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Plasma catecholamines and clonidine test in the differential diagnosis of essential hypertension and pheochromocytoma.
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A]H-APRIL 1999-VOL. 12, NO. 4, PART 2
A S H XlV A B S T R A C T S
E009
E010
ORTHOSTATISM MODIFIES I N S U L I N - L I K E G R O W T H FACTOR 1 AND INSULIN P L A S M A LEVELS IN ESSENTIAL H Y P E R T E N S I O N . G. Andronico*, L. Fcrrara, MT. Mangano, R. FerraroMortellaro, D. Lamanna and G. Cerasola*. Institute of Internal Medicine and Cardiovascular Diseases. University of Palermo. Italy.
Insulin-Like Growth Factor I (IGF-1) and Insulin have dilatory and growth promoting activities on vascular bed. In our study we analyzed the modification of insulin and IGF-1 plasma concentrations following orthostatic stimulation in 21 patients with mild to moderate essential hypertension. Insulin and IGF-I were measured at 8 am after at least 2h laying down and after lh upright position, by means of radioimmunoassay. Results are given as means ~: SE. Differently than in normal people, in the studied hypertensive subjects, after standing, plasma insulin was significantly higher (12.1 :t: 1.4 vs 7.6 + 0.8 uU/mL - p: 0.0003) whereas plasma glucose was not different. IGF-1 plasma levels were also higher after standing (34.7 + 2.1 vs 30.8 + 2.0 nmol/L- p: 0.017) but an inverse relationship was found between per cent increase of insulin and percent increase ofIGF-I (r=--0.48; p: 0.04). Blood pressure was not modified in upright position, whereas heart rate was higher (81.5 + 3.1 vs 69.1 ± 2.0 b/min - p<0.0001). Our results show that orthostatie stimulation in essential hypertensive can induce an increase of circulating insulin and 1GF-1 which could have vasodilatory effects in response to sympathetic stimulation.
KeyWords:
Insulin - IGF-1 - Vascular smooth muscle
USE OF MONOCLONAL ANTIBODIES FOR AFFINITY CHROMATOGRAPHY OF PARATHYROID HYPERTENSIVE FACTOR S. I
EOll
E012
PLASMA CATECHOLAMINES AND CLONIDINE TEST IN THE DIFFERENTIAL DIAGNOStS OF ESSENTIAL HYPERTENSION AND PHEOCHROMOCYTOMA.JD Mediavilla, M L6pez de la Torte, G Pi6drota, C Hidalgo, L Le6n, L Aliaga, P Pinel, C Fernandez. Virgen de [as Nieves Hospital. Granada.Spain. We have studied 69 subjects: 14 patients with pheochrornocytoma(6 men and 8 women, 48+16 years), 26 patients with essential hypertension (8 men and 18 women, 49±12 years) and 29 matchedcontrols (12 men and 17 women, 45+16 years). Plasma catecholamines were measured by HPLC according to our laboratory procedures, avoiding all known interferences. A clonidine test was performed in both patients and controls. This test consisted in the oral administration of 0,3 mg of clonidine, with samples for epinephrine, norepinephrine and doparnine before and alter 60, 120 and 180 minutes; basal and after 180 minutes were used for the final diagnosis. Basal and after 180 minutes norepinephrine levels were significantly higher (p<0.05) in patients with pheochromocytoma than in both patients with essential hypertension and controls, with no differences between these two groups. Plasma cefesholamines (including epinephrine and norepinephrine) showed similar results both basal and alter 180 minutes. However, epinephrine values did not display any differences in the three groups studied, either basal or after 180 minutes. We have found a non-significant tendencyto suppression of plasma cefecholamines levels during the elonidine test in patients with essential hypertension and controls, whilst there was no suppression in patients with pheochrornocytoma; this last group even showed a paradoxical increase in catesholamines along the test. Applying a logistic regression analysis, we have calculated that the odds ratio (OR) of pheochromocytoma for a patient whose plasma catecholamines (including epinephrine and norepinephrine) levels were ~tween 300 pg/ml and 400 pg/ml was 0.57 times higher than that of a patient with values lower than 300 pg/ml. The OR when plasma catecbolamines exceeded 400 pg/ml was 7.71 times higher than it the valueswere within the normal range. Plasma catesholamines values are a very useful tool to calculate the risk for a patient to present a pheochromocytoma. Clonidine test may help in the final diagnosis.
DIVERGENT EFFECTS OF DIHYDROPYRIDINE AND PHENYLALKYLAMINE CALCIUM ANTAGONIST ON PLASMA NOREPINEPHRINE BEFORE AND AFTER COLD PRESSOR TEST IN MILD TO MODERATE HYPERTENSION. JD Lefrendt, A Urbigkeit, K Sevre, M Castellano, M Hausberg, M Fallon, L Fluckiger, J Heitmann, M Rostrup, E Agabiti Rosei, KH Rahn, M Murphy, F Zannad, PJ de Kam and AJ Smit. University Hospital, Groningen, The Net'nedands. Hypertension is often accompanied by increased resting plasma norepinephdne (NE). We compared the affects of two different cafoiumantagonists on resting blood pressure and NE responses to a Cold Pressor (CP) test, known to stimulate the sympathetic nervous system. 145 Patients with mild to moderate hypertension (SBP<_180, 95_
Key Words:
pheochromocytoma,catecholamines,clonidine test, essential hypertension
Key Words:
Calpium antagonists, norepinephrine, cold pressor
A]H-APRIL 1999-VOL. 12, NO. 4, PART 2
A S H XlV A B S T R A C T S
E009
E010
ORTHOSTATISM MODIFIES I N S U L I N - L I K E G R O W T H FACTOR 1 AND INSULIN P L A S M A LEVELS IN ESSENTIAL H Y P E R T E N S I O N . G. Andronico*, L. Fcrrara, MT. Mangano, R. FerraroMortellaro, D. Lamanna and G. Cerasola*. Institute of Internal Medicine and Cardiovascular Diseases. University of Palermo. Italy.
Insulin-Like Growth Factor I (IGF-1) and Insulin have dilatory and growth promoting activities on vascular bed. In our study we analyzed the modification of insulin and IGF-1 plasma concentrations following orthostatic stimulation in 21 patients with mild to moderate essential hypertension. Insulin and IGF-I were measured at 8 am after at least 2h laying down and after lh upright position, by means of radioimmunoassay. Results are given as means ~: SE. Differently than in normal people, in the studied hypertensive subjects, after standing, plasma insulin was significantly higher (12.1 :t: 1.4 vs 7.6 + 0.8 uU/mL - p: 0.0003) whereas plasma glucose was not different. IGF-1 plasma levels were also higher after standing (34.7 + 2.1 vs 30.8 + 2.0 nmol/L- p: 0.017) but an inverse relationship was found between per cent increase of insulin and percent increase ofIGF-I (r=--0.48; p: 0.04). Blood pressure was not modified in upright position, whereas heart rate was higher (81.5 + 3.1 vs 69.1 ± 2.0 b/min - p<0.0001). Our results show that orthostatie stimulation in essential hypertensive can induce an increase of circulating insulin and 1GF-1 which could have vasodilatory effects in response to sympathetic stimulation.
KeyWords:
Insulin - IGF-1 - Vascular smooth muscle
USE OF MONOCLONAL ANTIBODIES FOR AFFINITY CHROMATOGRAPHY OF PARATHYROID HYPERTENSIVE FACTOR S. I
EOll
E012
PLASMA CATECHOLAMINES AND CLONIDINE TEST IN THE DIFFERENTIAL DIAGNOStS OF ESSENTIAL HYPERTENSION AND PHEOCHROMOCYTOMA.JD Mediavilla, M L6pez de la Torte, G Pi6drota, C Hidalgo, L Le6n, L Aliaga, P Pinel, C Fernandez. Virgen de [as Nieves Hospital. Granada.Spain. We have studied 69 subjects: 14 patients with pheochrornocytoma(6 men and 8 women, 48+16 years), 26 patients with essential hypertension (8 men and 18 women, 49±12 years) and 29 matchedcontrols (12 men and 17 women, 45+16 years). Plasma catecholamines were measured by HPLC according to our laboratory procedures, avoiding all known interferences. A clonidine test was performed in both patients and controls. This test consisted in the oral administration of 0,3 mg of clonidine, with samples for epinephrine, norepinephrine and doparnine before and alter 60, 120 and 180 minutes; basal and after 180 minutes were used for the final diagnosis. Basal and after 180 minutes norepinephrine levels were significantly higher (p<0.05) in patients with pheochromocytoma than in both patients with essential hypertension and controls, with no differences between these two groups. Plasma cefesholamines (including epinephrine and norepinephrine) showed similar results both basal and alter 180 minutes. However, epinephrine values did not display any differences in the three groups studied, either basal or after 180 minutes. We have found a non-significant tendencyto suppression of plasma cefecholamines levels during the elonidine test in patients with essential hypertension and controls, whilst there was no suppression in patients with pheochrornocytoma; this last group even showed a paradoxical increase in catesholamines along the test. Applying a logistic regression analysis, we have calculated that the odds ratio (OR) of pheochromocytoma for a patient whose plasma catecholamines (including epinephrine and norepinephrine) levels were ~tween 300 pg/ml and 400 pg/ml was 0.57 times higher than that of a patient with values lower than 300 pg/ml. The OR when plasma catecbolamines exceeded 400 pg/ml was 7.71 times higher than it the valueswere within the normal range. Plasma catesholamines values are a very useful tool to calculate the risk for a patient to present a pheochromocytoma. Clonidine test may help in the final diagnosis.
DIVERGENT EFFECTS OF DIHYDROPYRIDINE AND PHENYLALKYLAMINE CALCIUM ANTAGONIST ON PLASMA NOREPINEPHRINE BEFORE AND AFTER COLD PRESSOR TEST IN MILD TO MODERATE HYPERTENSION. JD Lefrendt, A Urbigkeit, K Sevre, M Castellano, M Hausberg, M Fallon, L Fluckiger, J Heitmann, M Rostrup, E Agabiti Rosei, KH Rahn, M Murphy, F Zannad, PJ de Kam and AJ Smit. University Hospital, Groningen, The Net'nedands. Hypertension is often accompanied by increased resting plasma norepinephdne (NE). We compared the affects of two different cafoiumantagonists on resting blood pressure and NE responses to a Cold Pressor (CP) test, known to stimulate the sympathetic nervous system. 145 Patients with mild to moderate hypertension (SBP<_180, 95_
Key Words:
pheochromocytoma,catecholamines,clonidine test, essential hypertension
Key Words:
Calpium antagonists, norepinephrine, cold pressor