Biochemical tests for diagnosis of phaeochromocytoma: urinary versus plasma determinations.

Plouin, P F; Duclos, J M; Menard, J; Comoy, E; Bohuon, C; Alexandre, J M

doi:10.1136/bmj.282.6267.853

Cited by 77 publications

(21 citation statements)

References 4 publications

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“…Hypertension is a common, although not invariable, feature of Cushing's syndrome and is also a recognized complication of exogenous steroid administration (Plotz et al, 1952;Greminger et al, 1982). The reported incidence of hypertension in this latter instance is at least 20%, which is considerably less than described in Cushing's syndrome, although the discrepancy may partly reflect the manner in which blood pressure data were recorded in the early studies of exogenous steroid therapy and the variable definition of hypertension (Savage et al, 1962;Treadwell et al, 1964).…”

Section: Glucocorticoid Hypertensionmentioning

confidence: 99%

Hormones and Hypertension

Fraser

Davies

Connell

1989

Clinical Endocrinology

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The importance of changes in hormone secretion in human hypertension is a complex problem and too large to be dealt with in uniform detail in a short review. The subject encompasses not only the effects on blood pressure of primary endocrine disorders but also hormonal changes secondary to increased blood pressure. Some aspects are more fully understood than others and have been the subjects of relatively recent detailed reviews. Where this is the case, the current review has summarized the present position and cited reviews and key papers, in order to reserve space for more controversial and less well understood conditions such as the hypertension of growth hormone, thyroid hormone or glucocorticoid excess. CORTICOSTEROIDSThe human adrenal cortex synthesizes and secretes a large number of steroid hormones, biosynthetically interrelated with each other and with qualitatively and quantitatively different biological activities. The two major categories of compound are the adrenal androgens (androstenedione, dehydroepiandrosterone and testosterone) which, as far as is known, are not important in blood pressure control and will not be considered further (although there exist experimental models of hypertension which may be androgendependent), and the corticosteroids. These C21 steroids of the pregnane series exert two main types of action, mineralocorticoid and glucocorticoid effects, and excess secretion of either has widespread repercussions, particularly for neuromuscular function and the control of salt and water metabolism. Mineralocorticoids act mainly on the distal nephron via specific receptor activation to promote sodium reabsorption (with associated changes in extracellular fluid and plasma volume) and increased potassium and proton excretion, so that excess activity is characterized by hypokalaemia and a metabolic alkalosis. Aldosterone is the major mineralocorticoid in man but deoxycorticosterone (DOC) and corticosterone also have significant activity. More recently discovered compounds-18-hydroxy DOC, 18-oxocortisol and several compounds modified at position 19 (19-hydroxy or 19-nor)-may also contribute to the total mineralocorticoid action of the adrenocortical secretion (see review by Fraser & Padfield, 1985). Cortisol is the major human glucocorticoid. Glucocorticoids promote liver glycogen and protein synthesis but are catabolic in most other tissues, increasing lipolysis and protein R. Fraser et al.breakdown and reducing glucose uptake from the circulation. However, the kidney also possesses specific glucocorticoid receptors and, under experimental conditions, glucocorticoids can be shown to promote both natriuresis and kaliuresis, at least partly by raising glomerular filtration rate (GFR) and also to modulate Na+-H+ exchange in the proximal nephron (Davis & Howell, 1953;Mahnensmith & Aronson, 1985; Kinsella et al., 1985). Excess of either mineralocorticoid or glucocorticoid activity is associated with hypertension.The control of adrenocortical function is similarly complex and the subject of sev...

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Section: Glucocorticoid Hypertensionmentioning

confidence: 99%

Hormones and Hypertension

Fraser

Davies

Connell

1989

Clinical Endocrinology

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“…The cornerstone of diagnosis is biochemical evidence of excessive CAT production. For screening purposes, determination of urinary metanephrine excretion appears to be the most sensitive test (7). of hypertension has been reported for tumours that secrete exclusively DA (16) or EPI (11,17).…”

Section: Introductionmentioning

confidence: 99%

The value of plasma markers for the clinical behaviour of phaeochromocytomas

Harst¹,

Herder²,

Krijger³

et al. 2002

European Journal of Endocrinology

106

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Objective: Phaeochromocytomas (PCCs) are widely known for their clinical unpredictability. This study intends to define predictive plasma markers for their variable postoperative behaviour. Furthermore, the diagnostic accuracy of these plasma tests was determined. Design and Methods: A retrospective correlative study was performed in a series of 83 operated and four autopsied patients in order to correlate preoperative catecholamine (CAT) levels of 103 PCCs with their clinical behaviour. In a subset of cases, chromogranin-A (Chr-A) and enzymes/precursors of the CAT biosynthesis were studied for their predictive value. Results: Basal CAT levels were elevated in 81/87 instances (sensitivity: 93%). Four of six cases with normal measurements showed only medullary hyperplasia. Larger PCCs, particularly those showing necrosis, capsular and vascular invasion, secreted higher CAT levels. Bilateral, hereditary tumours were less productive than their unilateral counterparts. Extra-adrenal PCCs secreted significantly lower levels of epinephrine (EPI) than intra-adrenal tumours. Fourteen patients developed metastases. According to Kaplan -Meier estimations, patients with higher levels of dopamine, norepinephrine (NE) and aromatic L-amino acid decarboxylase as well as lower ratios of EPI/EPI þ NE, had significantly shorter metastases-free intervals. Existence of preoperative hypertension, left ventricular hypertrophy and measured blood pressures showed significant positive relationships with CAT levels, but not with Chr-A. Conclusions: These data showed that plasma CAT measurement is a sensitive method in the diagnostic work-up of PCCs. Those tumours producing normal levels are commonly small and asymptomatic. Furthermore, certain secretion patterns are indicative of the presence of metastases as well as the size and site of sporadic and syndrome-related PCCs.

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“…All underwent a standardized aetiological work-up as previously described (Menard et al, 1982) and none had evidence of secondary forms of hypertension. Briefly, iatrogenic hypertension was excluded by a carefully taken history , a renal parenchymal disease was ruled out by measurement of blood and urinary creatinine and proteins, hyperaldosteronism was excluded by determination of blood and urinary electrolytes and measurement of plasma renin activity (PRA) and finally phaeochromocytoma was excluded by measurement of the 24 h excretion of total metanephrines (Plouin et al, 1981). Moreover, intravenous pyelography was performed in case of a lateralized abdominal murmur, of a severe hypertension (diastolic at rest above 120 mm Hg and/or fundus grade III or IV) (Menard et al, 1979) and when a history of proteinuria, nephritis or repeated urinary infections was present.…”

Section: Patientsmentioning

confidence: 99%

Captopril: pharmacokinetics, antihypertensive and biological effects in hypertensive patients.

Richer¹,

Giroux²,

Plouin³

et al. 1984

Brit J Clinical Pharma

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1 The kinetics of captopril plasma levels and of the drug-induced plasma converting enzyme activity (PCEA), plasma renin activity (PRA) and diastolic blood pressure (DBP) modifications were studied over 24 h after oral administration of captopril, 1 mg/kg, to ten hypertensive patients. 3 The onset of PCEA inhibition and of DBP decrease closely followed the rise of captopril's plasma levels, while that of PRA increase was delayed. In contrast, while captopril rapidly disappeared from plasma, its biological and antihypertensive effects were long-lasting. 4 The lack of correlation between the relative bioavailability of captopril and the induced reduction in DBP (evaluated by the corresponding AUCs) suggests that free unchanged captopril plasma monitoring is not an adequate indicator of hypertensive patients' potential responsiveness to captopril's blood pressure lowering effects.

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Biochemical tests for diagnosis of phaeochromocytoma: urinary versus plasma determinations.

Cited by 77 publications

References 4 publications

Hormones and Hypertension

Hormones and Hypertension

The value of plasma markers for the clinical behaviour of phaeochromocytomas

Captopril: pharmacokinetics, antihypertensive and biological effects in hypertensive patients.

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