Feocromocitoma adrenal gigante derecho. Reporte de un caso / Right giant adrenal pheochromocytoma. A case report

Introducción. El feocromocitoma es una neoplasia endocrina productora de catecolaminas, poco común, que generalmente se origina en la medula suprarrenal, y rara vez en el tejido cromafín extraadrenal, dándosele el nombre de paraganglioma. Existe una gran variedad de signos y síntomas secundarios a la secreción excesiva de catecolaminas por lo que su diagnóstico y tratamiento oportunos son fundamentales para evitar complicaciones potencialmente fatales. Caso clínico. Paciente femenina de 54 años, con dolor abdominal intermitente y con aumento progresivo, localizado en el cuadrante superior derecho. Por estudios imagenológicos se diagnosticó una gran masa suprarrenal derecha, con pruebas de laboratorio que encontraron niveles de metanefrinas y catecolaminas en orina normales. Discusión. Debido al tamaño del tumor y al íntimo contacto con las estructuras adyacentes, se realizó la resección por vía abierta, sin complicaciones y con una buena evolución postoperatoria. El informe anatomopatológico confirmó el diagnóstico de feocromocitoma suprarrenal derecho. Conclusión. Aunque poco frecuente, el feocromocitoma es una patología que se debe sospechar ante la presencia de masas suprarrenales y alteraciones relacionadas con la secreción elevada de catecolaminas. Se debe practicar el tratamiento quirúrgico de forma oportuna.

Introduction. Pheochromocytoma is a rare catecholamine-producing endocrine neoplasm that generally originates in the adrenal medulla, and rarely in extra-adrenal chromaffin tissue, giving it the name of paraganglioma. There is a wide variety of signs and symptoms secondary to excessive secretion of catecholamines, so its timely diagnosis and treatment are essential to avoid potentially fatal complications. Clinical case. A 54-year-old female patient with intermittent abdominal pain and progressive increase, located in the right upper quadrant. By imaging studies, a large right adrenal mass was diagnosed, with laboratory tests that found normal levels of metanephrines and catecholamines in urine. Discussion. Due to the size of the tumor and the intimate contact with the adjacent structures, the resection was performed by open approach, without complications and with a good postoperative evolution. The pathology report confirmed the diagnosis of right adrenal pheochromocytoma. Conclusion. Although rare, pheochromocytoma is a pathology that should be suspected in the presence of adrenal masses and changes related to elevated catecholamine secretion. Surgical treatment should be performed in a timely manner.

Caso clínico: Feocromocitoma Gigante / Case Report: Giant Pheocromocytoma

INTRODUCCIÓN: El feocromocitoma es una neoplasia neuroendocrina localizada en la médula adrenal, llamado paraganglioma cuando su ubicación es extraadrenal. Su incidencia anual es de 2-8 por millón de personas, sin predilección de sexo. Su cuadro clínico se caracteriza por: cefalea, diaforesis, taquicardia e hipertensión arterial. El tratamiento es la resección quirúrgica con una preparación preoperatoria multidisciplinaria. CASO CLÍNICO: Se trata de una paciente de 36 años, femenina con antecedentes de hipertensión arterial de un año de evolución, acompañado de cefalea, pérdida de peso, dolor abdominal, diaforesis, malestar general y otros; hospitalizada por varias ocasiones debido a crisis hipertensivas. Tensión arterial 180/120 mmHg, Frecuencia cardíaca 90/min, Índice de masa corporal 19.2 Kg/m2. Abdomen: masa palpable en hipocondrio y flaco izquierdos de aproximadamente 10 cm, no doloroso a la palpación. EVOLUCIÓN: Dentro de los exámenes complementarios, la determinación de catecolaminas en plasma fueron normales, en la tomografía computarizada se evidenció una masa retroperitoneal que involucraba riñón y suprarrenal izquierdos; ante la persistencia de hipertensión, se realiza la resección de la neoplasia por laparotomía más nefrectomía izquierda, flebotomía de cava inferior y transversectomía. Como complicación en el postoperatorio inmediato presentó hemoperitoneo requiriendo relaparotomía con esplenectomía, además adquirió neumonía la cual fue superada satisfactoriamente y fue dada el alta médica en buenas condiciones. CONCLUSIONES: El feocromocitoma es una patología infrecuente y compleja, cuya resolución quirúrgica es mandatoria, con una preparación prequirúrgica multidisciplinaria para disminuir al máximo la morbimortalidad y con un seguimiento a largo plazo en todos los casos.(AU)

INTRODUCTION: Pheochromocytoma is a neuroendocrine tumor located in the adrenal medulla or paraganglioma when its location is extraadrenal. The annual incidence is 2-8million people, no sex predilection. Clinical symptoms are characterised by: headache, diaphoresis,tachycardia, and hypertension. The treatment is surgical resection with a multidisciplinary preoperative preparation. CASE REPORT: This isa36 year old female patient,withahistory of hypertension forayear,accompanied by headache, weight loss, abdominal pain, diaphoresis, malaise and others; hospitalized for several times due to hypertensive crises. BP: 180/120 mmHg; HR: 90 per minute; BMI 19.2 kg / m2. Abdomen: palpablemass in upper quadrant and left flank of approximately 10 cm, not painful on palpation. EVOLUTION: About the examinations, the plasma catecholamines tests were normal and the CT scan showed a retroperitoneal mass which involved kidney and adrenal on left side. At the persistence of hypertension, the resection of the tumor was performed by laparotomy; also was performed left nephrectomy, phlebotomy of inferior cava and the resection ofthe transverse colon. Inthe immediatepostoperativeperiod,thepatientpresentedhemoperitoneumandasplenectomy was performed; also contracted pneumonia which was successfully treated. She left the hospital in good condition. CONCLUSIONS: The Pheochromocytoma is an infrequent and complex disease, whose surgical treatment is mandatory. A multidisciplinary preoperative preparation is important to reduce the morbidity andmortality associated and the follow-upmust be long termin all cases.(AU)

Feocromocitoma quístico gigante: reporte de un caso / Pheochromocytoma giant cystic: a case report

El feocromocitoma quístico gigante es tumor adrenal raro en el que predomina el curso asintomático; por lo que muchos de los casos no son diagnosticados hasta el momento de la cirugía. La simple movilización del tumor se asocia con el paso a la sangre de grandes cantidades de catecolaminas y a una elevada morbimortalidad.; por esta razón la cirugía per se y su manejo perioperatorio constituyen un enorme desafío. En este artículo se presenta el caso de un feocromocitoma gigante maligno (35 cm) que ocupaba todo el hemiabdomen derecho. Aun con el diagnóstico preoperatorio de feocromocitoma, el bloqueo farmacológico preoperatorio y las medidas intraoperatorias, el paciente falleció poco antes de que finalizara la cirugía.

The giant cystic pheochromocytoma is a rare adrenal tumor in the predominantly asymptomatic course; so many cases are not diagnosed until the time of surgery. The simple mobilization of the tumor is associated with the passage to the blood of large amounts of catecholamines and high morbidity and mortality. So the surgery itself and perioperative management are a huge challenge. This article describes the case of a malignant giant pheochromocytoma (35 cm) which occupied the entire right abdomen. Even with the preoperative diagnosis of pheochromocytoma, pharmacological blockade preoperative and intraoperative measures, the patient died shortly before the end of surgery.

Effect of propofol on secretory function of adrenal medullary chromaffin cells of rats / 中华麻醉学杂志

Objective To investigate the effect of propofol on the secretory function of adrenal medullary chromaffin cells of rats.Methods The rat adrenal pheochromocytoma cells cultured in vitro were seeded in 24-well plates at a density of 1×1010 cells/ml and divided into 5 groups (n=12 each) using a random number table:control group (group C),different concentrations of propofol groups (P1 and P2 groups),and different concentrations of etomidate groups (E1 and E2 groups).Propofol was added with the final concentrations of 30 and 100 μmol/L in P1 and P2 groups,respectively.Etomidate was added with the final concentrations of 4 and 40 μmol/L in EI and E2 groups,respectively.The cells were then incubated for 10 min in an incubator at 37 ℃.At the end of incubation with drugs,6 wells in each group were selected,and physiological salt solution 200 μl was added;another 6 wells in each group were selected,and high K+ physiological salt solution was added.[3 H] PSS and [3 H] K+-PSS were measured by [3 H] norepinephrine release assays.Results Compared with group C,[3 H] K+-PSS and [3 H] K+-PSS/PSS were significantly decreased in P1,P2 and E2 groups (P＜0.05),and no significant changes were found in [3H] K+-PSS and [3H] K+-PSS/PSS in group E1 (P＞0.05).Compared with group P1,[3 H] K+-PSS and [3 H] K+-PSS/ PSS were significantly decreased in group P2 (P＜0.05).Conclusion Propofol can inhibit the secretory function of adrenal medullary chromaffin cells of rats in a concentration-dependent manner.

Adrenal glands of Spix's yellow-toothed cavy (Galea spixii, Wagler, 1831): morphological and morphometric aspects / Glândulas adrenais de preás (Galea spixii, Wagler, 1831): aspectos morfológicos e morfométricos

Abstract Considering the physiological importance and need of greater morphophysiological knowledge of adrenal glands, the aims of present study were compare the morphometric data between left and right adrenal of male and female; perform a histological, scanning and transmission electron microscopy study showing tissue constitution of glands; finally, in order to define the presence and correct site of the cytochrome P450c17 expression in adrenal glands, immunohistochemical study of this enzyme was performed in 18 adrenal glands (right n=9 and left n=9) of nine adult Galea spixii (four males and five females). Right adrenal was more cranially positioned than left adrenal; dimensions (weight, length and width) of right adrenal was larger than left adrenal; no differences between male and female body and adrenal measurements were found; the morphology of cells and different amounts of lipid droplets may be related to the different demands of steroid hormones production, related to each zone of the adrenal cortex; and, the cytochrome P450c17 immunolocalization in fasciculate and reticular zone may be related with synthesis of 17-hydroxy-pregnenolone, 17-hydroxy-progesterone, dehydroepiandrosterone or androstenedione.

Resumo Considerando a importância fisiológica e a necessidade de melhor conhecimento morfofisiológico das glândulas adrenais, os objetivos do presente estudo foram comparar dados morfométricos entre adrenais direitas e esquerdas de machos e fêmeas; realizar estudos histológicos e microscopia eletrônica de varredura e transmissão revelando a constituição tecidual das glândulas; finalmente, foi realizado estudo imunohistoquímico com objetivo de definir a presença e correto sítio de expressão da citocromo P450c17 nas glândulas adrenais em 18 glândulas adrenais (direita n=9 e esquerda n=9) de nove Galea spixii adultos (quatro machos e cinco fêmeas). A glândula adrenal direita estava posicionada mais cranialmente que a adrenal esquerda; as dimensões (peso, comprimento e largura) da glândula adrenal direita foram maiores que as da esquerda; não houve diferença entre as medidas corpóreas e das adrenais entre machos e fêmeas; a morfologia das células e diferentes quantidades de gotículas lipídicas podem estar relacionadas a diferentes demandas na produção de hormônios esteroides relacionados a cada zona do córtex adrenal; e, a imunolocalização da citocromo P450 na zona fasciculada e reticular pode estar relacionado com a síntese de 17-hidroxi-pregnenolona, 17-hidroxi-progesterona, dehidroepiandrosterona ou androstenediona.

Clinical efficacy of atorvastatin and salvia miltiorrhiza polyphenols in COPD combined with PH / 中国生化药物杂志

Objective To evaluate the clinical efficacy of atorvastatin combined with salvianolate in treatment of chronic obstructive pulmonary disease (COPD) complicated with pulmonary arterial hypertension (PH) , and its influence on hypoxia inducible factor-1 alpha (HIF-1α), endothelin-1 (ET-1), adrenomedullin (ADM) in serum.Methods 30 cases of COPD patients with PH were randomly divided into 2 groups, each of 15 cases.The two groups were given conventional treatment, including rest, continuous low flow oxygen, anti infection, relieving cough and phlegm, relaxing tracheal, correcting water and electrolyte balance.Control group was received Atorvastatin Calcium Tablets 20 mg orally, once daily.Observation group was received Atorvastatin Calcium Tablets 20 mg once daily, once daily;salvianolic 200 mg+0.9% sodium chloride solution 250 mL, intravenous drip, once daily.The course of treatment was 10 d.Before and after treatment, 6 min walking distance(6 MWD) and hemodynamic parameters were detected, including pulmonary artery systolic blood pressure (PASP), cardiac output (CO), right ventricular end diastolic pressure (RVEDP) , and HIF-1, ET-1 and ADM level in serum.Results After treatment, 6MWD, PASP, CO, RVEDP of the two groups were significantly improved compared with the same group before treatment.But compared with control group, observation group was improved significantly, the difference was statistically significant (P<0.05).After treatment, HIF-1 alpha, ET-1 of the two groups were significantly lower than the same group before treatment, but ADM were significantly increaser( P <0.05 ) .Compared with control group, HIF-1 alpha, ET-1 of observation group were significantly decreased, while the ADM was significantly increased, the difference was statistically significant (P<0.05).Conclusion Atorvastatin combined with salvia miltiorrhiza polyphenols can significantly reduce the pulmonary artery pressure in patients with COPD and PH, increase exercise tolerance, and its mechanism maybe related to the regulation of the expressions of HIF-1, ET-1 and ADM.

Gintonin facilitates catecholamine secretion from the perfused adrenal medulla

The present study was designed to investigate the characteristics of gintonin, one of components isolated from Korean Ginseng on secretion of catecholamines (CA) from the isolated perfused model of rat adrenal gland and to clarify its mechanism of action. Gintonin (1 to 30 µg/ml), perfused into an adrenal vein, markedly increased the CA secretion from the perfused rat adrenal medulla in a dose-dependent fashion. The gintonin-evoked CA secretion was greatly inhibited in the presence of chlorisondamine (1 µM, an autonomic ganglionic bloker), pirenzepine (2 µM, a muscarinic M₁ receptor antagonist), Ki14625 (10 µM, an LPA₁/₃ receptor antagonist), amiloride (1 mM, an inhibitor of Na⁺/Ca²⁺ exchanger), a nicardipine (1 µM, a voltage-dependent Ca²⁺ channel blocker), TMB-8 (1 µM, an intracellular Ca²⁺ antagonist), and perfusion of Ca²⁺-free Krebs solution with 5mM EGTA (a Ca²⁺chelater), while was not affected by sodium nitroprusside (100 µM, a nitrosovasodialtor). Interestingly, LPA (0.3~3 µM, an LPA receptor agonist) also dose-dependently enhanced the CA secretion from the adrenal medulla, but this facilitatory effect of LPA was greatly inhibited in the presence of Ki 14625 (10 µM). Moreover, acetylcholine (AC)-evoked CA secretion was greatly potentiated during the perfusion of gintonin (3 µg/ml). Taken together, these results demonstrate the first evidence that gintonin increases the CA secretion from the perfused rat adrenal medulla in a dose-dependent fashion. This facilitatory effect of gintonin seems to be associated with activation of LPA- and cholinergic-receptors, which are relevant to the cytoplasmic Ca²⁺ increase by stimulation of the Ca²⁺ influx as well as by the inhibition of Ca²⁺ uptake into the cytoplasmic Ca²⁺ stores, without the increased nitric oxide (NO). Based on these results, it is thought that gintonin, one of ginseng components, can elevate the CA secretion from adrenal medulla by regulating the Ca²⁺ mobilization for exocytosis, suggesting facilitation of cardiovascular system. Also, these findings show that gintonin might be at least one of ginseng-induced hypertensive components.

Feocromocitoma

El feocromocitoma (Feo) y el paraganglioma (PGL) son tumores endocrinos de rara aparición que derivan de la médula suprarrenal o de la cresta neuronal, conocidos como paraganglia. El Feo o el PGL pueden surgir en forma esporádica o ser parte de un síndrome tumoral hereditario. Estos tumores se originan por la mutación en los genes VHL, RET, también pueden comprometer genes que se encuentran involucrados como parte de síndromes. La clínica dependerá de la funcionalidad o del predominio simpático del Feo/PGL. Los signos y los síntomas del tumor simpático cromafín incluyen hipertensión arterial sostenida o en episodios paroxísticos. Presenta la clásica triada de cefalea, palpitaciones y diaforesis de aparición paroxística, palidez, hipotensión ortostática y síncope, temblor, ansiedad. Así también como, dolor precordial, arritmias, hipertrofia cardíaca, cardiomiopatía, hasta evolucionar a insuficiencia cardíaca. El diagnóstico del Feo/PGL ha sido simplificado gracias a los avances en los estudios para detectar y cuantificar los niveles de catecolaminas y sus metabolitos, tanto en sangre como en orina. La localización del tumor puede ser a través de tomografía computada y resonancia magnética nuclear, ambos métodos muy útiles. Los test funcionales utilizan la centellografía nuclear con metaiodobenzilguanidina (MIBG), siendo altamente específicos para confirmar la secreción natural de catecolaminas por el tumor. Se realiza tratamiento preparatorio para la resección quirúrgica del tumor, iniciándose 1 a 2 semanas antes de la cirugía. El pronóstico del tumor resecado en su totalidad es muy bueno. Hasta la actualidad no se dispone de un sistema de estadificación para el Feo/PGL maligno y la expectativa de vida dependerá de la ubicación de las metástasis (MTS), con una sobrevida menor a 5 años en los pacientes que presentan MTS a nivel pulmonar o hepático. También puede observarse un síndrome símil a una cardiomiopatía por estrés (Tako-tsubo), es decir que el Feo es capaz de producir una cardiomiopatía reversible. El diagnóstico precoz del Feo/PGL puede reducir su morbi-mortalidad, y si no es diagnosticado puede llevar a la muerte del paciente.

Pheochromocytoma Pheochromocytoma (Pheo) and paraganglioma (PGL) are rarely seen endocrine tumors derived from the adrenal medulla or the neuronal crest known as paraganglia. The Pheo or PGL may emerge sporadically or be part of a hereditary tumor syndrome. These tumors originate by mutation in the VHL, RET genes, and may also compromise genes that are involved as part of syndromes. The clinic will depend on the functionality or sympathetic predominance of Pheo/PGL. Signs and symptoms of sympathetic chromaffin tumor include sustained or paroxysmal hypertension episodes. Present the classic triad of headache, palpitations and diaphoresis of paroxysmal onset, pallor, orthostatic hypotension and syncope, tremor, anxiety. So also as chest pain, arrhythmias, cardiac hypertrophy, cardiomyopathy, to evolve at heart failure. The diagnosis of Pheo/PGL has been simplified by advances in studies to detect and quantify the levels of catecholamines and their metabolites in blood and urine. The location of the tumor can be through computed tomography and magnetic resonance imaging useful methods. The functional test using nuclear scintigraphy with metaiodobenzylguanidine (MIBG) is highly specific to confirm the natural secretion of catecholamines by the tumor. Pre-treatment is performed for surgical resection of the tumor, starting 1 to 2 weeks prior to surgery. The prognosis of the resected tumor as a whole is very good. To date there is no staging system for Pheo/PGL malignant and life expectancy depend on the location of metastases (MTS), with a lower 5-year survival in patients with pulmonary or hepatic MTS level. May also be observed a simile syndrome stress cardiomyopathy (Tako-tsubo), i.e. the Pheo is able to produce a reversible cardiomyopathy. Early diagnosis of Pheo/PGL may reduce your morbidity and mortality if not diagnosed and may lead to death.

Feocromocitoma Feocromocitoma (Feo) e paraganglioma (PGL) são tumores neuroendócrinos de rara aparição derivados da medula supra-renal ou da crista neural conhecido como paragânglia. O Feo ou o PGL pode ocorrer esporadicamente ou ser parte de uma síndrome tumoral hereditária. Estes tumores são causados por mutações nos genes VHL, RET, também pode implicar genes que estão envolvidos, como parte de síndromes. A clínica vai depender da funcionalidade ou a predominância do simpático de Feo/PGL. Sinais e sintomas de tumor cromafin simpático incluem hipertensão sustentada ou episódios paroxísticos. Têm a tríade clássica de dor de cabeça, palpitações e sudorese de início paroxística, palidez, hipotensão ortostática e síncope, tremor, ansiedade. Assim também como dor torácica, arritmias, hipertrofia cardíaca, cardiomiopatia, de progredir para insuficiência cardíaca. O diagnóstico de Feo/PGL foi simplificado pelos avanços nos estudos para detectar e quantificar os níveis de catecolaminas e seus metabólitos no sangue e na urina. A localização do tumor pode ser através de tomografia computadorizada e ressonância magnética, métodos úteis. Os testes funcionais usando cintigrafia de corpo com metaiodobenzilguanidina (MIBG) são altamente específicos para confirmar a secreção natural de catecolaminas pelo tumor. O pré-tratamento é realizado durante a ressecção cirúrgica do tumor, a partir de 1 ou 2 semanas antes da cirurgia. O prognóstico do tumor ressecado como um todo é muito bom. Até o momento não há nenhum sistema de estadiamento para Feo/PGL maligno e a expectativa de vida vai depender da localização das metástases (MTS), com uma menor sobrevida em 5 anos em pacientes com MTS nos pulmões ou fígado. Também pode ser observada uma síndrome símile na cardiomiopatia de estresse (Tako-tsubo), ou seja, o Feo é capaz de produzir uma cardiomiopatia reversível. O diagnóstico precoce de Feo/PGL pode reduzir a morbidade e mortalidade, e se não diagnosticada ...

Significance detecting adrenomedullin and high sensitive C reactive protein in acute coronary syndrome / 心血管康复医学杂志

Objective:To explore the clinical significance detecting adrenomedullin (ADM)and high sensitive C reac-tive protein (hsCRP)in patients with acute coronary syndrome (ACS).Methods:A total of 51 inpatients,which were eliminated for coronary heart disease (CHD)by coronary angiography (CAG),were enrolled as non CHD group,and 124 ACS patients diagnosed by CAG were regarded as ACS group.ADM and hsCRP concentrations were measured before and after CAG in non CHD group and before and after percutaneous coronary intervention (PCI) in ACS group,and they were compared between two groups.Results:Before CAG/PCI,compared with non CHD group,ADM [(28.7±1.6)pg/ml vs.(36.7±2.5)pg/ml]and hsCRP [(4.74±3.21)mg/L vs.(27.65±11.76) mg/L]levels significantly rose in ACS group,P0.05 all).Conclusion:Detecting arenomedullin combined high sensitive C-reac-tive protein is gelpful to early diagnosis and evaluating lesion severity for acute coronary syndrome.

Inhibitory Effects of Ginsenoside-Rb2 on Nicotinic Stimulation-Evoked Catecholamine Secretion

The aim of the present study was to investigate whether ginsenoside-Rb2 (Rb2) can affect the secretion of catecholamines (CA) in the perfused model of the rat adrenal medulla. Rb2 (3~30 microM), perfused into an adrenal vein for 90 min, inhibited ACh (5.32 mM)-evoked CA secretory response in a dose- and time-dependent fashion. Rb2 (10 microM) also time-dependently inhibited the CA secretion evoked by DMPP (100 microM, a selective neuronal nicotinic receptor agonist) and high K+ (56 mM, a direct membrane depolarizer). Rb2 itself did not affect basal CA secretion (data not shown). Also, in the presence of Rb2 (50 microg/mL), the secretory responses of CA evoked by veratridine (a selective Na+ channel activator (50 microM), Bay-K-8644 (an L-type dihydropyridine Ca2+ channel activator, 10 microM), and cyclopiazonic acid (a cytoplasmic Ca2+-ATPase inhibitor, 10 microM) were significantly reduced, respectively. Interestingly, in the simultaneous presence of Rb2 (10 microM) and L-NAME (an inhibitor of NO synthase, 30 microM), the inhibitory responses of Rb2 on ACh-evoked CA secretory response was considerably recovered to the extent of the corresponding control secretion compared with the inhibitory effect of Rb2-treatment alone. Practically, the level of NO released from adrenal medulla after the treatment of Rb2 (10 microM) was greatly elevated compared to the corresponding basal released level. Collectively, these results demonstrate that Rb2 inhibits the CA secretory responses evoked by nicotinic stimulation as well as by direct membrane-depolarization from the isolated perfused rat adrenal medulla. It seems that this inhibitory effect of Rb2 is mediated by inhibiting both the influx of Ca2+ and Na+ into the adrenomedullary chromaffin cells and also by suppressing the release of Ca2+ from the cytoplasmic calcium store, at least partly through the increased NO production due to the activation of nitric oxide synthase, which is relevant to neuronal nicotinic receptor blockade.

Comparison of Inhibitory Effects between Enalapril and Losartan on Adrenal Catecholamine Secretion

BACKGROUND: The present study was attempted to compare enalapril, an angiotensin-converting enzyme inhibitor with losartan an angiotensin II (Ang II) receptor blocker in the inhibitory effects on the secretion of catecholamines (CA) from the perfused model of the rat adrenal gland. METHODS: The adrenal gland was isolated and perfused with Krebs-bicarbonate. CA was measured directly by using the fluorospectrophotometer. RESULTS: Both enalapril and losartan during perfusion into an adrenal vein for 90 minutes inhibited the CA release evoked by acetylcholine (ACh), 1.1-dimethyl-4-phenyl piperazinium (DMPP, a selective Nn agonist), high K+ (a direct membrane-depolarizer), 3-(m-chloro-phenyl-carbamoyl-oxy-2-butynyl-trimethyl ammonium (McN-A-343, a selective M1 agonist), and Ang II in a time-dependent manner. Also, in the presence of enalapril or losartan, the CA release evoked by veratridine (an activator of voltage-dependent Na+ channels), 6-dimethyl-3-nitro-4-(2-trifluoromethyl-phenyl)-pyridine-5-carboxylate (BAY-K-8644, an L-type Ca2+ channel activator), and cyclopiazonic acid (a cytoplasmic Ca2+-ATPase inhibitor) were significantly reduced. Based on the same concentration of enalapril and losartan, for the CA release evoked by ACh, high K+, DMPP, McN-A-343, Ang II, veratridine, BAY-K-8644, and cyclopiazonic acid, the following rank order of inhibitory potency was obtained: losartan > enalapril. In the simultaneous presence of enalapril and losartan, ACh-evoked CA secretion was more strongly inhibited compared with that of enalapril- or losartan-treated alone. CONCLUSIONS: Collectively, these results demonstrate that both enalapril and losartan inhibit the CA secretion evoked by activation of both cholinergic and Ang II type-1 receptors stimulation in the perfused rat adrenal medulla. When these two drugs were used in combination, their effects were enhanced, which may also be of clinical benefit. Based on concentration used in this study, the inhibitory effect of losartan on the CA secretion seems to be more potent than that of enalapril.

Extra Adrenal Pheochromocytoma Presenting as Hypertensive Crisis in a Young Male.

Pheochromocytoma is a tumor of aderenal medulla which secrets catecholamines and usually presents as hypertension. Extra-adrenal pheochromocytomas are extremely rare. They occur in the organ of zukerkundle, bladder, retroperitonium, posterior mediastinum and sympathetic chain. We present a case of a young male who presented with hypertension and eventually was found to have extra adrenal pheochromocytoma of the bladder.

Influence of PD 123319 (AT2-Receptor Antagonist) on Catecholamine Secretion in the Perfused Rat Adrenal Medulla

BACKGROUND: The aim of this study was to examine whether PD 123319 (an angiotensin II type 2 [AT2] receptor antagonist) can influence the release of catecholamines (CA) from the perfused model of the rat adrenal medulla. METHODS: The adrenal gland was isolated by the modification of Wakade method, and perfused with normal Krebs-bicarbonate solution. The content of CA was measured using the fluorospectrophotometer. RESULTS: During perfusion of PD 123319 (range, 5 to 50 nM) into an adrenal vein for 90 minutes the CA secretory responses evoked by acetylcholine (ACh), high K+, 1,1-dimethyl-4-phenylpiperazinium iodide (DMPP), and McN-A-343 was dose- and time-dependently inhibited. Furthermore, loading with PD 123319 for 90 minutes also markedly inhibited the CA secretory responses evoked by 4-dihydro-2,6-dimethyl-3-nitro-4-(2-trifluoro-methyl-phenyl)-pyridine-5-carboxylate (Bay-K-8644), cyclopiazonic acid, veratridine, and angiotensin II (Ang II). PD 123319 did not affect basal CA output. Simultaneous perfusion of PD 123319 and CGP 42112 perfused into an adrenal vein for 90 minutes rather more potently inhibited the CA seretory responses evoked by Ach, high K+, DMPP, Bay-K-8644, veratridine, and Ang II compared to the inhibitory effect by PD123319-treated alone. CONCLUSIONS: Taken together, these results show that PD 123319 inhibits the CA secretion evoked by both cholinergic and Ang II receptor stimulation from the perfused rat adrenal medulla. This inhibitory effect of PD 123319 seems to be exerted by blocking the influx of both Na+ and Ca2+ through their voltage-dependent channels into the rat adrenomedullary chromaffin cells as well as by reducing the Ca2+ release from its cytoplasmic calcium store, which may be relevant to AT2 receptor blockade. Based on these present data, it is thought that PD 123319 has different activity from previously known AT2 antagonist activity in the perfused adrenal medulla, and that AT2 receptors may be involved in the rat adrenomedullary CA secretion.

Preliminary study of pathogenesis on respiratory syncytial virus-related asthma / 重庆医学

Objective To explore the underlying mechanism of respiratory syncytial virus-related asthma .Methods Totally 30 sprague-dawley rats were randomly divided into control group ,respiratory syncytial virus (RSV) group ,and anti-NGF group ,with 10 in each group .RSV infection model was established by nasal drip once a week .In anti-NGF antibody intervention group ,each rat was given intraperitoneal injection of anti-NGF for 3 h before identical RSV infection .transmission electron microscopy(TEM) were performed to observe the ultramicro-structure changes in adrenal medullary cell .The concentrations of adrenaline and NGF in serum were measured by ELISA .The NGF expression was assayed by immunohistochemistry .The expression difference of neurofilament protein mRNA was detected by RT-PCR .Results (1) Electron microscope showed ,medullary cells riched in mitochondria ,Chro-maffin granule concentration decreased obviously ,and membrane could saw clubbing phenomenon of neurite outgrowth clearly in RSV infection group .Meanwhile ,NGF expression was significantly increased in RSV infection group .(2) ELISA results showed that the concentrations of NGF in the RSV group was significantly increased compared with control group and anti-NGF group(P 0 .05) .Compared with control group ,the adrenaline concentration of RSV group and anti-NGF group was significantly decreased(P<0 .01) ,and the adrenaline concentration of RSV group was significantly decreased compared with anti-NGF antibody group(P<0 .05) .(3) NF-LmRNA expression was significantly increased in RSV group .However ,compared with control group ,the NF-LmRNA expression was significantly decreased in anti-NGF group .(4) RT-PCR results show that ,Compared with control group ,adrenal medullary cells NF-LmRNA expression of RSV group and the anti-NGF group was significantly increased .Compared with RSV group ,NF-LmRNA adrenal medulla cells in Anti-NGF group was significantly decreased .Conclusion RSV infection may induce the adrenal medullary cell differentiation to nerve cell by over-expressed NGF ,and result in the decrease of adrenaline in serum to involve in asthma progression .

Influence of Fimasartan (a Novel AT1 Receptor Blocker) on Catecholamine Release in the Adrenal Medulla of Spontaneously Hypertensive Rats

The aim of this study was to determine whether fimasartan, a newly developed AT1 receptor blocker, can affect the CA release in the isolated perfused model of the adrenal medulla of spontaneously hypertensive rats (SHRs). Fimasartan (5~50 microM) perfused into an adrenal vein for 90 min produced dose- and time-dependently inhibited the CA secretory responses evoked by ACh (5.32 mM), high K+ (56 mM, a direct membrane depolarizer), DMPP (100 microM) and McN-A-343 (100 microM). Fimasartan failed to affect basal CA output. Furthermore, in adrenal glands loaded with fimasartan (15 microM), the CA secretory responses evoked by Bay-K-8644 (10 microM, an activator of L-type Ca2+ channels), cyclopiazonic acid (10 microM, an inhibitor of cytoplasmic Ca(2+)-ATPase), and veratridine (100 microM, an activator of Na+ channels) as well as by angiotensin II (Ang II, 100 nM), were markedly inhibited. In simultaneous presence of fimasartan (15 microM) and L-NAME (30 microM, an inhibitor of NO synthase), the CA secretory responses evoked by ACh, high K+, DMPP, Ang II, Bay-K-8644, and veratridine was not affected in comparison of data obtained from treatment with fimasartan (15 microM) alone. Also there was no difference in NO release between before and after treatment with fimasartan (15 microM). Collectively, these experimental results suggest that fimasartan inhibits the CA secretion evoked by Ang II, and cholinergic stimulation (both nicotininc and muscarinic receptors) as well as by membrane depolarization from the rat adrenal medulla. It seems that this inhibitory effect of fimasartan may be mediated by blocking the influx of both Na+ and Ca2+ through their ion channels into the rat adrenomedullary chromaffin cells as well as by inhibiting the Ca2+ release from the cytoplasmic calcium store, which is relevant to AT1 receptor blockade without NO release.

Inhibitory Effects of Olmesartan on Catecholamine Secretion from the Perfused Rat Adrenal Medulla

The present sutdy aimed to determine whether olmesartan, an angiotensin II (Ang II) type 1 (AT1) receptor blocker, can influence the CA release from the isolated perfused model of the rat adrenal medulla. Olmesartan (5~50 micrometer) perfused into an adrenal vein for 90 min produced dose- and time-dependent inhibition of the CA secretory responses evoked by ACh (5.32 mM), high K+ (56 mM, a direct membrane-depolarizer), DMPP (100 micrometer) and McN-A-343 (100 micrometer). Olmesartan did not affect basal CA secretion. Also, in adrenal glands loaded with olmesartan (15 micrometer), the CA secretory responses evoked by Bay-K-8644 (10 micrometer, an activator of voltage-dependent L-type Ca2+ channels), cyclopiazonic acid (10 micrometer, an inhibitor of cytoplasmic Ca2+ -ATPase), veratridine (100 micrometer, an activator of voltage-dependent Na+ channels), and Ang II (100 nM) were markedly inhibited. However, at high concentrations (150~300 micrometer), olmesartan rather enhanced the ACh-evoked CA secretion. Taken together, these results show that olmesartan at low concentrations inhibits the CA secretion evoked by cholinergic stimulation (both nicotininc and muscarinic receptors) as well as by direct membrane depolarization from the rat adrenal medulla, but at high concentrations it rather potentiates the ACh-evoked CA secretion. It seems that olmesartan has a dual action, acting as both agonist and antagonist at nicotinic receptors of the isolated perfused rat adrenal medulla, which might be dependent on the concentration. It is also thought that this inhibitory effect of olmesartan may be mediated by blocking the influx of both Na+ and Ca2+ into the rat adrenomedullary chromaffin cells as well as by inhibiting the Ca2+ release from the cytoplasmic calcium store, which is thought to be relevant to the AT1 receptor blockade, in addition to its enhancement on the CA secreton.

Effect of cold stress on the expression of Huntingtin-associated protein 1 in the rat adrenal medulla / 解剖学报

Objective To observe the ultrastructure location of Huntingtin-associated protein 1(HAP1) in rat adrenal medulla and the effect of cold stress on the expression of HAP1 in rat adrenal medulla. Methods Fourteen healthy male Wistar rats were used in the present study and among them two rats were used for immune electron microscopy and twelve rats for cold stress experiment. In the cold stress experiment, animals were divided into control and cold groups randomly with six rats in each group. During the experiment, rats were housed in a room at the temperature of 4℃ for 12 hours and then immunohistochemistry and Western blotting were used to measure the expression of HAP1 in adrenal medulla. Results By using the immune electron microscopy, the results showed HAP1 was located on the external membrane of secretory vesicles of adrenal medulla and their membranous organelles. The expression of HAP1 in adrenal medulla of cold group significantly decreased as compared with that of control group ( P <0.01). Conclusion HAP1 might be related with the adrenal medulla cells endocrine granula and involved in the transmission and release of adrenaline or noradrenaline in secretory granule.

Effects of Losartan on Catecholamine Release in the Isolated Rat Adrenal Gland

The aim of this study was to determine whether losartan, an angiotensin II (Ang II) type 1 (AT1) receptor could influence the CA release from the isolated perfused model of the rat adrenal medulla. Losartan (5~50 micrometer) perfused into an adrenal vein for 90 min produced dose- and time-dependent inhibition of the CA secretory responses evoked by ACh (5.32 mM), high K+ (56 mM, a direct membrane depolarizer), DMPP (100 micrometer) and McN-A-343 (100 micrometer). Losartan failed to affect basal CA output. Furthermore, in adrenal glands loaded with losartan (15 micrometer) for 90 min, the CA secretory responses evoked by Bay-K-8644 (10 micrometer, an activator of L-type Ca2+ channels), cyclopiazonic acid (10 micrometer, an inhibitor of cytoplasmic Ca2+-ATPase), veratridine (100 micrometer, an activator of Na+ channels), and Ang II (100 nM) were markedly inhibited. However, at high concentrations (150~300 micrometer), losartan rather enhanced the CA secretion evoked by ACh. Collectively, these experimental results suggest that losartan at low concentrations inhibits the CA secretion evoked by cholinergic stimulation (both nicotininc and muscarinic receptors) as well as by membrane depolarization from the rat adrenal medulla, but at high concentration it rather inhibits ACh-evoked CA secretion. It seems that losartan has a dual action, acting as both agonist and antagonist to nicotinic receptors of the rat adrenal medulla, which might be dependent on the concentration. It is also thought that this inhibitory effect of losartan may be mediated by blocking the influx of both Na+ and Ca2+ into the rat adrenomedullary chromaffin cells as well as by inhibiting the Ca2+ release from the cytoplasmic calcium store, which is thought to be relevant to the AT1 receptor blockade, in addition to its enhancement of the CA release.

Provinol Inhibits Catecholamine Secretion from the Rat Adrenal Medulla

The aim of the present study was to examine the effect of provinol, which is a mixture of polyphenolic compounds from red wine, on the secretion of catecholamines (CA) from isolated perfused rat adrenal medulla, and to elucidate its mechanism of action. Provinol (0.3~3 microgram/ml) perfused into an adrenal vein for 90 min dose- and time-dependently inhibited the CA secretory responses evoked by ACh (5.32 mM), high K+ (a direct membrane-depolarizer, 56 mM), DMPP (a selective neuronal nicotinic NN receptor agonist, 100 micrometer) and McN-A-343 (a selective muscarinic M1 receptor agonist, 100 micrometer). Provinol itself did not affect basal CA secretion. Also, in the presence of provinol (1 microgram/ml), the secretory responses of CA evoked by Bay-K-8644 (a voltage-dependent L-type dihydropyridine Ca2+ channel activator, 10 microgram), cyclopiazonic acid (a cytoplasmic Ca2+-ATPase inhibitor, 10 microgram) and veratridine (an activator of voltage-dependent Na+ channels, 10 microgram) were significantly reduced. Interestingly, in the simultaneous presence of provinol (1 microgram/ml) plus L-NAME (a selective inhibitor of NO synthase, 30 micrometer), the CA secretory responses evoked by ACh, high K+, DMPP, McN-A-343, Bay-K-8644 and cyclpiazonic acid recovered to the considerable extent of the corresponding control secretion in comparison with the inhibition of provinol-treatment alone. Under the same condition, the level of NO released from adrenal medulla after the treatment of provinol (3 microgram/ml) was greatly elevated in comparison to its basal release. Taken together, these data demonstrate that provinol inhibits the CA secretory responses evoked by stimulation of cholinergic (both muscarinic and nicotinic) receptors as well as by direct membrane-depolarization from the perfused rat adrenal medulla. This inhibitory effect of provinol seems to be exerted by inhibiting the influx of both calcium and sodium into the rat adrenal medullary cells along with the blockade of Ca2+ release from the cytoplasmic calcium store at least partly through the increased NO production due to the activation of nitric oxide synthase.

Polyphenols of Rubus coreanum Inhibit Catecholamine Secretion from the Perfused Adrenal Medulla of SHRs

The present study was attempted to investigate whether polyphenolic compounds isolated from wine, which is brewed from Rubus coreanum Miquel (PCRC), may affect the release of catecholamines (CA) from the isolated perfused adrenal medulla of the spontaneously hypertensive rats (SHRs), and to establish its mechanism of action. PCRC (20~180 microgram/ml) perfused into an adrenal vein for 90 min relatively dose-dependently inhibited the CA secretory responses to ACh (5.32 mM), high K+ (56 mM), DMPP (100 micrometer) and McN-A-343 (100 micrometer). PCRC itself did not affect basal CA secretion (data not shown). Also, in the presence of PCRC (60 microgram/ml), the CA secretory responses to veratridine (a selective Na+ channel activator (10 micrometer), Bay-K-8644 (a L-type dihydropyridine Ca2+ channel activator, 10 micrometer), and cyclopiazonic acid (a cytoplasmic Ca2+ -ATPase inhibitor, 10 micrometer) were significantly reduced, respectively. In the simultaneous presence of PCRC (60 microgram/ml) and L-NAME (an inhibitor of NO synthase, 30 micrometer), the inhibitory responses of PCRC on the CA secretion evoked by ACh, high K+, DMPP, and Bay-K-8644 were considerably recovered to the extent of the corresponding control secretion compared with that of PCRC-treatment alone. The level of NO released from adrenal medulla after the treatment of PCRC (60 microgram/ml) was greatly elevated compared with the corresponding basal level. Taken together, these results demonstrate that PCRC inhibits the CA secretion from the isolated perfused adrenal medulla of the SHRs evoked by stimulation of cholinergic receptors as well as by direct membrane-depolarization. It seems that this inhibitory effect of PCRC is mediated by blocking the influx of calcium and sodium into the adrenal medullary chromaffin cells of the SHRs as well as by inhibition of Ca2+ release from the cytoplasmic calcium store at least partly through the increased NO production due to the activation of NO synthase.