Difficulties in the diagnosis of pheochromocytoma in children]

Pheochromocytoma was the cause of arterial hypertension observed in 0.9% of children treated in 1982-1989. Out of clinical features the most characteristic was sustained hypertension often complicated by the accelerated phase of malignant hypertension and encephalopathy. Sustained tachycardia was also found in all patients. Increased urinary excretion of catecholamines and its metabolites confirmed the diagnosis in all cases. The most sensitive and specific methods for tumor diagnosis were ultrasonography and computer tomography of the adrenals while scintigraphy with meta-iodobenzylguanidine+ labelled with iodine-131 radioisotope gave a high percentage of false negative results.     

Opioid peptides and catecholamines in human pheochromocytoma

Opioid peptides (OP) and catecholamines (CA) were measured in twelve human pheochromocytomas (PHEO). In all tumors the CA concentrations were much higher than those OP (range: 300-85,000 fold higher). Large intertumor variability in the levels of both substances was encountered (mean +/- S.E.M. = CA: 44.9 +/- 7.7 mumoles/g; OP: 38.1 +/- 17.1 nmoles/g; range = CA: 10.1-93.1 mumoles/g; OP: 0.7-181 nmoles/g). Norepinephrine (NE) was the main CA in seven of the 12 tumors. In four of these PHEO, NE accounted for 85% or more of the total CA. These "noradrenergic PHEO" derived from the right adrenals, were of smaller size (36 +/- 15g), had the lowest levels of OP (1.1 +/- 0.3 nmoles/g) and CA (28 +/- 10 mumoles/g), produced moderate to severe sustained hypertension (MBP: 160 +/- 11 mmHg) and the most severe and persistent clinical manifestations. Epinephrine (EPI) was the main CA in five of the 12 tumors. These PHEO had intermediate levels of OP (12 +/- 3 nmoles/g), and four of them were of left adrenal origin. Patients bearing these tumors were generally normotensive (MBP: 103 +/- 4 mmHg) and asymptomatic, with occasional paroxysmal crisis. The highest levels of OP (132 +/- 24 nmoles/g) were found in two tumors of extra-adrenal location and in one of right adrenal origin. The proportion of NE and EPI ranged between 60-80% and 20-40% respectively, of total tumor CA. The two extra-adrenal PHEO were the largest of this series (180 and 245g). These patients had mild hypertension (MBP: 118 +/- 7 mmHg) of sustained or paroxysmal course, and frequent symptomatic episodes. Differences in the synthesis, storage, metabolism and release of CA and OP in PHEO probably account for their variable tumoral content, as well as for the clinical heterogeneity produced by these tumors. It remains to be seen whether OP can contribute to the clinical manifestations of patients with pheochromocytomas.     

Effect of isradipine on urinary excretion of catecholamines and their metabolites in patients with pheochromocytoma]

An effect of calcium antagonist-isradipine-on catecholamines and their metabolites excretion with the urine in 4 patients with pheochromocytoma has been analysed. It was found that the excretion of OFFnoradrenaline and vanilaminomandelic acid is reduced. It may indicate inhibitory effect of calcium antagonists on catecholamines secretion in patients with pheochromocytoma.     

Use of plasma catecholamines in diagnosing pheochromocytoma and neuroblastoma

The diagnosis in two cases of neural crest tumours was confirmed by the measurement of concentration of plasma catecholamines. A histamine provocative test monitored by values of plasma catecholamines provided support for a diagnosis of pheochromocytoma in a patient with normal blood pressure and elevated values of urinary amines. In the second case the presence of a ganglioneuroblastoma secreting abnormal amounts of catecholamines was detected by plasma epinephrine and norepinephrine measurements when values of urinary free catecholamines were normal.     

Effect of catecholamines in blood flow in arteries of distribution]

In large arteries, distributing blood to an area (hind leg of dog), the vasomotor substances (catecholamines) induce differences in flow. In case of state of vasoconstriction, the mean velocity of flow decreases, while the amplitude of pulsatile flow and the pressure increase. The radial expansion is wider. In case of state of dilatation, inverse reactions are observed.     

Reversible endocytosis apparatus of the blood platelets]

The functioning of ganules of blood platelets participating in the reversible endocytosis reaction was investigated in rabbits. Eczocytosis was shown to be initiated by inducers of two types: proteolytic enzymes and compounds accumulated by the granules (biogenic amines, dyes, anesthetics and phenothiazines). Heparin inhibits thrombin-induced eczocytosis. During eczocytosis produced by accumulation of compounds by blood platelet granules, the cells lose their capacity for maintaining the aggregation state. The nature of blood platelet granules participating in the reversible endocytosis reaction is discussed.     

Immunoenzymatic method for determining thyroglobulin levels in human blood serum]

An inexpensive enzyme immunoassay method was designed for the determination of thyroglobulin concentration in human blood serum. The range of concentrations of thyroglobulin which can be measured by the method is between 6 and 800 ng/ml. The sensitivity of the method is comparable to that of the commercial test kits. The values of thyroglobulin concentration obtained with the use of the described method are strongly correlated (r = 0.946) with those obtained by using the reference method (IRMA kit of Byk, Sweden). The intraassay coefficient of variation ranged from 5.5 to 10.2% and interassay coefficient of variation from 9.5 to 13.2% depending on the thyroglobulin concentration. The upper limit of blood serum thyroglobulin concentration in healthy subjects was 70 ng/ml. The results of thyroglobulin determination obtained with the described method are falsely lowered in the presence of antithyroglobulin antibodies; simultaneous determination of these antibodies is thus necessary in such a case. It seems that the described method may be used for monitoring the patients after surgical treatment of differentiated thyroid cancer aimed at early detection of metastases.     

Plasma free and conjugated catecholamines in clinical disorders

Plasma free and sulfoconjugated norepinephrine (NE), epinephrine (E) and dopamine (DA) concentrations measured in patients with thrombocytopenia or thrombocytosis, in newborns and pregnant women were not statistically different from values determined in 41 healthy volunteers. The percentage free to total NE, E and DA was 30 +/- 10%, 35 +/- 11% and 1.5 +/- 1.1% (mean +/- SE) in the controls, resp; not different from the previously described patients or from patients with liver failure who showed significantly higher free and conjugated NE and E levels when compared with controls (p less than 0.01, resp.). Conjugated catecholamine (CA) levels from the femoral artery and from multiple sites in the venous system sampled in patients undergoing intracardiac measurements were identical. The data suggest that sulfation of CA may not be simply ascribed to platelets, to the liver, to vascular beds, or to organs along the vena cava including the adrenal glands. The parallel increase of free and conjugated NE with age in healthy controls, as well as the unchanged degree of conjugation in patients with increased spillover of NE and E caused by a pheochromocytoma or by a heart attack, suggest that there is a balance between free and sulfated CA. A normal ratio of free to conjugated NE and E observed in patients receiving high dosage DA infusion further indicates that there is an adequate sulfate supply and no apparent substrate inhibition of the conjugation process. Because the percentage free of total NE, E and DA were significantly lower in patients in the hypothyroid state when compared with controls (p less than 0.01, resp.), hypothyroidism may affect the balance of free to conjugated CA in a yet unknown way.     

Free and conjugated catecholamines in digestive tissues of rats

Using a radioenzymatic technique, the highest concentrations of free catecholamines were found in the duodenum, and the lowest in the liver of untreated rats. When compared to the antrum, the concentration of free dopamine was higher, and that of norepinephrine lower in the fundus. As far as conjugated catecholamines are concerned, the tissue concentrations of both sulfo- and glucurono-conjugates were usually low, and often non detectable, with an exception: the concentration of glucurono-conjugated dopamine was very high in the duodenum, ileum, and liver of untreated rats.     

Evaluation of the usefulness of certain localization methods in diagnosis of pheochromocytoma]

Localization tests including TC-scans, scintigraphy with 131I-radiolabelled metaiodobenzylguanidine and ultrasound have been performed in 68 patients with diagnosed pheochromocytoma. Diagnosis was based on clinical symptoms and increased catecholamines and/or their metabolites excretion with the urine. Proper diagnosis with CT-scans was 97%, scintigraphy--92%, and ultrasound--93%; false negative results in scintigraphy amounted to 8% (3 patients) and 5% (3 patients) in case of ultrasound. CT-scans were free of such errors. False positive diagnosis was made in 2 (3%) patients with CT-scans and in 1 (2%) patient tested with ultrasound. These results suggest that pheochromocytoma may be precisely localized with non-invasive techniques, especially CT-scans.