Serum Catecholamine Levels Research Articles

Differential involvement of central and peripheral catecholamines between Alzheimer's disease and vascular dementia

Background and aimThe important role of catecholamines has been gradually emphasized in the pathogenesis of neurodegenerative process. As the most prevalent form of cognitive dysfunction, Alzheimer's disease (AD) and vascular dementia (VaD) have the distinct pathological features and pathogenic mechanisms, however, the differential involvement of central and peripheral catecholamines between AD and VaD was still unclear. MethodsTriple-transgenic AD (3 × Tg-AD) mice and chronic cerebral hypoperfusion (CCH) in rats induced by two-vessel occlusion (2VO) were used as the AD and VaD model in this study, respectively. The concentrations of catecholamines (dopamine, epinephrine and norepinephrine) and their metabolites (3-methoxytyramine, metanephrine and normetanephrine) in serum and five brain regions (hippocampus, cortex, corpus striatum, thalamus and pons) from 3 × Tg-AD mice and 2VO rats were quantitatively determined by liquid chromatography-tandem mass spectrometry (LC-MS/MS) assay. ResultsHigh expression and distribution of hippocampal dopamine, and epinephrine and norepinephrine in the cortex and thalamus were found in the early 3 × Tg-AD model, whereas chronic cerebral hypoperfusion induced by 2VO mainly affected the central noradrenergic and noradrenergic system, but not dopaminergic system. The increased serum levels of catecholamines were investigated in the 2VO rats, but not in the 3 × Tg-AD mice. ConclusionThe differential expression and distribution of central catecholamines and their metabolites suggests the distinct catecholamines-related pathogenesis between AD and VaD. Peripheral catecholamine surge may be involved in the development of VaD, and the treatment strategy to prevent or reverse the effects of peripheral catecholamines may be protective for VaD.

Association between serum catecholamine levels and VNTR polymorphism in the promoter region of the monoamine oxidase A gene in forensic autopsy cases

Monoamine oxidase A (MAOA) catalyzes oxidative deamination of catecholamines. A functional variable number tandem repeat (VNTR) polymorphism in the promoter region of the MAOA gene has been previously reported. In the present study, we measured serum adrenaline (Adr), noradrenaline (Nad), and dopamine (DA) levels in 90 male and 34 female Japanese autopsy cases in which amphetamines or psychotropic drugs were not detected.We examined the frequencies of MAOA-uVNTR alleles in these cases and investigated the effects of the MAOA-uVNTR polymorphism on serum Adr, Nad, and DA levels. Evaluation indicated no significant association between MAOA-uVNTR polymorphism and serum Adr, Nad, or DA levels in males, although a significant association between MAOA-uVNTR polymorphism and serum Adr and DA levels were observed in females. Females with the 3/3 genotype had higher serum Adr and DA levels than those with a 4-repeat allele (3/4 and 4/4 genotypes) (p = 0.048 and 0.020, respectively). There was no significant association between MAOA-uVNTR polymorphism and serum Nad levels in females. The present study indicates that MAOA-uVNTR polymorphism influences serum Adr and DA levels only in females.

The regulatory effects of serum catecholamines and endothelial cells in pig hemorrhagic shock and fluid resuscitation models

BackgroundAcute blood loss not only leads to systemic compensatory response, but also the induced changes in vascular endothelial function.These pathological changes may have potential compensatory significance for maintaining organ perfusion and fluid resuscitation. ObjectiveTo understand trauma-induced endotheliopathy and their compensatory roles in acute hemorrhage, a porcine model of hemorrhagic shock (HS) was used to evaluate changes in vascular endothelial factors and catecholamine levels at different time points from shock to fluid resuscitation. Methods: HS was induced in female pigs by rapid bleeding via the arterial sheath. Hemodynamic monitoring was performed using a pulse index continuous cardiac output (PiCCO) system in HS and fluid resuscitation. Femoral vein blood samples were collected at baseline and 40% mean arterial pressure (MAP, shock), MAP recovery, and 30 min, 1 h, and 2 h after recovery. Serum levels of catecholamine and Angiopoietin-1 (Ang-1), Angiopoietin-2 (Ang-2), Tie-2, Eselectin, intracellular adhesion molecule-1 (ICAM-1), soluble thrombomodulin (sTM), and Syndecan-1 (SDC-1) were evaluated using enzyme-linked immunosorbent assay (ELISA). ResultsSerum catecholamine levels were significantly higher in the shock than in the baseline state. Ang-1 and Ang-2 are endothelial growth factors secreted with distinct roles. Ang-1 stabilizes the endothelium and inhibits vascular leakage, and Ang-2 has the opposite effect. The ratio of Ang-2/Ang-1 was significantly higher in the shock state than in the baseline state; however, the Ang-1/Tie-2 ratio was comparable between the two states. This suggests that changes in vascular permeability may mainly depend on the upregulation of Ang-2 function. Serum levels of E-selectin, ICAM-1, sTM, and SDC-1 were significantly higher in the shock state than in the baseline state. After the MAP was restored to the baseline state, the levels of E-selectin, and SDC-1 remained higher compared with the baseline state until 1 h after MAP recovery. Conclusions: serum levels of catecholamines and vascular endothelial markers increased transiently under HS, promoting a compensatory response of the circulatory system to acute bleeding. This may be one of the potential theoretical basis for restrictive fluid resuscitation.

Challenges in the diagnosis of the enigmatic primary adrenal leiomyosarcoma: two case reports and review of the literature

BackgroundPrimary adrenal leiomyosarcoma is a rare and aggressive mesenchymal tumor derived from the smooth muscle wall of a central adrenal vein or its tributaries; therefore, tumors tend to invade the inferior vena cava and cause thrombosis. The great majority of tumors grow rapidly, which makes the disease difficult to diagnose in its early clinical stages and needs differentiation from adrenocortical carcinomas for the selection of chemotherapy including mitotane which causes adrenal insufficiency.Case presentationWe presented two patients with adrenal leiomyosarcoma who were referred to our hospital with abdominal pain and harboring large adrenal tumors and inferior vena cava thrombosis. The endocrine findings, including serum catecholamine levels, were unremarkable. These two patients were considered clinically inoperable, and CT-guided core needle biopsy was performed to obtain the definitive histopathological diagnosis and determine the modes of therapy. The masses were subsequently diagnosed as primary adrenal leiomyosarcoma based on the histological features and positive immunoreactivity for SMA (smooth muscle actin), desmin, and vimentin.ConclusionsAdrenal leiomyosarcoma derived from the smooth muscle wall of a central adrenal vein or its tributaries is rare but should be considered a differential diagnosis in the case of nonfunctioning adrenal tumors extending directly to the inferior vena cava. CT-guided biopsy is considered useful for histopathological diagnosis and clinical management of patients with inoperable advanced adrenal tumors without any hormone excess.

Relation of Plasma Catecholamine Concentrations and Myocardial Mitochondrial Respiratory Activity in Anesthetized and Mechanically Ventilated, Cardiovascular Healthy Swine.

Chronic heart failure is associated with reduced myocardial β-adrenergic receptor expression and mitochondrial function. Since these data coincide with increased plasma catecholamine levels, we investigated the relation between myocardial β-receptor expression and mitochondrial respiratory activity under conditions of physiological catecholamine concentrations. This post hoc analysis used material of a prospective randomized, controlled study on 12 sexually mature (age 20-24 weeks) Early Life Stress or control pigs (weaning at day 21 and 28-35 after birth, respectively) of either sex. Measurements in anesthetized, mechanically ventilated, and instrumented animals comprised serum catecholamine (liquid-chromatography/tandem-mass-spectrometry) and 8-isoprostane levels, whole blood superoxide anion concentrations (electron spin resonance), oxidative DNA strand breaks (tail moment in the "comet assay"), post mortem cardiac tissue mitochondrial respiration, and immunohistochemistry (β2-adrenoreceptor, mitochondrial respiration complex, and nitrotyrosine expression). Catecholamine concentrations were inversely related to myocardial mitochondrial respiratory activity and β2-adrenoceptor expression, whereas there was no relation to mitochondrial respiratory complex expression. Except for a significant, direct, non-linear relation between DNA damage and noradrenaline levels, catecholamine concentrations were unrelated to markers of oxidative stress. The present study suggests that physiological variations of the plasma catecholamine concentrations, e.g., due to physical and/or psychological stress, may affect cardiac β2-adrenoceptor expression and mitochondrial respiration.

FRI366 “Carotid Body Tumor” Is A Misnomer For Head And Neck Paraganglioma

Abstract Disclosure: S. Rabiei: None. V. Kantorovich: None. Introduction: Glomus tumors are often treated as benign, hormonally inactive tumors through simple surgical resection. In many cases, full endocrine work-up and post-resection surveillance are overlooked. Endocrine consultation is currently underutilized in patients with glomus tumors because features of paragangliomas (PGs) such as multiple tumors are not always clinically evident at the time of initial presentation. It is important to be aware that carotid body and glomus tumors should be considered a variant of head and neck paraganglioms (HNPGs) and endocrinology consultation should be requested early on to optimize patients’ outcome. Case Presentation: Patient is a 52-year-old female who presented with back pain and difficulty walking. Imaging obtained for back pain work-up revealed a 6.2 x 4.4 x 4.2 cm right paraspinal soft tissue mass at T9 level on MRI with local invasion and cortical destruction of the T9 vertebra and involvement of the spinal canal. She was also found to have a 0.2 cm solid pulmonary nodule within the right lower lobe on chest CT. The history was also significant for resection of a jugular glomus tumor 12 years prior at the age of 40. Pathology findings at the time were consistent with glomus tumor. She also reported history of glomus tumor in her sister. However, the patient did not undergo genetic study at the time of diagnosis of her primary tumor.The patient subsequently underwent T9 corpectomy. Pathology report revealed a 5-cm tumor with characteristic histologic appearance of PG with epithelioid foci growing in distinctive small nests (Zellballen pattern), separated by prominent fibrovascular stroma with moderate cellularity and with slightly elevated (approximately 5%) Ki-67. Genetic study revealed a carrier state for a pathogenic variant of SDHD (c.112C>T; p.Arg38*). Gallium-68 DOTATATE PET/CT demonstrated intense focal DOTATATE uptake at the site of previous left-sided jugular glomus tumor resection as well as small foci of uptake bilaterally in upper and mid neck. Intense DOTATATE avidity was also identified at T8, T9, and T10 levels. Serum metanephrine, catecholamine, and PTH levels were within normal range. Chromogranin A is pending at this time. Discussion: We presented a case of glomus tumor in a young patient with a positive family history for glomus tumor who did not receive genetic study upon initial diagnosis of her primary tumor. The patient presented 12 years later with metastatic thoracic PG. Considering high mortality and morbidity of PGs, it is recommended to request endocrinology consultation at the time of diagnosis of carotid body or glomus tumors to prevent negative effects of disease recurrence. Presentation: Friday, June 16, 2023

The Association Between Ventricular Fibrillation and Serum Catecholamine Levels.

Background and objective Epinephrine (Ep) is the first choice as a vasoconstrictor in cardiopulmonary resuscitation (CPR) for patients with cardiopulmonary arrest (CPA); however, the Ep concentration in the serum of CPA patients is still unclear. The aim of this study was to evaluate the association between serum Ep levels and achieving the return of spontaneous circulation (ROSC) in out-of-hospital cardiac arrest (OHCA) patients with ventricular fibrillation (VF). Methods This was a prospective, observational clinical study involving OHCA patients with VFtransferred to our hospital from July 2014 to July 2017. The measurement of serum catecholamines [Ep, norepinephrine (Nep), and dopamine (DOA)] and vasopressin [antidiuretic hormone (ADH)] levels was performed with blood samples obtained immediately upon patients' arrival at our hospital. Patients were classified into two groups: the ROSC(+) group and ROSC(-) group; the serum concentrations of catecholamines and ADH were compared between these two groups. Results The serum Ep and Nep levels were lower in the ROSC(+) group than those in the ROSC(-) group and the difference was statistically significant. On the other hand, no significant differences were found in serum DOA and ADH levels between the two groups. Conclusions The results of this study suggest that an increment in serum Ep levels does not promote achieving ROSC in OHCA patients with VF.

Abstract P2007: Novel Regulatory Axis In Heart-adrenal Cross Talk Mediated By Mtor-eprs

Adrenal catecholamines, including norepinephrine and epinephrine play an important role in cardiovascular physiology. Serum catecholamine level is tightly regulated in response to metabolic and cardiac stress. The biosynthesis of catecholamine is driven by a series of enzymatic reaction carried out by the key rate-limiting enzymes, including tyrosine hydroxylase (TH), DOPA decarboxylase (DDC) and phenylethanolamine-N-methyltransferase (PNMT). Although the transcription regulation of these enzymes has been described before, the regulatory mechanism at post-transcription or protein translation level has never been explored. Using a system genetics approach, we explored genes associated with the adrenal gland traits in HMDP at basal and post isoproterenol treatment. We have identified EPRS (Glutamyl-Prolyl-tRNA synthetase) to be significantly associated with adrenal gland mass post ISO treatment. EPRS is a tRNA synthetase responsible for charging tRNA during protein translation, EPRS also regulates mRNA translation as an RNA binding protein. To explore the functional impact of EPRS in adrenal gland physiology, we generated an EPRS adrenal gland specific knockout mouse model (EPRS-aKO). Inactivation of EPRS in adrenal gland led to a decrease of adrenal gland mass associated with reduced systemic catecholamine level. Interestingly, we further observed a moderate yet significantly decreased heart rate and ejection fraction in EPRS-aKO mice. Through both in vivo and in vitro analysis, we confirmed inactivation of EPRS led to a reduced protein, but not mRNA expression for both TH and DDC. In adipose tissue, activation of EPRS through mTOR signaling pathway is critical for its function as RNA binding protein. To further explore the mechanism through EPRS mediated catecholamine synthesis, we treated PC12 cells with rapamycin to inhibit mTOR activity. Treatment with Rapamycin diminished EPRS activity and expression, reduced TH protein expression along with a decrease of catecholamine level. Our results identified a novel regulatory scheme of catecholamine synthesis through mTOR-EPRS axis, adding a novel layer of gene regulation in catecholamine production and providing new mechanistic insights for heart-adrenal cross talk.

Effect of analgesia nociception index monitor-based nociception control on perioperative stress responses during laparoscopic surgery in Trendelenburg position: a randomized controlled trial.

The analgesia nociception index (ANI) monitor is a nociception monitoring device based on heart rate variability. We aimed to determine the effect of ANI monitor-based intraoperative nociception control on the perioperative stress response during laparoscopic surgery in the Trendelenburg position. Altogether, 72 female patients who underwent total laparoscopic hysterectomy were randomized to either the control or ANI group. Intraoperative nociception was controlled by remifentanil administration in a conventional manner (based on blood pressure and heart rate) in the control group and by ANI monitoring in the ANI group. Perioperative stress responses were estimated by measuring the levels of serum catecholamines and catabolic stress hormones at three timepoints: after loss of consciousness, at the end of surgery, and 1 h after the end of surgery. The serum cortisol level at the end of surgery was significantly higher in the ANI group than in the control group (p < 0.001), although more remifentanil was administered in the ANI group than in the control group (p < 0.001). Changes in the other estimators' levels were comparable between groups during the perioperative period. The hemodynamic profiles during surgery were also significantly different between the two groups. Phenylephrine use to treat hypotension was more common in the ANI group than in the control group (p = 0.005). However, postoperative clinical outcomes such as pain and nausea/vomiting did not differ between groups. ANI monitor-based nociception control in laparoscopic surgery in the Trendelenburg position did not improve perioperative stress responses, intraoperative opioid consumption, or postoperative clinical outcomes.Clinical trial registration: ClinicalTrials.gov (NCT04343638).

Endogenous Catecholamine Release in COVID-19 Related Acute Respiratory Distress Syndrome: Link between Enhanced Sympathetic Stimulation, Cardiac Dysfunction and Outcome

The aim of this study was to measure the serum levels of catecholamines in patients admitted to intensive care unit (ICU) with COVID-19-related acute respiratory distress syndrome (ARDS) and describe their relation with clinical, inflammatory and echocardiographic parameters. Serum levels of endogenous catecholamines (norepinephrine, epinephrine and dopamine) were measured at ICU admission. We enrolled 71 patients consecutively admitted to ICU due to moderate to severe ARDS. 11 patients (15.5%) died during the admission in ICU. Serum levels of endogenous catecholamines were significantly elevated. Norepinephrine levels were higher in those with RV and LV systolic dysfunction, higher CRP, and higher IL-6. Patients with higher mortality rate were those with norepinephrine values ≥ 3124 ng/mL, CRP ≥ 17.2 mg/dL and IL-6 ≥ 102 pg/mL. Univariable analysis by Cox proportional hazards regression modelling showed that norepinephrine, IL-6 and CRP had the highest risk of acute mortality. Multivariable analysis showed that only norepinephrine and IL-6 retained in the model. Marked increase of serum catecholamine levels is present during acute phase of critically ill COVID-19 and it is associated with inflammatory and clinical parameters.

Assessment of Sympathetic Activity of Adrenal Medullae in Patients with Kidney Stone Treated by Extracorporeal Shock Wave Lithotripsy (ESWL)

Background: Extracorporeal shock wave lithotripsy (ESWL) is the most widely used method for treating kidney and upper ureteric stones smaller than 2 cm due to its effectiveness, safety, non-invasive, and an outpatient procedure. Objective: The present study aims to assess the effect of ESWL on the sympathetic activity of adrenal medullae in patients with renal stone. Materials and Methods: A cross-sectional study was conducted at the ESWL Unit, AL-Hilla Teaching Hospital, Babil Province, Iraq on 50 patients from October 1, 2021 to April 30, 2022. Before and right after an ESWL session, patients underwent a history, physical examination and laboratory tests to measure their levels of serum catecholamines (CAs). Results: The results of this study revealed that there is a significant increase of serum epinephrine and norepinephrine levels (P-value &lt;0.001) after ESWL session. There is a significant (P &lt;0.1) increase in epinephrine and norepinephrine levels in patients treated for upper pole renal stones when compared with mid and lower pole renal stones after having an ESWL session. Changing the lithotripter’s parameters (energy, frequency, and number of shock waves) did not significantly (P &gt; 0.05) correlate with the level of both norepinephrine and epinephrine in the serum after the ESWL session. Conclusion: The study found that patients with renal stones treated with ESWL had elevated serum CA levels after the session. The CA level correlates with the site of stone (the stone comes near to the adrenal medullae as there was an increase in the CA level), whereas it was unaffected by the lithotripter’s parameters.

Effects of dexmedetomidine on perioperative monitoring parameters and recovery in patients undergoing laparoscopic cholecystectomy in a 300 bedded hospital, Jaipur

Background: Laparoscopic cholecystectomy has emerged over the open cholecystectomy as gold standard for surgical treatment of symptomatic gall stones. Although pain after laparoscopic cholecystectomy is less intense, but many patients may experience considerable pain during first 24 hours in post-operative period. Intravenous (i.v.) use of dexmedetomidine in perioperative period lead to 90% decrease in the serum catecholamine levels, and further diminishing the haemodynamic response and sedating the patient and decrease analgesic requirements in the post-operative period. The efficacy of dexmedetomidine in providing hemodynamic stability during perioperative period and anesthesial recovery in patients undergoing laparoscopic cholecystectomy is studied. Methods: 60 patients of ASA grade I and II and of either sex (20–50 years) allocated in one of two parallel groups containing 30 patients each. In Group A- Dexmedetomidine (i.v.) bolus over 10min and continuous maintenance infusion 0.5µg/kg/h and in group B-0.9% normal saline i.v. bolus and continuous maintenance infusion was done. Parameters noted were heart rate, mean arterial pressure, oxygen saturation, post-operative pain were evaluated using VAS and analgesic requirement. Results: Both the groups were similar results in terms of age, sex, weight, ASA status, duration of surgery and hemodynamic parameters. SBP, DBP, MAP, SpCO2, EtCO2 values for both the groups were similar at all the intervals of time. No significant side effects were noted. Conclusion: Dexmedetomidine, pre-anaesthetic medication and its intraoperative infusion, further reducing the intraoperative anaesthetic requirement, sympathoadrenal response to intubation, maintains intraoperative cardiovascular stability, smooth extubation, sedation, and reduction in postoperative complications.

Prognostic Role of Catecholamine in Moderate-to-Severe Traumatic Brain Injury: A Prospective Observational Cohort Study.

Objective Traumatic brain injury leads to the activation of sympathetic nervous system and elevation in serum catecholamine levels. The aim of this study was to determine whether catecholamine level obtained within 24 hours of traumatic brain injury provides a reliable prognostic marker for outcome. Materials and Methods This study was a prospective observational cohort study on 36 moderate-to-severe traumatic brain injury. Plasma epinephrine (E), norepinephrine (NE), and dopamine (DA) levels were measured by using computed tomography enzyme-linked immunosorbent assay test and compared with Glasgow coma scale (GCS) that was obtained concurrently. Neurological outcome was determined by GCS at day 7 of treatment and by Glasgow outcome scale at mean follow-up of 9.73 ± 2.26 months. Results Patients with GCS 3 to 4 had markedly increase in baseline mean E (771.5 ± 126.0), NE (2,225.0 ± 215.4), and DA (590.2 ± 38.8) levels as compared with control, while patients with better GCS (11-12) had mildly elevated levels. Patients with GCS 5 to 10 had intermediate values. Cases with markedly elevated baseline E, NE, and DA level were either died or remained in poor GCS (3 or 4) at day 7 of treatment and remained in persistent vegetative state at mean follow-up of 9.73 ± 2.26 months. Cases with only mildly elevated E, NE, and DA level were improved to better GCS on treatment and had good recovery on follow-up. Conclusion These data indicate that a markedly elevated catecholamine level was an excellent endogenous and readily quantifiable marker that appears to reflect the extent of brain injury and predict the likelihood of recovery.

COMPARISON OF NTG VS DEXMEDETOMIDINE FOR CONTROL OF HAEMODYNAMIC RESPONSE IN PATIENTS DURING EMERGENCE FROM ANAESTHESIA AND EXTUBATION FOLLOWING LAPAROSCOPY

Endotracheal intubation as well as extubation are associated with various cardiovascular and airway responses leading to increase in heart rate (tachycardia), hypertension (HTN), cardiac arrhythmias, myocardial ischemia (MI), coughing, agitation, bronchospasm, increased bleeding, raised intracranial tension etc. Pneumoperitoneum creation in laparoscopic surgeries, leads to adverse changes in various systems of human body including cardiovascular, respiratory and acid base balance system. Various factors which leads to haemodynamic changes in patient are release of catecholamine, carbon di-oxide absorption, vasopressin release and position of the patient. NTG generate NO (Nitric oxide) which causes vasodilatation in vascular smooth muscle leading to decrease in blood pressure. It also relaxes the respiratory tract smooth muscle and hence it is preferred by anaesthesiologist to prevent laryngospasm. Dexmedetomidine is an 2-adrenoreceptor agonist used to facilitate the extubation after surgeries. Dexmedetomidine used in the intraoperative period causes decrease in serum catecholamine levels by 90%, which in turn blunts the haemodynamic response to laryngoscopy, tracheal intubation, pneumo-peritoneum and extubation. So we did the comparative study between IV dexmedetomidine and IV NTG on hemodynamic response during extubation in laparoscopic surgeries. To study and compare the effect of intravenous nitro-glycerine (NTG) with dexmedetomidine in patients undergoing laparoscopic surgery and during recovery in terms of haemodynamic response during tracheal extubation, airway reexes during tracheal extubation by using extubation quality score, sedation by using Ramsay Sedation Scale &amp; side effects of drug. 60 patients of ASA grade 1 and 2 undergoing laparoscopic surgery were divided into two groups of thirty each. GROUP D (n=30) will receive Dexmedetomidine infusion at the rate of 0.75 mics/kg over 10 minutes and GROUP N (n=30) will receive NTG infusion at the rate of 2 mics/kg over 10 minutes .patients were assessed on the basis of ramsay sedation scale , extubation quality scale and vas scale every 1, 3, 5, 10 and 15 minutes. When both the groups were compared it was found out there was statistically signicant difference in dexmedetomidine group as compared to NTG in terms of decrease in HR , BP, SBP , DBP, MAP , extubation quality score , ramsay sedation scale, and VAS scale .there was no overall complication in both groups. In conclusion, the Dexmedetomidine at a dose of 0.75µg/kg body weight as compared to NTG ( 2 µg/kg body weight )when administered as infusion over 10 minutes, before tracheal extubation attenuates the airway reexes and hemodynamic responses effectively during emergence from anaesthesia providing smooth extubation. It provide adequate sedation, maintaining patient's arousability and delay the need for analgesia in the post-operative period.

Comparison of the hemodynamic response of dexmedetomidine versus additional intravenous lidocaine with propofol during tracheal intubation: a randomized controlled study

BackgroundLaryngoscopy and tracheal intubation are strong stimuli that cause a reflex increase in blood pressure (BP), heart rate (HR), and serum catecholamine level. These can lead to myocardial infarction or cerebrovascular accidents. The purpose of this study is to compare the efficacy of dexmedetomidine and lidocaine combined with propofol in attenuating the hemodynamic response following laryngoscopy and endotracheal intubation.MethodsThis study was a randomized controlled study and adhered to the CONSORT guidelines. One-hundred and six patients undergoing elective general anesthesia with endotracheal intubation were divided randomly into two groups. Group D received dexmedetomidine (1 μg kg− 1) before induction. Group LP received lidocaine (1.5 mg kg− 1) before induction with additional propofol (0.5 mg kg− 1) before laryngoscopy. The primary endpoint was hemodynamic including systolic (S) BP, diastolic (D) BP, mean arterial blood pressure (MAP) and HR measured before and after induction and ≤ 10 min after intubation. Secondary outcome was complications/adverse effects.ResultsAfter induction, the mean SBP, DBP, MAP and HR decreased significantly from baseline in both groups except for mean HR in group LP at 1 min. Differences in mean values of SBP, DBP, and MAP were significantly lower in group D after intubation at 4–10 min (P < 0.05). Group LP had a non-inferior effect in blunting BP at all time points except 1 and 2 min after induction, and 2 min after intubation. The mean difference in HR in group D was significantly lower than that in group LP at all time points (P < 0.001). Group D had significantly more episodes of bradycardia (18.87% vs. 0%, P = 0.001) and hypotension (52.83% vs. 15.09%, P < 0.001) than did group LP.ConclusionLidocaine (1.5 mg kg− 1) with additional propofol (0.5 mg kg− 1) had a non-inferior effect compared with dexmedetomidine (1 μg kg− 1) in attenuating the hemodynamic response following laryngoscopy and endotracheal intubation, and had fewer adverse effects.Trial registrationThai Clinical Trial Registry, (TRTC20190206002). Retrospectively registered 4 February 2019.

Increased sympathetic tone and hypothalamic–pituitary–adrenal (HPA) axis activation impact in metabolic parameters from hypertensive rats

• Hypertensive rats showed a reduction in adiposity when compared to their controls; • SHR presented the most evident lipodystrophy; • SHR exhibited significant alteration in endocrine function of adipose tissue. Increased activity of the sympathetic nervous system (SNS) may play an important role in the development of hypertension and in adiposity disorders. We aimed to investigate the influence of increased sympathetic tone and hypothalamic–pituitary–adrenal (HPA) axis activation in metabolic parameters by evaluating the morphometry of isolated adipocytes from different fat pads and energy consumption. Serum levels of catecholamines, HPA hormones, T3 and adipokines were measured in 15-weeks-old Wistar (WIS), Wistar-Kyoto (WKY), Spontaneously Hypertensive Rats (SHR) and WIS treated with N G -nitro-L-arginine methyl ester (L-NAME). L-NAME and SHR showed a reduced adiposity when compared to their controls, which may be related to higher concentrations of T3. However, SHR presented the most evident lipodystrophy, presenting significant changes in the morphometry from isolated adipocytes and the production of adipokines. Thus, our study suggests that endocrine changes in hypertension models may highlight possible therapeutic targets in the treatment of metabolic changes associated with hypertension.

The role of adrenergic and muscarinic receptors in stress-induced cardiac injury.

Takotsubo syndrome (TS) is a rare but dangerous disease that can be fatal. The pathogenesis of TS is not well understood because there is no animal model of TS that fully mimics TS. It has now been documented that stress exposure (24h) of rats induced the state which is similar TS in human: contracture damage of myofibrils, elevation of the serum creatine kinase MB level, increased 99mTc-pyrophosphate (99mTc-PYP) accumulation in the heart, QTc interval prolongation, and contractility dysfunction of the heart. Immobilization stress resulted in an increase in coronary blood flow. Emotional stress increased the serum catecholamine level. Blockade of β1-adrenergic receptor (AR) prevented stress-induced cardiac injury (SICI). Blockade of β2-AR aggravated stress-induced cardiac injury. Stimulation of β2-AR increased cardiac tolerance to stress. Inhibition of β3-AR, α1-AR had no effect on SICI. Blockade of peripheral muscarinic receptors or α2-AR aggravated SICI. Pretreatment with the selective β1-AR antagonist atenolol attenuates stress-induced cardiac contractility dysfunction, but recovery of cardiac contractility is not complete. There is indirect evidence that circulating catecholamines play an important role in SICI. Consequently, the activation of β1-AR plays a significant role in SICI. However, there are other receptors which are also involved in SICI and require further investigation.

Streptozotocin-induced type 1 and 2 diabetes in rodents: a model for studying diabetic cardiac autonomic neuropathy.

Several animal models are continually being developed to study diabetic complication. Several conflicting regimen for diabetes induction exist in the literature with varying dose strength and regimen for different study interest in diabetes. This study aims to show the effect of high dose streptozotocin (STZ) on the one hand compared with multiple low doses after high fat diet induction on diabetic cardiac autonomic neuropathy (DCAN). Eighty-four Wistar rats were used to demonstrate DCAN induction using 2 approaches one for T1DM (STZ 50mg/kg) and the other for T2DM (HFD for 8 weeks with STZ 25mg/Kg daily for five days). DCAN features were assessed using invasive biomarkers, histology patterns and cardiac nerve densities. Diabetes induction rate was 76% and 89% in T1DM and T2DM model respectively. T1DM group had significant weight loss, reduced c-peptide, and insulin level post induction. The T2DM additionally showed significantly higher total cholesterol and Homeostatic model assessment (HOMA) compared with control. Serum levels of catecholamine, choactase, nerve growth factor and cardiac nerve density confirms development of DCAN. High single dose of STZ and HFD with multiple low doses of STZ may be recommended for DCAN study in T1DM and T2DM rat model respectively.

FOLLOW THE HEART OR THE GUT?

Abstract Objective: This case underlines the importance of thoroughly investigating alternative causes for hypertension in patients with atypical presentations, regardless of their age and risk factors. Design and method: Clinical case. Results: We present the case of a 68 year old woman without known cardiovascular diseases who came to the ER complaining of headaches, palpitations and chest pain of two hours duration. Upon admission, her blood pressure was 300/150 mmHg - overlapping values in all limbs with no asymmetric pulse. Heart rate was 140 bpm, rhythmic and without heart murmurs, abdomen without murmurs or palpable masses. Her ECG showed diffuse ST segment depression and high sensitivity troponin level at 0 h was 258 ng/L. Cardiac echo showed no wall motion abnormalities and no hypertrophy of the left ventricle. Her BP was acutely controlled with ACEi and iv nitroglycerin. Two hours after admission her BP returned to normal and remained within normal range without medication. Her ECG showed normal sinus rhythm with no other pathological findings. Coronary angiography was performed the next day and showed no atherosclerotic lesions. At this stage, her diagnosis was type 2 MI caused by severely elevated BP. Blood and urine tests revealed high levels of serum catecholamines and urinary normetanephrines - over 4000 micrograms/24 h. Abdominal ultrasound found a mass near her right kidney. Abdominal CT confirmed the presence of a nodular 5 × 3 cm mass in the right adrenal gland, compatible with a pheochromocytoma. She was submitted to laparoscopic adrenalectomy with normalization of her BP after the surgery. During follow-up, the patient presented with persistently normal blood pressure and normal ECG aspect without any chronic medication. Conclusions: Pheochromocytoma is a rare neuroendocrine tumour originating in the adrenal gland medulla. Sustained or paroxysmal arterial hypertension is sometimes associated with the classic triad: episodic headaches, profuse sweating and tachycardia. A timely diagnosis and an effective therapeutic strategy are important, as this is a potentially fatal disease with a very good prognosis if discovered and treated early. It should be excluded in patients with high paroxysmal BP, especially if under 20 or over 50 years old.

Laparoscopic resection of a large clinically silent paraganglioma at the organ of Zuckerkandl: a rare case report and review of the literature

BackgroundLarge paraganglioma of the Zuckerkandl organ (POZ) is extremely rare. The patient can occasionally be paucisymptomatic, further obscuring the diagnosis and carrying high mortality. Recommended treatment for large paraganglioma (PGL) is open surgical removal. We report a case of successful laparoscopic resection of a large POZ with normal blood pressure in a 45-year-old man.Case presentationA 45-year-old man was hospitalized because of hyperglycemia. Computed tomography of the abdomen and the serum and urinary catecholamine levels confirmed the diagnosis of large POZ. But his blood pressure was normal and he underwent laparoscopic tumor excision successfully. During 6 months follow-up after laparoscopy, serum and urinary catecholamines were normal but glycaemia remained high level. DNA analysis of the succinate dehydrogenase complex subunits B (SDHB) and SDHD revealed no mutation.ConclusionsPOZ is an unusual mass and preoperative diagnosis can be difficult in clinically silent cases. PGL cannot be excluded in patients with normal blood pressure. Even a large POZ can be excised laparoscopically by following proper techniques.