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Endocrine diseases and pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Pheochromocytoma is generally suspected based on the presence of maternal symptoms, hypertension, or identification of a family history of MEN, von Hippel–Lindau, or neurofibromatosis. Elevated plasma catecholamines and metanephrines are strikingly elevated and are reflected in 24-hour urinary samples for catecholamines (epinephrine and norepinephrine) and metanephrines (metanephrine and normetanephrine). Most surgically confirmed pheochromocytomas have been associated with 24-hour urinary secretion three or more times the upper limit of normal for one or more of these hormones (83). When clinical suspicion is heightened by the finding of one or more extremely elevated urinary catecholamines or metanephrines (epinephrine, norepinephrine, metanephrine, or normetanephrine), adrenal imaging with non-gadolinium-enhanced MRI is accomplished, to investigate whether there is a unilateral adrenal tumor. Characteristically, pheochromocytomas image very bright on T2-weighted MRI and may be very helpful in the pregnant patient, for whom imaging modality options are limited (84).
Dietary Substances Not Required in Human Metabolism
Published in Luke Bucci, Nutrients as Ergogenic Aids for Sports and Exercise, 2020
Ferulic acid is a common phenolic acid found in almost every plant.852 Gamma oryzanol, a ferulate ester of sterols found in rice bran, has also been the subject of studies. Gamma oryzanol is mostly converted to ferulic acid during digestion.852 Ferulic acid closely mimics the structure of normetanephrine, the primary metabolite of norepinephrine.852 Animal studies have found that ferulate administration can mimic effects of increased hypothalamic norepinephrine,852 such as stimulation of somatotropin synthesis by the pituitary.853–855 Infusion of 100 or 500 mg of ferulic acid (0.3 mg/kg) into heifers elevated serum somatotropin levels significantly.856 Other pituitary hormones were generally not affected.852–856
Pure Autonomic Failure
Published in David Robertson, Italo Biaggioni, Disorders of the Autonomic Nervous System, 2019
Kopin et al. (1983b) evaluated the urinary excretion of the major noradrenaline metabolites (VMA, MHPG and NMN) in patients with autonomic failure. Patients with PAF showed a significant decrease in total catecholamine excretion and individual catecholamine metabolite excretion in comparison to normal controls and patients with SDS. Patients with SDS showed a disproportionate reduction in urinary normetanephrine excretion. Normetanephrine represents the o-methylated metabolite of noradrenaline, and is thus the predominant metabolite of released (extra-neuronal) noradrenaline. The authors therefore suggested that their results in patients with SDS were consistent with the inability to release noradrenaline appropriately from an intact peripheral nervous system. Again there was overlap in measurements between patients groups and single measurements are not of value in the diagnosis of individual patients.
An adrenal cortical adenoma with neuroendocrine-type granules mimicking pheochromocytoma
Published in Ultrastructural Pathology, 2023
Leonardo Rossi, Carlo Enrico Ambrosini, Liborio Torregrossa, Maria Margherita de Santi, Raffaella Guazzo, Tommaso Simoncini, Alessandra Bacca, Benard Gjeloshi, Francesco Pignatelli, Mattia Iachini, Elisa Loguercio, Chiara Becucci, Gabriele Materazzi
A 59-year-old woman with a medical history of hypertension, hypertensive cardiopathy, severe obesity and Obstructive Sleep Apnea Syndrome (OSAS) was under follow-up since 2017 for a left adrenal nodule. Due to the increase of catecholamine secretion (24 h urinary normetanephrine 1407.6 mcg, 24 h urinary metanephrine 8.1 mcg), in 2019 the patient underwent Metaiodobenzylguanidine (MIBG) scintigraphy that resulted negative. Notwithstanding, later on the patient complained that her blood pressure had become difficult to control and laboratory evaluation revealed a progressive increase of 24 h urinary normetanephrine (3016 mcg/24 h), with normal level of metanephrine (20.0 mcg/24 h). The patient underwent computed tomography which confirmed a 15-mm nodule of the left adrenal gland with benign contrast-enhancement features; besides, a 25-mm tumor of uterus was documented. Hysteroscopy was performed with uterine endometrial biopsy, which revealed a well-differentiated endometrioid endometrial adenocarcinoma. With the presumptive diagnosis of pheochromocytoma associated with endometrioid endometrial adenocarcinoma, a laparoscopic left adrenalectomy along with hysteroannessiectomy was scheduled.
The effect of acid use as a preservative on the results of biochemical tests measured in 24-h urine
Published in Scandinavian Journal of Clinical and Laboratory Investigation, 2022
Ceylan Bal, Canan Topcuoğlu, Ahmet Rıfat Balık, Fatma Meriç Yılmaz, Özcan Erel, Gülsen Yılmaz
As a result, we found that chloride, microalbumin, amylase and protein tests, which are recommended to be measured in the sample without preservatives, are affected by acid addition. Adrenaline and noradrenaline, which are the tests recommended to be measured in acid-added urine are degraded in the samples without acid, and the level of metanephrine and normetanephrine were not significantly degraded in the absence of preservatives. For this reason, it is not appropriate to use a single sample type with or without preservatives as to all the parameters we measured and we believe that the sample selection should be made in terms of the analyzed parameters. In addition, we think that for the parameters recommended to measure with the acid-added sample, the urine should contain acid from the moment it starts to be collected. To the best of our knowledge, our study is the most comprehensive study in the literature in terms of parameters measured in 24-h urine. We now have more and better tests for 24-h urine measurements but there is still much to be learned about how to check the preanalytical phase of these tests to achieve better patient outcomes. In this respect, this study might be important and used as guidance in selecting an appropriate urine collection process approach for patients who need to collect multiple urine samples at a time.
Intrarenal hemodynamics and kidney function in pheochromocytoma and paraganglioma before and after surgical treatment
Published in Blood Pressure, 2021
Magdalena Januszewicz, Piotr Dobrowolski, Andrzej Januszewicz, Ewa Warchoł-Celińska, Katarzyna Jóźwik-Plebanek, Daria Motyl, Marek Kabat, Mariola Pęczkowska, Ilona Michałowska, Urszula Ambroziak, Sadegh Toutounchi, Zbigniew Gałązka, Louisiane Courcelles, Marco Pappaccogli, Graeme Eisenhofer, Alexandre Persu, Jacques W. M. Lenders, Jacek Kądziela, Aleksander Prejbisz
Catecholamine biochemical phenotypes were assessed based on relative tumour-derived increases in plasma concentrations of normetanephrine, metanephrine, and methoxytyramine. Tumour-derived increments were calculated by subtracting from the concentration of each metabolite in each patient with a PPGL the mean concentration of the corresponding metabolites- normetanephrine (52 pg/mL), metanephrine (26 pg/mL) and methoxytyramine (5 pg/mL) in a previously described reference group [14]. We defined adrenergic tumours as those exhibiting both an increase in plasma metanephrine above a predefined cut-off (62 pg/mL) and a tumour-derived increment of metanephrine larger than 5% of combined increments of all O-methylated metabolites. We defined all other tumours as non-adrenergic, including both noradrenergic and dopaminergic tumors [15]. Within the non-adrenergic group only one patient was characterised by solitary increased secretion of dopamine but not of noradrenaline nor adrenaline.