Catecholamine Overproduction Research Articles

8050 Incidence And Geographic Distribution Of Pheochromocytoma And Paraganglioma In The Slovak Population

Abstract Disclosure: I. Jochmanova: None. M. Ircha: None. Pheochromocytoma (PHEO) and Paraganglioma (PGL) are neuroendocrine tumors originating from chromaffin tissues of the adrenal medulla or extra-adrenal paraganglia and are characterized by catecholamine overproduction. Excess of catecholamines and the risk of metastatic disease lead to increased morbidity and mortality as well as decreased quality of life of patients. While many studies focus on the etiopathogenesis, diagnosis, and treatment of these tumors, their epidemiology is not well known in many, especially small, countries. In our present study, we assessed the incidence of PHEO/PGL in Slovakia and compared it to other countries. Based on the acquired data, the incidence of PHEO/PGL in Slovakia is 0.13 cases per 100,000 inhabitants, while PHEO prevails (0.12 cases per 100,000 inhabitants). Within the Slovak Republic, we noted differences between the districts of the country. Compared to other countries, the overall incidence of PHEO/PGL in Slovakia seems to be slightly lower, however, this can also be the result of lower reporting of the cases into the national database. Presentation: 6/2/2024

7783 Pheochromocytoma Unusually Presenting As Intestinal Pseudo-Obstruction: A Case Report

Abstract Disclosure: J.V. Chua: None. E.C. Cunanan: None. J.G. Sazon: None. J.L. Reyes: None. Introduction: Pheochromocytoma is a rare neuroendocrine tumor that arises from the adrenal medulla. It may present with a variety of symptoms that can resemble other diseases as a result of the effects of catecholamine overproduction on the different organ systems of the body, occasionally making diagnosis difficult and delaying appropriate treatment.Intestinal pseudo-obstruction is an unusual presentation of pheochromocytoma from the effects of excessive catecholamines on the gastrointestinal system, resulting in decreased peristalsis with constriction of the sphincter muscles, consequently prolonging intestinal transit time. Currently, there is no available data on its incidence or prevalence rate. Clinical Case: This is a case of a 50-year-old Filipino male initially presenting with abdominal pain and enlargement with inability to pass stool and flatus, not relieved by laxatives, enemas, and nasogastric and rectal tube decompression. Abdominal radiograph revealed segmental ileus versus partial large bowel obstruction, while abdominal CT scan showed fecal impaction and an incidental finding of an enhancing adrenal mass on the left adrenal gland. Colonoscopy findings were unremarkable. Laboratory workup demonstrated elevated 24-hour urine metanephrine levels with a value of 44.62 mg/24 hours (normal value: 0-1.0 mg/24 hours). The patient was initially managed conservatively, but no improvement in symptoms was noted. Pre-operative preparation was done with terazosin and intravenous saline infusion, and the patient then underwent left open adrenalectomy with bowel decompression, which provided resolution of symptoms and resumption of regular bowel movement post-operatively. The final result of the histopathologic examination confirmed the diagnosis of pheochromocytoma. Conclusion: Gastrointestinal symptoms such as ileus and pseudo-intestinal obstruction are uncommon presentations of pheochromocytoma. A high index of suspicion is necessary among patients presenting with these symptoms, and pheochromocytoma should be considered as part of the differential diagnosis. Presentation: 6/1/2024

Cardiovascular Complications in Pheochromocytoma and Paraganglioma: Does Phenotype Matter?

Adrenaline-producing tumors are mostly characterized by a sudden release of catecholamines with episodic symptoms. Noradrenergic ones are usually less symptomatic and characterized by a continuous overproduction of catecholamines that are released into the bloodstream. Their effects on the cardiovascular system can thus be different. The aim of this study was to determine the prevalence of cardiovascular complications by catecholamine phenotype. We retrospectively analyzed data on the prevalence of cardiovascular events in 341 consecutive patients with pheochromocytoma and paraganglioma treated from 1995 to 2023. Biochemical catecholamine phenotype was determined based on plasma or urinary catecholamines and metanephrines. According to the phenotype, 153 patients had noradrenergic pheochromocytoma and paraganglioma and 188 had adrenergic pheochromocytoma and paraganglioma. In the whole sample, the incidence of serious cardiovascular complications was 28% (95 patients), with no difference between the phenotypes or sexes. The noradrenergic phenotype had significantly more atherosclerotic complications (composite end point of type 1 myocardial infarction and symptomatic peripheral artery disease; odds ratio, 3.58 [95% CI, 1.59-8.83]; P=0.003), while the adrenergic phenotype more often had type 2 myocardial infarction and takotsubo-like cardiomyopathy (OR, 0.24 [95% CI, 0.09-0.57]; P=0.002). These changes remained even after adjustment for conventional risk factors of atherosclerosis. We found a 28% incidence of cardiovascular complications in a consecutive group of patients with pheochromocytoma and paraganglioma. Patients presenting with a noradrenergic phenotype have a higher incidence of atherosclerotic complications, while the adrenergic phenotype is associated with a higher incidence of acute myocardial damage due to takotsubo-like cardiomyopathy.

THU619 Atypical Clinical Presentation Of Adrenal Hemorrhage

Abstract Disclosure: T.L. Madsen-Barbosa: None. F.H. Antoni: None. A. Ghazi: None. Introduction: Adrenal hemorrhage (AH) is an uncommon condition that is challenging to diagnose due to its nonspecific findings. We illustrate a case of AH that presented with acute clinical deterioration and had catecholamine overproduction. Case: A 58-year-old woman with a history of migraine headaches and prediabetes presented to the emergency department for “the worst headache of her life” and palpitations of 4 hours duration. On admission, her blood pressure was 224/139 mmHg and heart rate was 102 bpm. Her physical examination was significant for diaphoresis and active vomiting. Initial laboratory tests showed hyperglycemia and leukocytosis. Her ECG, non-contrast CT scan of the head and CT angiography of the head and neck were unremarkable. Her hospital course was complicated by recurrent hypertensive episodes, arrhythmias including Torsades de pointes, and left flank pain. A CT chest, abdomen, and pelvis revealed a large left retroperitoneal hemorrhagic collection which seemed to arise from the inferior aspect of the left adrenal gland. She subsequently underwent successful IR embolization of the left inferior suprarenal artery. Further workup showed elevated urinary fractionated metanephrine and normetanephrine levels, as well as elevated levels of plasma free metanephrine and normetanephrine. Given concern for pheochromocytoma, phenoxybenzamine was started. A repeat CT abdomen after six days demonstrated shrinkage in hematoma and a 7 mm hypoattenuating nodule arising from the medial limb of the left adrenal gland. Outpatient follow-up CT abdomen showed left adrenal thickening with a 2.3 cm nodular area with 78.9 Hounsfield units and absolute washout of 60.9% suggestive of adenoma. After one month, repeat catecholamine levels normalized. Discussion: The clinical manifestation of AH varies widely. Acute adrenal insufficiency is seen if bilateral glands and 90% of the cortices are compromised. However, unilateral AH is most often asymptomatic - found incidentally on imaging. Having elevated catecholamines is described in 30% of patients in one case series. Differentiating spontaneous AH from hemorrhagic adrenal tumors is also a dilemma. Among the hemorrhagic adrenal masses, pheochromocytoma is the most common. Conclusion: This case highlights that clinicians should be aware of clinical manifestations of catecholamine excess when evaluating patients with AH. A catecholamine producing adrenal mass (pheochromocytoma) should also be ruled out in these situations. Reference:1- Elhassan YS, Ronchi C, Wijewickrama P, Balvedeweg SE. Approach to the patient with adrenal hemorrhage. J Clin Endocrinol Metab. 2023, 108 (4):995-1006.2- Karwacka IM, Obolonczyk L, Sworczak K. Adrenal hemorrhage: a single center experience and literature review. Adv Clin Exp Med. 2018; 27 (5): 681-687. Presentation: Thursday, June 15, 2023

Imaging and pathologic correlation of composite pheochromocytoma-ganglioneuroma.

A 50-year-old man consulted our institution for headaches and uncontrolled high blood pressure. Laboratory work-up and endocrine evaluation were consistent with pheochromocytoma with elevated plasma free metanephrine, free normetanephrine, plasma epinephrine, norepinephrine, total catecholamines, and 24-hour urine fractionated metanephrines, normetanephrines and total metanephrines levels. CT showed a contrast-enhancing 11.5 × 12.4 × 8.8 cm right adrenal complex cystic mass (Fig. 1A). Subsequent 68Ga-DOTATATE PET/CT confirmed the large right adrenal lesion with prominent tracer avidity (Fig. 1B). Surgical resection and pathology (Figs. 1C and 2) reached the diagnosis of composite pheochromocytoma-ganglioneuroma (CPG). The patient’s symptoms resolved after surgery. Genetic testing was normal. CPG, a rare tumor of mostly third-to-fifth decade of life with no gender preference, contains both pheochromocytoma (PC) and ganglioneuroma (GN) neoplastic components. CPG features symptoms of catecholamine overproduction: headache, palpitations, hypertension, and diaphoresis, and abdominal pain and watery diarrhea from excess VIP production by ganglioneuroma cells. CPG is indistinguishable from PC by clinical presentation, imaging features and biomarkers. Most CPG patients present with elevated catecholamines (1,2). CPG appears on CT as a well-circumscribed, heterogeneous or cystic adrenal mass with contrast enhancement. 68Ga-DOTATATE PET/CT may be an effective functional imaging modality for the detection and post-surgical monitoring of CPG based on its PC component (2). Diagnosis is histological with the identification of admixed regions of usually dominant PC and GN. PC cells stain positively for synaptophysin, GN cells with NeuN and Schwann cells with S-100. BRAF and HRAS mutations are frequently associated with CPG (3). CPG resection proceeds like PC surgery with preoperative adrenergic blockade, increased oral hydration and salt supplementation. The overall risk of malignancy associated with CPG is notably lower than with pure PC. Symptoms usually resolved upon CPG surgical resection, as seen in our case. One-out-of-eight treated patients may develop recurrence within 15 months (1).

Circulating GLP-1 Levels in Patients with Pheochromocytoma/Paraganglioma.

The sympathoadrenal system has been shown to stimulate the secretory activity of enteroendocrine cells, although the response is transient. Our aim was to investigate the effects of long-term catecholamine excess on circulating glucagon-likepeptide-1 (GLP-1) levels in patients with pheochromocytoma/paraganglioma (PPGL). Thirty patients diagnosed with PPGL were analyzed. A significant negative association was observed between fasting plasma GLP-1 levels and elevated plasma-free metanephrine (r = -0.407, p = 0.026). After adjustment for age, sex, body mass index (BMI), serum creatinine, and the presence of hyperglycemia, the negative association between plasma GLP-1 and metanephrine persisted by multiple linear regression analysis (β = -0.493, p = 0.013). Positive correlations between fasting glucose and plasma metanephrine (r = 0.380, p = 0.038) and normetanephrine levels (r = 0.450, p = 0.013) were also found. Mean fasting levels of total GLP-1 increased significantly from 25.81 to 39.01 pmol/L (p = 0.017) after PPGL resection. In conclusion, long-term overproduction of catecholamines appears to induce suppression of GLP-1 production compared to an acute response to a stress stimulus. Further studies are required to elucidate the mechanism of GLP-1 secretion with chronic exposure to catecholamine.

Hypermetabolism and Substrate Utilization Rates in Pheochromocytoma and Functional Paraganglioma.

The overproduction of catecholamines in pheochromocytoma/paraganglioma (PPGL) induces a hypermetabolic state. The aim of this study was to evaluate the incidence of a hypermetabolic state and differences in substrate metabolism in consecutive PPGL patients divided by catecholamine phenotype. Resting energy expenditure (REE) and respiratory quotient (RQ) were measured in 108 consecutive PPGL patients and 70 controls by indirect calorimetry. Hypermetabolic state was defined according to the Mifflin St. Jeor Equation as a ratio above 110%. Hypermetabolic state was confirmed in 70% of PPGL patients, regardless of phenotype. Older age, prevalence of diabetes mellitus and arterial hypertension were correlated with hypermetabolic PPGL as compared to normometabolic form. Analysis according to overproduced catecholamine showed differences in VCO2 (p < 0.05) and RQ (p < 0.01) and thus different substate metabolism between phenotypes in hypermetabolic form of PPGL. Lipid utilization was higher in the adrenergic phenotype (p = 0.001) and positively associated with the percentage of REE ratio (R = 0.48, p < 0.001), whereas the noradrenergic phenotype preferentially oxidizes carbohydrates (P = 0.001) and is correlated with the percentage of REE ratio (R = 0.60, p < 0.001). Hypermetabolic state in PPGL is a common finding in both catecholamine phenotypes. Hypermetabolic PPGL patients are older and suffer more from diabetes mellitus and arterial hypertension. Under basal conditions, the noradrenergic type preferentially metabolizes carbohydrates, whereas the adrenergic phenotype preferentially metabolizes lipids.

Effect of adrenalectomy on remission of subclinical left ventricular dysfunction in patients with pheochromocytoma: a speckle-tracking echocardiography study.

BackgroundPheochromocytomas (PHEO) are tumours with the ability to produce, metabolize and secrete catecholamines. Catecholamines overproduction leads to the decrease of longitudinal function of the left ventricle (LV) measured by speckle-tracking echocardiography. Patients with PHEO have a lower magnitude of global longitudinal strain (GLS) than patients with essential hypertension. GLS normalization is expected after resolution of catecholamine overproduction.MethodsTwenty-four patients (14 females and 10 males) with a recent diagnosis of PHEO have been examined before and 1 year after adrenalectomy. An echocardiographic examination including speckle-tracking analysis with the evaluation of GLS and regional longitudinal strain (LS) in defined groups of LV segments (basal, mid-ventricular and apical) was performed.ResultsOne year after adrenalectomy, the magnitude of GLS increased (−14.3 ± 1.8 to −17.7 ± 1.6%; P < 0.001). When evaluating the regional LS, the most significant increase in the differences was evident in the apical segment compared to mid-ventricular and basal segments of LV (−5.4 ± 5.0 vs −1.9 ± 2.7 vs −1.6 ± 3.8; P < 0.01).ConclusionsIn patients with PHEO, adrenalectomy leads to an improvement of subclinical LV dysfunction represented by the increasing magnitude of GLS, which is the most noticeable in apical segments of LV.

EFFECT OF ADRENALECTOMY ON REMISSION OF SUBCLINICAL LEFT VENTRICULAR DYSFUNCTION IN PATIENTS WITH PHEOCHROMOCYTOMA: A SPECKLE-TRACKING ECHOCARDIOGRAPHY STUDY

Abstract Objective: Pheochromocytomas (PHEO) are tumors arising from chromaffin cells from the adrenal medulla, having the ability to produce, metabolize and secrete catecholamines. The overproduction of catecholamines leads by many mechanisms to the decline of longitudinal function of the left ventricle measured by speckle tracking echocardiography. Patients with PHEO have a lower magnitude of global longitudinal strain (GLS) than the patients with essential hypertension, although the ejection fraction of left ventricle (LV EF) remains in normal range. Design and method: We analysed 24 patients (14 females and 10 males) with recent diagnosis of PHEO and one year after adrenalectomy. We performed an echocardiographic examination including the evaluation of GLS by speckle tracking analysis. Results: One year after adrenalectomy magnitude of GLS increased (-14.3 ± 1.8 to -17.7 ± 1.6 %; p &lt; 0.001), although values of LV EF remained unchanged (0.66 ± 0.07 vs. 0.65 ± 0.05; n.s.). In addition, there was also found a decrease in the indexed mass of the left ventricle (95.3 ± 18.7 to 83.6 ± 17.8 g/m2; p &lt; 0.05). Conclusions: In patients with PHEO, adrenalectomy leads to an improvement of subclinical left ventricular dysfunction represented by increasing magnitude of GLS.

Feocromocitoma y Paraganglioma: un reto más allá de la clínica

Los feocromocitomas y paragangliomas son tumores raros que se originan en las células cromafines. Tienen un amplio espectro clínico que va desde el hallazgo incidental hasta manifestaciones por la producción exagerada de catecolaminas. El diagnóstico bioquímico se realiza mediante medición de metanefrinas libres en plasma. El tratamiento ideal es la escisión quirúrgica completa previo bloqueo de receptores α y β adrenérgicos. En caso de enfermedad metastásica, las opciones de tratamiento sistémico actuales son limitadas y con escasa tasa de respuesta. Está en investigación el uso de antiangiogénicos.

Superior mediastinal paraganglioma initially suspected of being a mediastinal thyroid goiter

Paraganglioma is a rare tumor arising from paraganglia. Few reports have described paragangliomas in the superior mediastinum. We report a case of superior mediastinal paraganglioma treated in our department. A 28-year-old woman visited our department because of suspected mediastinal tumor during a medical checkup. Contrast-enhanced CT showed a 39 × 35 × 65-mm tumor with a well-defined border extending from the lower pole of the left thyroid gland to the superior mediastinum. Laboratory tests showed no evidence of catecholamine overproduction. Mediastinal thyroid goiter was the most suspected preoperative diagnosis. We decided to perform a transcervical excision for both diagnosis and treatment. The tumor was easily detached from the lower pole of the left thyroid gland and was not continuous. The tumor capsule was brittle and bled easily. The operating time was 3 h and 11 min, and the amount of bleeding was 571 mL. The pathological diagnosis was paraganglioma. Paragangliomas are characterized by abundant blood flow and are likely to result in a high intraoperative bleeding volume. In addition, if the tumor is functional, circulatory abnormalities can occur during the perioperative period. Accurate preoperative diagnoses are important, and the possibility that paragangliomas can develop in the superior mediastinum should be considered.

Cell Reactions in the Limbic Cerebral Cortex After Ethanol Poisoning, Alcohol Abstinence and Chronic Alcohol Intoxication in Humans

The aim of the study was to identify characteristics of the neuron reactions and macroglial cells in the limbic cerebral cortex after ethanol poisoning, alcohol withdrawal and chronic alcohol intoxication in humans. Material and methods. The study included Nissl stained histological sections in the area 24 b in healthy people (n=5), in people died from ethanol poisoning (in the period of ethanol resorption, n=5) and in people during alcohol withdrawal (at the end of ethanol elimination, n=5) having early signs of an alcohol disease. The number and proportion of neurons in identification groups (unmodified/low- modified, hypochromic, shriveled hyperchromic, “shadow cells”), the number of satellite cells and the ratio of satellite cells to the number of unchanged neurons (glio-neuronal index), the average area of the neuron bodies was calculated on horizontal sections of the anterior limbic cortex 1 mm 2 in area. Results. The study proposed to distinguish between acute (or transient), delayed and chronic response of neuronal cells. The acute reaction that develops during ethanol poisoning is expressed by acute swelling of neurons and results from a combination of altering factors: the toxic effects of ethanol and the overproduction of catecholamines. The acute reaction is more pronounced in the dopaminergic layer III of the anterior limbic cortex than in layer V. It is transient, since in the period of alcohol withdrawal (ethanol elimination) it regresses and becomes delayed. The latter is to increase and dominate the proportion of atrophic reduced in the size of lowmodified and atrophic wrinkled neurons, increased phagocytic activity of dead neurons, as well as the development of compensatory-adaptive reaction of the satellite form of glia, the most pronounced in layer III. Delayed reaction of neurons is due to the weakening and cessation of acute effects of toxicants; as a result, the signs of previous long-term intoxication effects of ethanol, its toxic metabolites and increased concentrations of catecholamines, hich caused cell atrophy, come to the fore. Chronic cell response is expressed by a significant increase in the proportion of neurons-"shadows", the number of macroglial cells and atrophic wrinkling of neurons. In people with early manifestations of an alcohol disease, signs of acute neuronal damage are combined with signs of atrophic ones.

An Adrenaline Rush: Management of Pheochromocytoma in Advanced Heart Failure

Background Pheochromocytoma is a rare neuroendocrine adrenal tumor characterized by overproduction of catecholamines by chromaffin cells. Clinical manifestations include paroxysms of severe hypertension, palpitations, diaphoresis and headaches. Tumor excision is curative but carries an elevated risk, as removal can lead to sudden fluctuations in catecholamine levels, resulting in life threatening arrhythmias, hemodynamic instability and death. We present a case of perioperative management of a pheochromocytoma in a patient with severe ischemic cardiomyopathy. Case A 47 year old man with hypertension presented with progressive dyspnea on exertion. An echocardiogram revealed a newly depressed ejection fraction of 10-15%. Subsequent coronary angiography demonstrated severe multivessel disease deemed not amenable to percutaneous or surgical intervention. Evaluation of his hemodynamics revealed RA12 RV 59/12 PAP 60/33/44 PCWP 25 MVO2 54% CO/CI 3.2/1.69. Routine CT chest and abdomen demonstrated an incidental 6 cm adrenal mass confirmed to be a pheochromocytoma by metaiodobenzylguanidine scan and urine metanephrines. His perioperative care was managed through a multidisciplinary approach with Advanced Heart Failure, Endocrinology, Oncology, and Surgery. Prior to excision, the patient underwent a 14 day load of phenoxybenzamine. A subclavian intra-aortic balloon pump and Swan Ganz catheter were placed preoperatively for continuous hemodynamic monitoring and support. He subsequently underwent laparoscopic removal without complications. His intra-aortic balloon pump was removed two days postoperatively with slow weaning of inotropic and vasoactive support. Phenoxybenzamine was ultimately discontinued, and he was initiated on goal directed neurohormonal blockade. He was discharged with close outpatient follow up. Discussion This case demonstrates successful management of a pheochromocytoma in a patient with ischemic cardiomyopathy in a decompensated low flow state utilizing preoperative mechanical circulatory support. Successful adrenalectomy was supported by an intra-aortic balloon pump and pre-treatment with alpha-blockade. Pertinent challenges in such cases include timing of surgery and use of temporary support devices. Previous data has been inconclusive regarding timing of excision and perioperative use of percutaneous circulatory support due to risks of anticoagulation. Our case highlights the use of this strategy in select high risk patients.

Effect of dietary status on plasma-fractionated metanephrines in healthy individuals measured by Elisa

ABSTRACT Pheochromocytoma is a rare tumor that typically originates in the adrenal glands, often causing the over-production of catecholamines. The aim of this study was to determine whether dietary status could affect the concentration of plasma-fractionated metanephrines. This study was conducted at the Chemical Pathology Laboratory, Royal Hospital, Oman. Three plasma samples were collected from each participant (16 male and 16 female) over three consecutive days (day one: dietary restriction,day two: excess intake of restricted foods, day three: random sample following the typical diet for each participant). Samples were collected and centrifuged to obtain the plasma, which was then stored at −20°C prior to analysis. Metanephrine and normetanephrine concentrations were measured by comparative ELISA. Plasma metanephrine and normetanephrine measured under the three different dietary conditions for each individual were not significantly different and within normal range. Pearson correlation coefficient analysis of plasma concentration of metanephrines within individual patients under the three dietary conditions revealed positive correlation. We found no significant effect of dietary status on plasma metanephrine or normetanephrine concentration. Therefore, samples taken under any dietary condition may be used to determine plasma MN and NMN concentration. However, dietary restrictions in the diagnosis of Pheochromocytoma need further investigations.

FGF21 Levels in Pheochromocytoma/Functional Paraganglioma.

Fibroblast growth factor 21 (FGF21) is a hepatokine with beneficial effects on metabolism. Our aim was to evaluate the relationship between the serum FGF21, and energy and glucose metabolism in 40 patients with pheochromocytoma/functional paraganglioma (PPGL), in comparison with 21 obese patients and 26 lean healthy controls. 27 patients with PPGL were examined one year after tumor removal. Basic anthropometric and biochemical measurements were done. Energy metabolism was measured by indirect calorimetry (Vmax-Encore 29N). FGF21 was measured by ELISA. FGF21 was higher in PPGL than in controls (174.2 (283) pg/mL vs. 107.9 (116) pg/mL; p < 0.001) and comparable with obese (174.2 (283) pg/mL vs. 160.4 (180); p = NS). After tumor removal, FGF21 decreased (176.4 (284) pg/mL vs. 131.3 (225) pg/mL; p < 0.001). Higher levels of FGF21 were expressed, particularly in patients with diabetes. FGF21 positively correlated in PPGL with age (p = 0.005), BMI (p = 0.028), glycemia (p = 0.002), and glycated hemoglobin (p = 0.014). In conclusion, long-term catecholamine overproduction in PPGL leads to the elevation in serum FGF21, especially in patients with secondary diabetes. FGF21 levels were comparable between obese and PPGL patients, despite different anthropometric indices. We did not find a relationship between FGF21 and hypermetabolism in PPGL. Tumor removal led to the normalization of FGF21 and the other metabolic abnormalities.

Catecholamines Induce Left Ventricular Subclinical Systolic Dysfunction: A Speckle-Tracking Echocardiography Study.

Background: Pheochromocytomas (PHEO) are tumors arising from chromaffin cells from the adrenal medulla, having the ability to produce, metabolize and secrete catecholamines. The overproduction of catecholamines leads by many mechanisms to the impairment in the left ventricle (LV) function, however, endocardial measurement of systolic function did not find any differences between patients with PHEO and essential hypertension (EH). The aim of the study was to investigate whether global longitudinal strain (GLS) derived from speckle-tracking echocardiography can detect catecholamine-induced subclinical impairments in systolic function. Methods: We analyzed 17 patients (10 females and seven males) with PHEO and 18 patients (nine females and nine males) with EH. The groups did not differ in age or in 24-h blood pressure values. Results: The patients with PHEO did not differ in echocardiographic parameters including LV ejection fraction compared to the EH patients (0.69 ± 0.04 vs. 0.71 ± 0.05; NS), nevertheless, in spackle-tracking analysis, the patients with PHEO displayed significantly lower GLS than the EH patients (−14.8 ± 1.5 vs. −17.8 ± 1.7; p < 0.001). Conclusions: Patients with PHEO have a lower magnitude of GLS than the patients with EH, suggesting that catecholamines induce a subclinical decline in LV systolic function.

Can the negative effects of ketamine abuse on female genital organs be prevented by nimesulide? An experimental study.

The objective of this study is to investigate the effects of nimesulide on ketamine-induced ovarian and uterine toxicity by biochemical and histopathological examinations. Ketamine is an anesthetic agent whose use leads to overproduction of catecholamines. Nimesulide is a cyclooxygenase-2 inhibitor, which has also been reported to exert a significant antioxidant effect. Wistar albino female rats were randomly divided into three groups as follows: ketamine group (60 mg/kg), ketamine (60 mg/kg) + nimesulide (50 mg/kg) group, and a healthy control group. Then, the biochemical levels and histopathological findings in the ovaries and uteri of the rats were examined for malondialdehyde, myeloperoxidase, total glutathione and superoxide dismutase. The study demonstrated that, in the uterine and ovarian tissues of rats that have been administered ketamine, there was a decrease in the levels of total glutathione and superoxide dismutase, while malondialdehyde and myeloperoxidase was increased: however it was observed that these ratios were reversed in the ketamine+nimesulide group. It was also proved that the negative effects of ketamine can be corrected with nimesulide when the myometrial and endometrial thicknesses are compared. Antioxidants such as nimesulide may protect against the damage caused by ketamine to the genital organs in young women.

Multiple endocrine neoplasia 2A (MEN 2A) syndrome

In the MEN 2A syndrome, which is the most common of the three types of MEN, three endocrine systems are affected simultaneously or subsequently by the development of tumours manifested by medullary thyroid gland carcinoma, pheochromocytoma (often bilateral) and hyperparathyroidism. 27 patients from 3 families affected by MEN 2A syndrome were examined clinically (by detecting the effects of catecholamine overproduction), biochemically (screening for metanephrine and normetanephrine in the serum), visualization (CT, MRI, MIBG, PET CT) and some of them also genetically (DNA fragment analysis obtained by PCR amplification). Familial incidence of pheochromocytoma was confirmed in 10 patients (4 males, 5 females and one girl) aged 6 to 54 years (average 22.8 years) . In 5 patients, the pheochromocytoma occurred on both sides, in one patient, with genetically proved MEN 2A syndrome, only one adrenal gland was affected by pheochromocytoma. In 10 patients, mutations were detected in the exon 10, 11 and 16 RET of the proto-oncogene in the centromeric region of the 10th chromosome. After proper preparation, 5 patients underwent bilateral adrenalectomy (unilateral adrenalectomy in one patient). Histological examination of the removed tumours in all cases excluded the malignant pheochromocytoma.The first of the operated patients (54 yr) died after surgery for cardiovascular failure. Others have lived 5 to 15 years after bilateral adrenalectomy without signs of local recurrence of the disease, and have no clinical signs of over-production of catecholamines. Bilateral pheochromocytoma and thyroid carcinoma are indications for detailed clinical and genetic examination of all family members. Bilateral adrenalectomy with lifetime supplementation of adrenal hormones is indicated in symptomatic patients and/or patients asymptomatic with tumours larger than 3 cm in diameter (Tab. 1, Fig. 11, Schema 1, Ref. 31).

Emerging role of dopamine in neovascularization of pheochromocytoma and paraganglioma.

Dopamine is a catecholamine that acts both as a neurotransmitter and as a hormone, exerting its functions via dopamine (DA) receptors that are present in a broad variety of organs and cells throughout the body. In the circulation, DA is primarily stored in and transported by blood platelets. Recently, the important contribution of DA in the regulation of angiogenesis has been recognized. In vitro and in vivo studies have shown that DA inhibits angiogenesis through activation of the DA receptor type 2. Overproduction of catecholamines is the biochemical hallmark of pheochromocytoma (PCC) and paraganglioma (PGL). The increased production of DA has been shown to be an independent predictor of malignancy in these tumors. The precise relationship underlying the association between DA production and PCC and PGL behavior needs further clarification. Herein, we review the biochemical and physiologic aspects of DA with a focus on its relations with VEGF and hypoxia inducible factor related angiogenesis pathways, with special emphasis on DA producing PCC and PGL.-Osinga, T. E., Links, T. P., Dullaart, R. P. F., Pacak, K., van der Horst-Schrivers, A. N. A., Kerstens, M. N., Kema, I. P. Emerging role of dopamine in neovascularization of pheochromocytoma and paraganglioma.

Simple dilute-and-shoot method for urinary vanillylmandelic acid and homovanillic acid by liquid chromatography tandem mass spectrometry

BackgroundNeuroblastomas are pediatric tumors characterized by overproduction of catecholamines. The catecholamine metabolites, vanillylmandelic acid (VMA) and homovanillic acid (HVA), are used in clinical evaluation of neuroblastoma. Tandem mass spectrometry (LC-MS/MS) is an effective analytical method for measurement of VMA and HVA in urine. MethodsDilute-and-shoot sample preparation was performed in a 96-well format using a liquid handler. Chromatographic separation was achieved using a reverse phase column; detection was accomplished by triple quadrupole mass spectrometry with electrospray ionization in positive mode. Data were acquired by multiple reaction monitoring. Two transitions, quantifier and qualifier, were monitored for each analyte and its stable isotope-labeled internal standard. Analytical specificity studies were performed. ResultsInjection-to-injection time was 4min. The method was validated for linearity, limit of quantification, imprecision, accuracy, and interference. Linearity was 0.5–100mg/l for both analytes. Within-run, between-day, and total imprecision were 1.0–4.1% for VMA and 0.8–3.8% for HVA. The method correlated well with our established HPLC method. Interferences precluding quantitation of VMA in 3% of specimens were reduced significantly (to 0.1% of specimens) using a modified LC gradient to reanalyze affected samples. ConclusionsA simple, robust, economical, fast LC-MS/MS method was developed and validated for measurement of urinary VMA and HVA.