging is accompanied by impairment in the nervous, immune, and endocrine systems as well as in neuroimmunoendocrine communication. In this context, there is an age-related alteration of the physiological response to acute stress, which is modulated by catecholamine (CA), final products of the sympathetic-adreno-medullary axis. The involvement of CA in essential functions of the nervous system is consistent with the neuropsychological deficits found in mice with haploinsufficiency (hemizygous; HZ) of tyrosine hydroxylase (TH) enzyme (TH-HZ). However, other possible alterations in regulatory systems have not been studied in these animals. The aim of the present work was to analyze whether adult TH-HZ female mice presented the impairment of behavioral traits and immunological responses that occurs with aging and whether they had affected their mean lifespan. ICR-CD1 female TH-HZ and wild type (WT) mice were used in a longitudinal study. Behavioral tests were performed on adult and old mice in order to evaluate their sensorimotor abilities and exploratory capacity, as well as anxiety-like behaviors. At the ages of 2 ± 1, 4 ± 1, 9 ± 1, 13 ± 1 and 20 ± 1 months, peritoneal leukocytes were extracted and several immune functions were assessed (phagocytic capacity, Natural Killer (NK) cytotoxicity, and lymphoproliferative response to lipopolysaccharide (LPS) and concanavalin A (ConA)). In addition, several oxidative stress parameters (catalase, glutathione reductase and glutathione peroxidase activities, and reduced glutathione (GSH) concentrations as antioxidant compounds as well as xanthine oxidase activity, oxidized glutathione (GSSG) concentrations, and GSSG/GSH ratio as oxidants) were analyzed. As inflammatory stress parameters TNF-alpha and IL-10 concentrations, and TNF-alpha/IL-10 ratios as inflammatory/anti-inflammatory markers, were measured. Animals were maintained in standard conditions until their natural death. The results indicate that adult TH-HZ mice presented worse sensorimotor abilities and exploratory capacity than their WT littermates as well as greater anxiety-like behaviors. With regards to the immune system, adult TH-HZ animals exhibited lower values of phagocytic capacity, NK cytotoxicity, and lymphoproliferative response to LPS and ConA than WT mice. Moreover, immune cells of TH-HZ mice showed higher oxidative and inflammatory stress than those of WT animals. Although these differences between TH-HZ and WT, in general, decreased with aging, this premature immunosenescence and impairment of behavior of TH-HZ mice was accompanied by a shorter mean lifespan in comparison to WT counterparts. In conclusion, haploinsufficiency of th gene in female mice appears to provoke premature aging of the regulatory systems affecting mean lifespan.

Protective effects of esmolol on lung function in septic rat

Objective To explore the protective effects of short-acting β1 receptor blocker esmolol on lung injury in septic rats and explore its mechanism. Methods Fifty-four male Sprague-Dawley rats were randomly(random number) divided into three groups (n=18 in each), namely sham operation group(Sham), sepsis group(Spesis),esmolol group(ES).Each group were further divided into three subgroups of 6 h,12 h and 24 h(n=6 in each subgroup).The sepsis models were established with cecal ligation and puncture (CLP) in rats of Sepsis group and ES group, while rats of SH group were treated with laparotomy without CLP. Dwelled cannulation in the left internal jugular vein was performed after the model establishment. Saline in the rate of 1 mL/h was continuously pumped intravenously into the rats of SH group and Sepsis group by micro pump for 6 h, and esmolol solution in the rate of 1 mL/h [15 mg/(kg·h)] was continuously pumped into the rats of ES group for 6h.Rats in each subgroup were sacrificed at 6h,12h and 24 h after modeling, separately. The levels of catecholamine (CA) in plasma and levels of NF-κB in lung tissue were measured by ELISA. The protein levels of TLR4 and NF-κB in lung tissue were detected by Western Blot. The protein content of alveolar lavage fluid, wet/dry weight ratio(W/D) of lung tissue, lung coefficient and lung water content were measured. The pathological changes of lung tissues were observed under an optical microscope. Results ①The levels of CA in plasma in Sepsis and ES groups at 6 h after modeling was significantly increased compared with Sham group (P<0.05), and the level of CA in plasma increased significantly in ES group compared with Sham and Sepsis groups (P<0.05). At 12 h after modeling, level of CA in plasma was still significantly increased in ES group compared with SH group (P<0.05); At 24 h after modeling, level of CA in plasma was increased significantly in ES group compared with Sepsis group (P<0.05).②At 6 h,12 h and 24 h after modeling, levels of NF-κB in lung tissue were significantly increased in Sepsis group and ES group compared with SH group (P<0.05),and levels of NF-κB in lung tissue in ES group were also significantly lower than those in Sepsis group at given intervals (P<0.05).③ At 6 h,12 h and 24 h after modeling, protein content of alveolar lavage fluid, wet/dry weight ratio (W/D) in lung tissue, lung coefficient and lung water content in Sepsis group and ES group were significantly increased compared with SH group (P<0.05), and protein content of alveolar lavage fluid, wet/dry weight ratio (W/D) in lung tissue, lung coefficient and lung water content in ES group also significantly lower than those in Sepsis group at given intervals (P<0.05).④Western Blot revealed at 6 h,12 h and 24 h after modeling, the protein levels of TLR4 and NF-κB in lung tissue in Sepsis group and ES group were significantly increased compared with SH group (P<0.05),and the protein levels of TLR4 and NF-κB in lung tissue of ES group were also significantly lower than those in Sepsis group at all given intervals (P<0.05).⑤The lightest degree of pathological change was observed in SH group, the most serious degree of pathological change was found in Sepsis group, and the pathological change was significantly alleviated in ES group compared with Sepsis group whereas the pathological change was significantly increased compared with SH group at all given intervals. Conclusions Esmolol can promote the secretion of catecholamine,inhibit the release of inflammatory cytokines,reduce lung permeability,reduce pulmonary edema,and thus play an important role in protecting the lungs.The mechanism may be that esmolol improves the responsiveness of β-adrenergic receptor to catecholamine,and regulates the level of inflammatory cytokines by inhibiting TLR4—NF-κB—TNF-α signaling pathways,thus exerting protective effect on the lungs. Key words: Sepsis; Esmolol; Catecholamine; TNF-α; NF-κB; Toll-like receptors 4

Does Vasopressin Exacerbate Cerebral Edema in Patients with Severe Traumatic Brain Injury?

To maintain CPP >60 mm Hg, 205 patients required no vasopressors, 41 received a single CAT, 12 received AVP, and 28 required both. Those who required no pressors were generally less injured; required less hyperosmolar therapy and less total fluid; and had lower plasma Na, lower intracranial pressure, less edema, and lower mortality (all P < 0.05). Edema; daily mean, minimum, and maximum Na levels; and mortality were similar with AVP versus CATs, but the daily requirement of mannitol and 3 per cent NaCl were reduced by 45 and 35 per cent (both P < 0.05). In patients with TBI who required CPP therapy, AVP reduced the requirements for hyperosmolar therapy and did not delay resolution or increase cerebral edema compared with CATs.

Effect mechanism of α-adrenoceptor on sepsis-induced acute respiratory distress syndrome

Acute respiratory distress syndrome (ARDS), characterized by acute hypoxic respiratory dysfunction or failure, is a manifestation of multiple organ failure (MOF) in the lung, which often caused by various non-cardiac reasons, included severe trauma, infection, shock; and the most common risk factor is sepsis which would cause uncontrolled host response to infecting factors. As a strong stressor during sepsis, the severe infectious state of the body triggers serious stress reaction. The hypothalamus-pituitary-adrenal cortical (HPA) axis and sympathetic-adrenal medulla axis were activated and participated the initiation and progression of the stress response through the production of adrenocorticotropic hormone (ACTH), glucocorticoid (GC), epinephrine and norepinephrine (NE). As the main hormones during sepsis, catecholamines (CA), including epinephrine and NE, could bind to adrenergic receptor (AR). After the binding, CA could play its role through the complicated signal way. Therefore, to explore the signal transduction pathway of α-AR, during sepsis, is important for revealing the mechanism of sepsis-induced ARDS.

Intractable hypoglycemia in an elderly lady with breast cancer

Paraneoplastic hypoglycemia is one of the rare causes of noninsulin-mediated hypoglycemia, which has been encountered mostly with solid tumors or mesenchymal in origin; however, it can also occur in patients with diverse kinds of tumor origin. Hypoglycemia related to tumors can be induced by different hormones produced by different tumors – for example, excessive secretion of insulin by islet cell tumors (insulinoma and neuroendocrine tumors); insulin-like growth factor 2 (IGF2) from mesenchymal and epithelial tumors; and rarely by secretion of IGF1, cytokines, and catecholamines or increased tumor metabolism of glucose. Herein, we report the case of an 89-year-old female, known to have type 2 diabetes mellitus with frequent hospital admission due to recurrent episodes of severe hypoglycemia, which was initially attributed to the insulin therapy she was taking; the patient continued to have episodes of hypoglycemia even after cessation of insulin. During her previous admission, she was found to have a swelling over the left breast. Ultrasound-guided biopsy was done and histopathology was suggestive of an invasive ductal cell breast carcinoma. We eventually found that these episodes of severe hypoglycemia were secondary to the paraneoplastic effect of invasive ductal cell carcinoma of the breast.

Plasma & urinary catecholamines & urinary vanillylmandelic acid levels in patients with generalized vitiligo.

Background & objectives:Vitiligo is an acquired skin disease characterized by depigmented areas of the skin. Increased release of catecholamines from autonomic nerve endings in microenvironment of melanocytes in affected skin might be involved in the aetiopathogenesis of vitiligo. Levels of catecholamines are considered as being related to onset or worsening of the disease. Therefore, in this study, the role of catecholamines was evaluated in mapping disease stability and outcome of vitiligo patients undergoing melanocyte transfer.Methods:In this study, circulatory and urinary levels of catecholamine (CA) and vanillylmandelic acid (VMA) were determined in 45 individuals (30 vitiligo patients and 15 healthy controls) using ELISA.Results:A significant increase for plasma and urinary catecholamines along with VMA was observed as compared to healthy controls. When the pre- and post-intervention levels were analyzed in responders and non-responders, respectively, only dopamine showed significant decline in urine, rest of the molecules in plasma as well as urine showed non-significant decline except VMA which showed insignificant increase.Interpretation & conclusions:Levels of plasma/urinary epinephrine, and plasma dopamine, could not be established as biomarkers for disease stability or successful outcome of autologous melanocyte transfer in generalized vitiligo patients. However, dopamine (urine) might be of help in determining the stability in patients with generalized vitiligo undergoing melanocyte transfer. Further studies need to be done on a large sample of patients to confirm our findings.

Adrenal cholangiocarcinoma: a case report and literature review

Objective To discuss the clinical characteristics and pathologic features of adrenal cholangiocarcinoma. Methods We reported one extremely rare adrenal cholangiocarcinoma case and review the relative literature. A 71-year-old male was admitted with right adrenal mass for 2 months. Patient has been suffered from hypertension and controlled by oral drugs for ten years. Enhanced computerized tomography (CT) revealed a mass in right adrenal gland area, with the size of 7.1 cm×6.8 cm×4.4 cm and inhomogeneous enhancement in arterial phase. Adrenal functional examination showed no obvious abnormalities of serum catecholamine, supine RAAS, cortisol determination and rhythm and urine VMA detection. Results After medical preparation of phenoxybenzamine for 3 weeks preoperatively, the patient's blood pressure was maintained at 110-125/80-90 mmHg and with stuffy nose and ruddy nail bed. The patient′s weight gained of 1kg than before. Retroperitoneal laparoscopic resection of right adrenal tumor was performed in general anesthesia. The tumor that related to the inferior vena cava and liver was successfully removed without any other damage. The operation time was 155 min and estimated blood volume was 50 ml. Perioperative blood pressure of patient was stable and recovery was well. According to clinical characteristic and pathological test and immunohistochemical results, patient was diagnosed with adrenal cholangiocarcinoma. Followed up for 15 months, no tumor recurrence and metastasis based on ultrasound examination and CT, and with normal blood pressure. Conclusions Adrenal cholangiocarcinoma was extremely rare type in the adrenal malignant tumors based on hepato-adrenal fusion histologically. This case constitutes a contribution for the knowledge of adrenal cholangiocarcinoma. The imaging findings were heterogeneous enhancement of soft tissue masses, and there was no obvious abnormality in adrenal functional examination. The retroperitoneal laparoscopic surgery is a treatment choice for this kind of patient. Key words: Adrenal gland neoplasm; Cholangiocarcinoma; Adrenalectomy