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Patra S, Boro H, Porchezhian P, Khan N, Pande M. Evaluation of bone mineral density (BMD) and trabecular bone score (TBS) in pheochromocytoma and paraganglioma; a multi-centric case-control study from India. Osteoporos Int 2024:10.1007/s00198-024-07198-y. [PMID: 39037490 DOI: 10.1007/s00198-024-07198-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 07/15/2024] [Indexed: 07/23/2024]
Abstract
Pheochromocytoma and paraganglioma (PPGL) have been associated with low bone mineral density (BMD) due to excess sympathetic system stimulation. Our study revealed low BMD and TBS (trabecular bone score) in cases compared to matched controls. Plasma-free nor-metanephrine and hypertension duration found to be most consistent predictive factors. PURPOSE Pheochromocytoma and paraganglioma (PPGL) have been associated with low bone mineral density (BMD) and increased fracture risks. Sympathetic nervous system stimulation has been shown to increase bone resorption and decrease bone formation via β2 receptors. Chronic inflammation and increased cytokine production add to more bone loss. TBS (trabecular bone score) is an established surrogate marker for bone histomorphometry. BMD and TBS data in pheochromocytoma and PPGL are scarce. The aim was to assess the BMD and TBS in pheochromocytoma and PPGL and look for clinical and biochemical predictors. METHODS This case-control study had sample size of 58 (29 cases and controls each). BMI-, age-, and sex-matched controls were taken for comparison. Both cases and controls had undergone DXA scan and BMD {Z-scores and bone mineral concentration (BMC) in g/cm2} and TBS were analyzed. Detailed clinical histories and relevant biochemistry values were noted. RESULTS The mean age of our case population was 29.5 ± 9.4 years with a mean age of HTN onset at 26.86 ± 6.6 years. Lumbar spine BMC (0.86 ± 0.14 vs 0.96 ± 0.15; p = 0.036), femoral neck Z-score (- 1.23 ± 1.07 vs - 0.75 ± 0.97; p = 0.003), and whole body BMC (0.91 ± 0.14 vs 1.07 ± 0.11; p = 0.000) were significantly low in cases compared to controls. Similarly, TBS was significantly lower in cases compared to controls (1.306 ± 0.113 vs 1.376 ± 0.083; p = 0.001). CONCLUSION This study establishes both low bone mass and poor bone quality in an Indian pheochromocytoma and PPGL patient's cohort. Plasma-free nor-metanephrine and duration of hypertension were found to be most consistent predictive factors in multivariate regression analysis.
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Affiliation(s)
- Shinjan Patra
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences Nagpur, Plot 2, Sector 20, Mihan, Nagpur, 441108, Maharashtra, India.
| | - Hiya Boro
- Department of Endocrinology, Aadhar Health Institute, Hisar, 125001, Haryana, India
| | - Pradakshna Porchezhian
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences Jodhpur, 2Nd Phase, M.I.A. Basni, Jodhpur, 342005, Rajasthan, India
| | - Naila Khan
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences Nagpur, Plot 2, Sector 20, Mihan, Nagpur, 441108, Maharashtra, India
| | - Minal Pande
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences Nagpur, Plot 2, Sector 20, Mihan, Nagpur, 441108, Maharashtra, India
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Dutta D, Nagendra L, Chandran M, Sharma M, Bhattacharya S, Mukhopadhyay S. Impact of Pheochromocytoma or Paraganglioma on Bone Metabolism: A Systemic Review and Meta-analysis. J Clin Densitom 2024; 27:101501. [PMID: 38796986 DOI: 10.1016/j.jocd.2024.101501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 05/29/2024]
Abstract
INTRODUCTION Preclinical and animal studies have suggested that excess catecholamines can lead to bone mineral loss. However, to date, no systematic review is available that has analyzed the impact of catecholamine excess in the context of pheochromocytoma/paraganglioma (PPGL) on bone metabolism. We conducted this meta-analysis to address this knowledge gap. METHODS Electronic databases were searched for studies evaluating bone metabolism, including assessments of bone mineral density (BMD), quantitative computed tomography (qCT), trabecular bone score (TBS), or bone turnover markers in patients with PPGL. These markers included those of bone resorption, such as tartrate-resistant acid phosphatase 5b (TRACP-5b) and cross-linked C-telopeptide of type I collagen (CTx), as well as markers of bone formation, such as bone-specific alkaline phosphatase (BS ALP). RESULTS Out of the initially screened 1614 articles, data from six studies published in four different patient cohorts with PPGL that met all criteria were analysed. Individuals with PPGL had significantly lower TBS [Mean Difference (MD) -0.04 (95% CI: -0.05--0.03); p < 0.00001; I2 = 0%], higher serum CTx [MD 0.13 ng/ml (95% CI: 0.08-0.17); p < 0.00001; I2 = 0%], and higher BS-ALP [MD 1.47 U/L (95% CI: 0.30-2.64); p = 0.01; I2 = 1%]. TBS at 4-7 months post-surgery was significantly higher compared to baseline [MD 0.05 (95% CI: 0.02-0.07); p < 0.0001]. A decrease in CTx has been documented post-surgery. CONCLUSION Bone health deterioration is a major concern in patients with PPGL. In addition to providing a definitive cure for catecholamine excess, monitoring and treating osteoporosis is essential for individuals with secondary osteoporosis due to PPGL. Long-term studies on bone health outcomes in PPGL are warranted.
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Affiliation(s)
- Deep Dutta
- Department of Endocrinology, Centre for Endocrinology, Arthritis, and Rheumatism (CEDAR), Superspeciality Healthcare, Dwarka, New Delhi, India
| | - Lakshmi Nagendra
- Department of Endocrinology, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka, India.
| | - Manju Chandran
- Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Singapore; DUKE-NUS Medical School, Singapore, Singapore
| | - Meha Sharma
- Department of Rheumatology, Centre for Endocrinology, Arthritis, and Rheumatism (CEDAR), Superspeciality Healthcare, Dwarka, New Delhi, India
| | | | - Satinath Mukhopadhyay
- Department of Endocrinology & Metabolism, Institute of Post-Graduate Medical Education & Research (IPGME&R) and Seth Sukhlal Karnani Memorial (SSKM) Hospital, Kolkata, India
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Yang Y, Zhou T, Zhao X, Cai Y, Xu Y, Gang X, Wang G. Main mechanisms and clinical implications of alterations in energy expenditure state among patients with pheochromocytoma and paraganglioma: A review. Medicine (Baltimore) 2024; 103:e37916. [PMID: 38669419 PMCID: PMC11049756 DOI: 10.1097/md.0000000000037916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Pheochromocytoma and paraganglioma (PPGL) are rare neuroendocrine tumors with diverse clinical presentations. Alterations in energy expenditure state are commonly observed in patients with PPGL. However, the reported prevalence of hypermetabolism varies significantly and the underlying mechanisms and implications of this presentation have not been well elucidated. This review discusses and analyzes the factors that contribute to energy consumption. Elevated catecholamine levels in patients can significantly affect substance and energy metabolism. Additionally, changes in the activation of brown adipose tissue (BAT), inflammation, and the inherent energy demands of the tumor can contribute to increased resting energy expenditure (REE) and other energy metabolism indicators. The PPGL biomarker, chromogranin A (CgA), and its fragments also influence energy metabolism. Chronic hypermetabolic states may be detrimental to these patients, with surgical tumor removal remaining the primary therapeutic intervention. The high energy expenditure of PPGL has not received the attention it deserves, and an accurate assessment of energy metabolism is the cornerstone for an adequate understanding and treatment of the disease.
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Affiliation(s)
- Yuqi Yang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Tong Zhou
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Xue Zhao
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Yunjia Cai
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Yao Xu
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Xiaokun Gang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Guixia Wang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
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Mizutani G, Isshiki M, Shimizu E, Saito D, Shimada A. Pheochromocytoma With High Adrenocorticotropic Hormone Production Capacity Without Pigmentation and Cushingoid Symptoms: A Case Report With a Literature Review. Cureus 2024; 16:e53358. [PMID: 38435205 PMCID: PMC10907887 DOI: 10.7759/cureus.53358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
Pheochromocytoma or paraganglioma (PPGL) originating from chromaffin cells can produce diverse hormones in addition to catecholamines, including adrenocorticotropic hormone (ACTH). In pheochromocytoma, high levels of ACTH might not result in pigmentation as typically observed in Addison's disease, and patients might not exhibit the symptoms of Cushing's syndrome, despite ACTH-dependent hypercortisolism. A 63-year-old male patient with hypertension was admitted to our facility, and computed tomography (CT) revealed a large right adrenal tumor. Despite high plasma ACTH (700-1300 pg/mL) and serum cortisol (90-100 µg/dL) levels, no physical pigmentation or Cushingoid symptoms were observed. Urinary metanephrine and normetanephrine levels reached as high as 16.0 mg and 3.2 mg, respectively. 123I-metaiodobenzylguanidine (MIBG) scintigraphy was negative. Low-dose dexamethasone paradoxically increased ACTH and cortisol levels, indicating the potential positive feedback regulation of both hormones by glucocorticoids. The patient was diagnosed with an ACTH-producing pheochromocytoma and underwent successful laparoscopic surgery to remove the adrenal tumor under the intravenous administration of a high-dose α-blocker and hydrocortisone. The levels of ACTH, cortisol, and urinary metanephrine/normetanephrine returned close to normal after tumor removal. We report a rare case of pheochromocytoma with extremely high ACTH/cortisol production but without pigmentation or Cushingoid symptoms. We also reviewed previous reports of ACTH-producing PPGL regarding the paradoxical regulation of ACTH/cortisol by glucocorticoids, pigmentation, Cushingoid symptoms, and negativity of 123I-MIBG scintigraphy.
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Affiliation(s)
- Gen Mizutani
- Department of Endocrinology and Diabetes, Saitama Medical University, Saitama, JPN
| | - Masashi Isshiki
- Department of Endocrinology and Diabetes, Saitama Medical University, Saitama, JPN
| | - Eisuke Shimizu
- Department of Endocrinology and Diabetes, Saitama Medical University, Saitama, JPN
| | - Daigo Saito
- Department of Endocrinology and Diabetes, Saitama Medical University, Saitama, JPN
| | - Akira Shimada
- Department of Endocrinology and Diabetes, Saitama Medical University, Saitama, JPN
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Patel T, Singleton LA, Mejia M, Senior A, Millis RM. Pheochromocytoma: A Troublesome Tumor. Cureus 2023; 15:e45490. [PMID: 37727845 PMCID: PMC10506759 DOI: 10.7759/cureus.45490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 09/21/2023] Open
Abstract
This report presents the case of a 45-year-old man with a history of episodic headaches, palpitations, and sweating for the past six months. His blood pressure on admission was 170/100 mmHg. The patient was diagnosed with pheochromocytoma confirmed by elevated levels of plasma catecholamines and metanephrines. CT imaging revealed a 3 cm mass in the left adrenal gland with evidence of local invasion into the surrounding tissues. The patient underwent a laparoscopic adrenalectomy and was discharged on the third postoperative day with normal blood pressure. Histopathological examination confirmed the diagnosis of pheochromocytoma. The patient was followed for six months postoperatively with the resolution of symptoms and no evidence of tumor recurrence on imaging. Recurrence involves complex environment-gene interactions that are poorly understood. The diagnosis of pheochromocytoma could take several weeks to several years mainly because the symptoms are nonspecific and episodic. Although sudden death is rare, the debilitations associated with pheochromocytoma are often multisystemic with cardiovascular, emotional, and metabolic components. This case report highlights the importance of early diagnosis, appropriate management, and follow-up for pheochromocytoma.
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Affiliation(s)
- Tirath Patel
- Department of Pathophysiology, American University of Antigua, St. John's, ATG
| | - Leah A Singleton
- Department of Pathophysiology, American University of Antigua, St. John's, ATG
| | - Michael Mejia
- Department of Pathophysiology, American University of Antigua, St. John's, ATG
| | - Amanda Senior
- Department of Pathophysiology, American University of Antigua, St. John's, ATG
| | - Richard M Millis
- Department of Pathophysiology, American University of Antigua, St. John's, ATG
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Nkodo A, Wu I, Hobgood S, Celi FS. Unexplained Cachexia as a Presenting Symptom of Pheochromocytoma in a Geriatric Patient. JCEM CASE REPORTS 2023; 1:luad037. [PMID: 37908484 PMCID: PMC10580407 DOI: 10.1210/jcemcr/luad037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Indexed: 11/02/2023]
Abstract
Pheochromocytomas are rare neuroendocrine tumors that may secrete catecholamines, resulting in a wide array of clinical symptoms. While patients classically present with hypertension, headache, diaphoresis, and flushing, these symptoms are present in only 40% of cases. Here, we describe a 70-year-old woman whose predominant symptom was unexplained severe weight loss over a 12-month period associated with fatigue, anxiety, and palpitations at her endocrinologist and geriatrician visits. Diagnostic imaging was performed to assess for malignancy and demonstrated a 2.0 cm × 2.0 cm left adrenal mass. The diagnosis of pheochromocytoma was confirmed by elevated plasma normetanephrine levels. After a 2-week alpha blockade with doxazosin, the patient underwent robotic left adrenalectomy. Following surgery, the patient regained weight, and her hypertension also improved significantly. We hope this uncommon clinical presentation in an older adult characterized by weight loss and frailty will increase the awareness of atypical pheochromocytoma symptomatology, particularly in older individuals.
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Affiliation(s)
- Amélie Nkodo
- Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA
| | - Iris Wu
- Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA
| | - Sarah Hobgood
- Department of Internal Medicine, Division of Geriatrics, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA
| | - Francesco S Celi
- Department of Medicine, Division of Endocrinology and Metabolism, UConn Health, Farmington, CT 06030, USA
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Khatiwada S, Agarwal S, Kandasamy D, Kumar R, Jyotsna VP, Tandon N. Prevalence and Predictors of Osteoporosis/BMD Below Expected Range for Age in Pheochromocytoma/Paraganglioma and BMD, TBS Change Post-Operatively: A Prospective Cohort Study. Indian J Endocrinol Metab 2023; 27:87-90. [PMID: 37215262 PMCID: PMC10198189 DOI: 10.4103/ijem.ijem_322_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/30/2022] [Accepted: 01/06/2023] [Indexed: 03/05/2023] Open
Abstract
Context Pheochromocytomas/paragangliomas (PPGLs) have recently been shown to be associated with lower bone mineral density (BMD) and trabecular bone score as compared to healthy controls suggesting low bone mineral concentration and disrupted bone microarchitecture. There is paucity of data on prevalence and clinical predictors of low BMD/osteoporosis in PPGL from India and the extent of change in BMD post-operatively. Aims This study aimed to find prevalence of low BMD/osteoporosis and trabecular bone score (TBS)-adjusted FRAX score in subjects with PPGL and to see the post-operative change in BMD and TBS at follow-up. Material and Methods 32 consecutively diagnosed adult cases with PPGL were enrolled. Although the provisional diagnosis of PPGL was made based on imaging consistent with PPGL supported by biochemical evidence of catecholamine excess, its confirmation was made histopathologically before final analysis. Results We found significantly low average BMD T-score/Z-score at spine, hip or wrist. Osteoporosis was evident in 87.5% of subjects (nine of 11 post-menopausal women or men >50 years of age) and BMD below the expected range for age in 42.9% of subjects (nine of 21 pre-menopausal women or men <50 years of age) by International Society for Clinical Densitometry criteria. Conclusions 87% of older subjects with PPGL had osteoporosis while 43% of younger subjects had BMD below expected range for age (Z-score ≤-2.0), more at lumbar spine than at hip. Decreased body weight was associated with osteoporosis in older or Z-score ≤-2.0 in younger subjects. There was no significant change in BMD and TBS scores at a median of four months post-operatively.
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Affiliation(s)
- Saurav Khatiwada
- Department of Endocrinology and Metabolism, AIIMS, New Delhi, India
| | | | | | | | - Viveka P Jyotsna
- Department of Endocrinology and Metabolism, AIIMS, New Delhi, India
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, AIIMS, New Delhi, India
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8
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Araujo-Castro M, Mínguez Ojeda C, García Centeno R, López-García MC, Lamas C, Hanzu FA, Mora M, Del Castillo Tous M, Rodríguez de Vera Gómez P, Parra Ramírez P, Alvarez-Escola C, Blanco Carrera C, Barahona San Millán R, Recasens M, Valdés N, Gracia Gimeno P, de Miguel Novoa P, Vicente A, Manjón L, García Sanz I, Michalopoulou T, Calatayud M. Glycemic disorders in patients with pheochromocytomas and sympathetic paragangliomas. Endocr Relat Cancer 2022; 29:645-655. [PMID: 36069783 DOI: 10.1530/erc-22-0218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/06/2022] [Indexed: 11/08/2022]
Abstract
The objective of our study was to determine the prevalence of glycemic disorders (diabetes mellitus and prediabetes) in patients with pheochromocytomas and sympathetic paragangliomas (PPGLs) and identify risk factors for their development and the likelihood of their resolution after surgery. A multicentric retrospective study of patients with PPGLs submitted to surgery between 2000 and 2021 in 17 Spanish hospitals was performed. Diabetes-specific data were collected at diagnosis, in the immediate- and long-term postsurgical follow-up. A total of 229 patients with PPGLs were included (218 with pheochromocytomas and 11 with sympathetic paragangliomas). Before surgery, glycemic disorders were diagnosed in 35.4% of the patients (n = 81): 54 with diabetes and 27 with prediabetes. The variables independently associated with a higher risk of glycemic disorders were sporadic PPGL (odds ratio (OR) = 3.26 (1.14-9.36)) and hypertension (OR = 3.14 (1.09-9.01)). A significant decrease in fasting plasma glucose and HbA1c levels was observed after surgery, in the short-term and long-term follow-up (P < 0.001). After a median follow-up of 48.5 months (range 3.3-168.9), after surgery, 52% of diabetic and 68% of prediabetic patients experienced a complete resolution. Lower body mass index (BMI) (P = 0.001), lower glucose levels (P = 0.047) and shorter duration of diabetes prior to surgery (P = 0.021) were associated with a higher probability of diabetes resolution. In conclusion, glycemic disorders in patients with PPGLs are present in more than a third of them at diagnosis. Sporadic PPGLs and hypertension are risk factors for their development. More than 50% of cases experience a complete resolution of the glycemic disorder after resection of the PPGLs.
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Affiliation(s)
- Marta Araujo-Castro
- Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain
- University of Alcalá, Madrid, Spain
| | | | - Rogelio García Centeno
- Endocrinology & Nutrition Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | | | - Cristina Lamas
- Endocrinology & Nutrition Department, Hospital Universitario de Albacete, Albacete, Spain
| | | | - Mireia Mora
- Endocrinology & Nutrition Department, Hospital Clinic, Barcelona, Spain
| | - María Del Castillo Tous
- Endocrinology & Nutrition Department, Hospital Universitario Virgen de la Macarena, Sevilla, Spain
| | | | - Paola Parra Ramírez
- Endocrinology & Nutrition Department, Hospital Universitario La Paz Madrid, Madrid, Spain
| | | | | | | | - Mónica Recasens
- Endocrinology & Nutrition Department, Institut Català de la Salut Girona, Girona, Spain
| | - Nuria Valdés
- Endocrinology & Nutrition Department, Hospital Universitario de Cabueñes, Asturias, Spain
| | - Paola Gracia Gimeno
- Endocrinology & Nutrition Department, Hospital Royo Villanova, Zaragoza, Spain
| | - Paz de Miguel Novoa
- Endocrinology & Nutrition Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Almudena Vicente
- Endocrinology & Nutrition Department, Hospital Universitario de Toledo, Toledo, Spain
| | - Laura Manjón
- Endocrinology & Nutrition Department, Hospital Universitario Central de Asturias, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA)
| | - Iñigo García Sanz
- General & Digestive Surgery Department, Hospital Universitario de La Princesa, Madrid, Spain
| | - Theodora Michalopoulou
- Department of Endocrinology and Nutrition, Joan XXIII University Hospital, Tarragona, Spain
| | - María Calatayud
- Endocrinology & Nutrition Department, Hospital Universitario Doce de Octubre, Madrid, Spain
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Zeng HL, Wang X, Li HJ, Yang Q. Quantitative analysis of catecholamines and their metabolites in 491 patients with adrenal tumors: a retrospective single-center cohort study. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04448-6. [DOI: 10.1007/s00432-022-04448-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/20/2022] [Indexed: 11/05/2022]
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Hypermetabolism and Substrate Utilization Rates in Pheochromocytoma and Functional Paraganglioma. Biomedicines 2022; 10:biomedicines10081980. [PMID: 36009527 PMCID: PMC9406117 DOI: 10.3390/biomedicines10081980] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 08/02/2022] [Accepted: 08/08/2022] [Indexed: 11/19/2022] Open
Abstract
The overproduction of catecholamines in pheochromocytoma/paraganglioma (PPGL) induces a hypermetabolic state. The aim of this study was to evaluate the incidence of a hypermetabolic state and differences in substrate metabolism in consecutive PPGL patients divided by catecholamine phenotype. Resting energy expenditure (REE) and respiratory quotient (RQ) were measured in 108 consecutive PPGL patients and 70 controls by indirect calorimetry. Hypermetabolic state was defined according to the Mifflin St. Jeor Equation as a ratio above 110%. Hypermetabolic state was confirmed in 70% of PPGL patients, regardless of phenotype. Older age, prevalence of diabetes mellitus and arterial hypertension were correlated with hypermetabolic PPGL as compared to normometabolic form. Analysis according to overproduced catecholamine showed differences in VCO2 (p < 0.05) and RQ (p < 0.01) and thus different substate metabolism between phenotypes in hypermetabolic form of PPGL. Lipid utilization was higher in the adrenergic phenotype (p = 0.001) and positively associated with the percentage of REE ratio (R = 0.48, p < 0.001), whereas the noradrenergic phenotype preferentially oxidizes carbohydrates (P = 0.001) and is correlated with the percentage of REE ratio (R = 0.60, p < 0.001). Hypermetabolic state in PPGL is a common finding in both catecholamine phenotypes. Hypermetabolic PPGL patients are older and suffer more from diabetes mellitus and arterial hypertension. Under basal conditions, the noradrenergic type preferentially metabolizes carbohydrates, whereas the adrenergic phenotype preferentially metabolizes lipids.
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Zeng H, Zhang X, Zhen Q, He Y, Wang H, Zhu Y, Sun Q, Ding M. Dual-Template Magnetic Molecularly Imprinted Polymer for Simultaneous Determination of Spot Urine Metanephrines and 3-Methoxytyramine for the Diagnosis of Pheochromocytomas and Paragangliomas. MOLECULES (BASEL, SWITZERLAND) 2022; 27:molecules27113520. [PMID: 35684457 PMCID: PMC9182035 DOI: 10.3390/molecules27113520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 05/27/2022] [Accepted: 05/28/2022] [Indexed: 11/16/2022]
Abstract
A novel dual-template magnetic molecularly imprinted polymer (MMIP) was synthesized to extract normetanephrine (NMN), metanephrine (MN) and 3-methoxytyramine (3-MT) from spot urine samples. As the adsorbent of dispersive solid-phase extraction (d-SPE), the MMIP was prepared using dopamine and MN as dual templates, methacrylic acid as the functional monomer, ethylene glycol dimethacrylate as the crosslinking reagent and magnetic nanoparticles as the magnetic core. NMN, MN, 3-MT and creatinine (Cr) in spot urine samples were selectively enriched by d-SPE and detected by HPLC-fluorescence detection/ultraviolet detection. The peak area (A) ratios of NMN, MN and 3-MT to Cr were used for the diagnosis of pheochromocytomas and paragangliomas (PPGLs). The results showed that the adsorption efficiencies of MMIP for target analytes were all higher than 89.0%, and the coefficient variation precisions of intra-assay and inter-assay for the analytes were within 4.9% and 6.3%, respectively. The recoveries of the analytes were from 93.2% to 112.8%. The MMIP was still functional within 14 days and could be reused at least seven times. The d-SPE and recommended solid-phase extraction (SPE) were both used to pretreat spot urine samples from 18 PPGLs patients and 22 healthy controls. The correlation coefficients of ANMN/ACr and AMN/ACr between d-SPE and SPE were both higher than 0.95. In addition, the areas under the receiver operator curves for spot urine ANMN/ACr, AMN/ACr and plasma free NMN and MN were 0.975, 0.773 and 0.990, 0.821, respectively, indicating the two methods had the similar performances. The d-SPE method took only 20 min, which was effective in clinical application.
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Affiliation(s)
- Hongyu Zeng
- Key Laboratory of Laboratory Medical Diagnostics, Ministry of Education, School of Laboratory Medicine, Chongqing Medical University, Chongqing 400016, China; (H.Z.); (X.Z.); (H.W.); (Y.Z.); (Q.S.)
| | - Xiaoqing Zhang
- Key Laboratory of Laboratory Medical Diagnostics, Ministry of Education, School of Laboratory Medicine, Chongqing Medical University, Chongqing 400016, China; (H.Z.); (X.Z.); (H.W.); (Y.Z.); (Q.S.)
| | - Qianna Zhen
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China; (Q.Z.); (Y.H.)
| | - Yifan He
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China; (Q.Z.); (Y.H.)
| | - Haoran Wang
- Key Laboratory of Laboratory Medical Diagnostics, Ministry of Education, School of Laboratory Medicine, Chongqing Medical University, Chongqing 400016, China; (H.Z.); (X.Z.); (H.W.); (Y.Z.); (Q.S.)
| | - Yang Zhu
- Key Laboratory of Laboratory Medical Diagnostics, Ministry of Education, School of Laboratory Medicine, Chongqing Medical University, Chongqing 400016, China; (H.Z.); (X.Z.); (H.W.); (Y.Z.); (Q.S.)
| | - Qi Sun
- Key Laboratory of Laboratory Medical Diagnostics, Ministry of Education, School of Laboratory Medicine, Chongqing Medical University, Chongqing 400016, China; (H.Z.); (X.Z.); (H.W.); (Y.Z.); (Q.S.)
| | - Min Ding
- Key Laboratory of Laboratory Medical Diagnostics, Ministry of Education, School of Laboratory Medicine, Chongqing Medical University, Chongqing 400016, China; (H.Z.); (X.Z.); (H.W.); (Y.Z.); (Q.S.)
- Correspondence:
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12
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Change of Computed Tomography-Based Body Composition after Adrenalectomy in Patients with Pheochromocytoma. Cancers (Basel) 2022; 14:cancers14081967. [PMID: 35454877 PMCID: PMC9024595 DOI: 10.3390/cancers14081967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/31/2022] [Accepted: 04/11/2022] [Indexed: 11/17/2022] Open
Abstract
Despite the potential biological importance of the sympathetic nervous system on fat and skeletal muscle metabolism in animal and in vitro studies, its relevance in humans remains undetermined. To clarify the influence of catecholamine excess on human body composition, we performed a retrospective longitudinal cohort study including 313 consecutive patients with histologically confirmed pheochromocytoma who underwent repeat abdominal computed tomography (CT) scans before and after adrenalectomy. Changes in CT-determined visceral fat area (VFA), subcutaneous fat area (SFA), skeletal muscle area (SMA), and skeletal muscle index (SMI) were measured at the level of the third lumbar vertebra. The mean age of all patients was 50.6 ± 13.6 years, and 171/313 (54.6%) were women. The median follow-up duration for repeat CTs was 25.0 months. VFA and SFA were 14.5% and 15.8% higher, respectively (both p < 0.001), after adrenalectomy, whereas SMA and SMI remained unchanged. Similarly, patients with visceral obesity significantly increased from 103 (32.9%) at baseline to 138 (44.1%) following surgery (p < 0.001); however, the prevalence of sarcopenia was unchanged. This study provides important clinical evidence that sympathetic hyperactivity can contribute to lipolysis in visceral and subcutaneous adipose tissues, but its impact on human skeletal muscle is unclear.
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Klímová J, Mráz M, Kratochvílová H, Lacinová Z, Novák K, Michalský D, Kvasnička J, Holaj R, Haluzíková D, Doležalová RP, Zítek M, Krátká Z, Todorovová V, Widimský J, Haluzík M, Zelinka T, Petrák O. Gene Profile of Adipose Tissue of Patients with Pheochromocytoma/Paraganglioma. Biomedicines 2022; 10:biomedicines10030586. [PMID: 35327387 PMCID: PMC8945850 DOI: 10.3390/biomedicines10030586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/23/2022] [Accepted: 02/27/2022] [Indexed: 02/07/2023] Open
Abstract
Background: Brown adipose tissue (BAT) is a therapeutic target to combat obesity and related disorders. Pheochromocytoma and functional paraganglioma (PPGL) are associated with activated BAT due to catecholamine excess. Our aim was to evaluate BAT activity by gene profile and assess its relation to clinical characteristics and overproduced catecholamine. Methods: mRNA expression of 15 genes in subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) was measured via RT-PCR in 25 patients with PPGL and 14 controls undergoing cholecystectomy. Results: We found in VAT of PPGL higher expression of UCP1 (p < 0.001), CEBPB, PPARGC1A (both p < 0.001), PRDM16 (p = 0.069) and DIO2 (p = 0.005). UCP1 expression correlated only with norepinephrine levels and its metabolite. UCP1 expression, among others, correlated negatively with BMI, age and positively with HDLc levels. Dominance of BAT or BeAT markers was not assessed in PPGL. In SAT of PPGL, we found higher expression of ADRB3, CIDEA (both p < 0.05), and PPARGC1A (p = 0.001), but not UCP1. Conclusion: We demonstrate signs of UCP1-dependent norepinephrine-induced thermogenesis connected with higher expression of DIO2, PPARGC1A, CEBPB and PRDM16 in retroperitoneal VAT of PPGL and its relations to circulating HDLc and triglycerides levels. However, no direct relationship with increased basal energy metabolism measured by calorimetry was found.
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Affiliation(s)
- Judita Klímová
- Center of Hypertension, 3rd Department of Medicine, First Faculty of Medicine and General Faculty Hospital, Charles University, 128 00 Prague, Czech Republic; (J.K.); (J.K.); (R.H.); (M.Z.); (Z.K.); (J.W.J.); (T.Z.)
| | - Miloš Mráz
- Center for Experimental Medicine and Diabetes Center, Institute for Clinical and Experimental Medicine, 140 00 Prague, Czech Republic; (M.M.); (Z.L.); (M.H.)
| | - Helena Kratochvílová
- Institute for Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine and General Faculty Hospital, Charles University, 128 00 Prague, Czech Republic;
| | - Zdeňka Lacinová
- Center for Experimental Medicine and Diabetes Center, Institute for Clinical and Experimental Medicine, 140 00 Prague, Czech Republic; (M.M.); (Z.L.); (M.H.)
| | - Květoslav Novák
- Department of Urology, First Faculty of Medicine and General Faculty Hospital, Charles University, 128 00 Prague, Czech Republic;
| | - David Michalský
- First Department of Surgery, First Faculty of Medicine and General Faculty Hospital, Charles University, 128 00 Prague, Czech Republic;
| | - Jan Kvasnička
- Center of Hypertension, 3rd Department of Medicine, First Faculty of Medicine and General Faculty Hospital, Charles University, 128 00 Prague, Czech Republic; (J.K.); (J.K.); (R.H.); (M.Z.); (Z.K.); (J.W.J.); (T.Z.)
| | - Robert Holaj
- Center of Hypertension, 3rd Department of Medicine, First Faculty of Medicine and General Faculty Hospital, Charles University, 128 00 Prague, Czech Republic; (J.K.); (J.K.); (R.H.); (M.Z.); (Z.K.); (J.W.J.); (T.Z.)
| | - Denisa Haluzíková
- Institute of Sport Medicine, First Faculty of Medicine and General Faculty Hospital, Charles University, 128 00 Prague, Czech Republic; (D.H.); (R.P.D.)
| | - Radka Petráková Doležalová
- Institute of Sport Medicine, First Faculty of Medicine and General Faculty Hospital, Charles University, 128 00 Prague, Czech Republic; (D.H.); (R.P.D.)
| | - Matěj Zítek
- Center of Hypertension, 3rd Department of Medicine, First Faculty of Medicine and General Faculty Hospital, Charles University, 128 00 Prague, Czech Republic; (J.K.); (J.K.); (R.H.); (M.Z.); (Z.K.); (J.W.J.); (T.Z.)
| | - Zuzana Krátká
- Center of Hypertension, 3rd Department of Medicine, First Faculty of Medicine and General Faculty Hospital, Charles University, 128 00 Prague, Czech Republic; (J.K.); (J.K.); (R.H.); (M.Z.); (Z.K.); (J.W.J.); (T.Z.)
| | - Veronika Todorovová
- Laboratory of Endocrinology and Metabolism, 3rd Department of Medicine, First Faculty of Medicine and General Faculty Hospital, Charles University, 128 00 Prague, Czech Republic;
| | - Jiří Widimský
- Center of Hypertension, 3rd Department of Medicine, First Faculty of Medicine and General Faculty Hospital, Charles University, 128 00 Prague, Czech Republic; (J.K.); (J.K.); (R.H.); (M.Z.); (Z.K.); (J.W.J.); (T.Z.)
| | - Martin Haluzík
- Center for Experimental Medicine and Diabetes Center, Institute for Clinical and Experimental Medicine, 140 00 Prague, Czech Republic; (M.M.); (Z.L.); (M.H.)
| | - Tomáš Zelinka
- Center of Hypertension, 3rd Department of Medicine, First Faculty of Medicine and General Faculty Hospital, Charles University, 128 00 Prague, Czech Republic; (J.K.); (J.K.); (R.H.); (M.Z.); (Z.K.); (J.W.J.); (T.Z.)
| | - Ondřej Petrák
- Center of Hypertension, 3rd Department of Medicine, First Faculty of Medicine and General Faculty Hospital, Charles University, 128 00 Prague, Czech Republic; (J.K.); (J.K.); (R.H.); (M.Z.); (Z.K.); (J.W.J.); (T.Z.)
- Correspondence: ; Tel.: +420-224-963073
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14
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Okazaki-Hada M, Fukuda I, Nagaoka R, Nagao M, Igarashi T, Kobayashi S, Oba T, Yamaguchi Y, Nagamine T, Sugitani I, Sugihara H. A case of pheochromocytoma associated with liver abscess and intestinal pseudo-obstruction. Ther Adv Endocrinol Metab 2022; 13:20420188221139652. [PMID: 36533183 PMCID: PMC9749039 DOI: 10.1177/20420188221139652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 10/31/2022] [Indexed: 12/14/2022] Open
Abstract
Pheochromocytomas can present with various symptoms. Nonspecific manifestations of pheochromocytoma include intestinal pseudo-obstruction and weight loss. Here, we present a case of pheochromocytoma in which prolonged intestinal pseudo-obstruction due to excess catecholamines was one of the factors leading to the development of a liver abscess. An 18-year-old male patient with a history of status epilepticus and severe intellectual disability was transferred to our hospital for a thorough examination of fever and constipation that had lasted for 2 months. When admitted to our hospital, he had fever, and his body mass index was 9.5 kg/m2. Upon comprehensive examination of the patient's fever, the blood culture was found positive for Bacteroides. Computed tomography showed findings of intestinal pseudo-obstruction and a low density region in the liver that indicated a liver abscess. Imaging studies also revealed a right adrenal mass and endocrinological test showed elevated plasma norepinephrine and urine normetanephrine levels. In addition, the right adrenal mass showed uptake on 123I-metaiodobenzylguanidine scintigraphy. These findings led to a definite diagnosis of pheochromocytoma. The patient was eventually diagnosed with a pheochromocytoma coexisting with a liver abscess. After treating the liver abscess with antibiotics and ultrasound-guided drainage, an adrenalectomy was performed. The pathological findings were consistent with pheochromocytoma. Postoperatively, the catecholamine excess normalized and intestinal pseudo-obstruction and weight loss improved. We suspected that prolonged intestinal pseudo-obstruction resulted in bacterial translocation and development of a liver abscess. To the best of our knowledge, this is the first report of a pheochromocytoma associated with a liver abscess. Moreover, the clinical presentation of this patient was unusual for pheochromocytoma, as the patient did not have typical symptoms such as hypertension or tachycardia, but rather presented with constipation, intestinal pseudo-obstruction, and weight loss. This case provides valuable insight regarding the impact of catecholamine excess on the intestinal tract and body weight.
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Affiliation(s)
- Mikiko Okazaki-Hada
- Department of Endocrinology, Metabolism and Nephrology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | | | - Ryuta Nagaoka
- Department of Endocrine Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Mototsugu Nagao
- Department of Endocrinology, Metabolism and Nephrology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Takehito Igarashi
- Department of Endocrine Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Shunsuke Kobayashi
- Department of Endocrinology, Metabolism and Nephrology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Takeshi Oba
- Department of Endocrinology, Metabolism and Nephrology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Yuji Yamaguchi
- Department of Endocrinology, Metabolism and Nephrology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Tomoko Nagamine
- Department of Endocrinology, Metabolism and Nephrology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Iwao Sugitani
- Department of Endocrine Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Hitoshi Sugihara
- Department of Endocrinology, Metabolism and Nephrology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
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15
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Hostrup M, Onslev J. The beta 2 -adrenergic receptor - a re-emerging target to combat obesity and induce leanness? J Physiol 2021; 600:1209-1227. [PMID: 34676534 DOI: 10.1113/jp281819] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 10/12/2021] [Indexed: 12/25/2022] Open
Abstract
Treatment of obesity with repurposed or novel drugs is an expanding research field. One approach is to target beta2 -adrenergic receptors because they regulate the metabolism and phenotype of adipose and skeletal muscle tissue. Several observations support a role for the beta2 -adrenergic receptor in obesity. Specific human beta2 -adrenergic receptor polymorphisms are associated with body composition and obesity, for which the Gln27Glu polymorphism is associated with obesity, while the Arg16Gly polymorphism is associated with lean mass in men and the development of obesity in specific populations. Individuals with obesity also have lower abundance of beta2 -adrenergic receptors in adipose tissue and are less sensitive to catecholamines. In addition, studies in livestock and rodents demonstrate that selective beta2 -agonists induce a so-called 'repartitioning effect' characterized by muscle accretion and reduced fat deposition. In humans, beta2 -agonists dose-dependently increase resting metabolic rate by 10-50%. And like that observed in other mammals, only a few weeks of treatment with beta2 -agonists increases muscle mass and reduces fat mass in young healthy individuals. Beta2 -agonists also exert beneficial effects on body composition when used concomitantly with training and act additively to increase muscle strength and mass during periods with resistance training. Thus, the beta2 -adrenergic receptor seems like an attractive target in the development of anti-obesity drugs. However, future studies need to verify the long-term efficacy and safety of beta2 -agonists in individuals with obesity, particularly in those with comorbidities.
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Affiliation(s)
- Morten Hostrup
- Section of Integrative Physiology, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Johan Onslev
- Section of Molecular Physiology, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
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16
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Kawashima A, Sone M, Inagaki N, Okamoto K, Tsuiki M, Izawa S, Otsuki M, Okamura S, Ichijo T, Katabami T, Takeda Y, Yoshimoto T, Naruse M, Tanabe A. Pheochromocytoma and paraganglioma with negative results for urinary metanephrines show higher risks for metastatic diseases. Endocrine 2021; 74:155-162. [PMID: 34272648 DOI: 10.1007/s12020-021-02816-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Few studies have assessed the clinical features of pheochromocytoma and paraganglioma (PPGL) not producing excessive catecholamine. We aimed to clarify the clinical characteristics of PPGL patients with negative results for urinary metanephrines. METHODS This is a retrospective cross-sectional study. We established a database by combining datasets from the Nationwide Cohort Study on the Development of Diagnosis and Treatment of Pheochromocytoma in Japan (PHEO-J) and the Advancing Care and Pathogenesis of Intractable Adrenal diseases in Japan (ACPA-J). We compared the clinical differences between PPGL patients with negative results for urinary metanephrines and those with catecholamine-producing PPGL. RESULTS Five hundred PPGL patients in the combined database were analyzed. Among them, 31 were negative for metanephrines. PPGL with negative results for urinary metanephrines was significantly associated with extra-adrenal disease (Odds ratio (OR) 6.58, 95% CI (confidence interval) 3.03-14.3, p < 0.001), the presence of metastatic disease (OR 4.22, 95% CI 1.58-11.3, p = 0.004), and negativity on meta-iodobenzylguanidine (MIBG) scintigraphy (OR 0.15, 95% CI 0.03-0.77, p = 0.023). CONCLUSIONS Our findings demonstrate that PPGL patients with negative results for urinary metanephrines are associated with extra-adrenal lesions, metastatic disease, and negative MIBG findings. This suggests that PPGL patients with negative results for urinary metanephrines have a greater need for systemic whole-body imaging other than MIBG scintigraphy and close follow-up to monitor for metastasis than do patients with PPGL overtly producing excessive catecholamine.
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Affiliation(s)
- Akiyuki Kawashima
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University, Kyoto, Japan
| | - Masakatsu Sone
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University, Kyoto, Japan.
- Division of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan.
| | - Nobuya Inagaki
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University, Kyoto, Japan
| | - Kentaro Okamoto
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University, Kyoto, Japan
| | - Mika Tsuiki
- Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Shoichiro Izawa
- Division of Endocrinology and Metabolism, Tottori University Faculty of Medicine, Yonago, Japan
| | - Michio Otsuki
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | | | - Takamasa Ichijo
- Department of Diabetes and Endocrinology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Takuyuki Katabami
- Division of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital, Yokohama, Japan
| | - Yoshiyu Takeda
- Department of Internal Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Takanobu Yoshimoto
- Department of Diabetes and Endocrinology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
- Department of Molecular Endocrinology and Metabolism, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mitsuhide Naruse
- Clinical Research Institute of Endocrinology and Metabolism, NHO Kyoto Medical Center and Endocrine Center, Ijinkai Takeda General Hospital, Kyoto, Japan
| | - Akiyo Tanabe
- Division of Endocrinology, National Center for Global Health and Medicine, Tokyo, Japan
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17
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Krumeich LN, Cucchiara AJ, Nathanson KL, Kelz RR, Fishbein L, Fraker DL, Roses RE, Cohen DL, Wachtel H. Correlation Between Plasma Catecholamines, Weight, and Diabetes in Pheochromocytoma and Paraganglioma. J Clin Endocrinol Metab 2021; 106:e4028-e4038. [PMID: 34089611 PMCID: PMC8475214 DOI: 10.1210/clinem/dgab401] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Indexed: 01/22/2023]
Abstract
CONTEXT Pheochromocytomas and paragangliomas (PCC/PGL) are neuroendocrine tumors with discrete catecholamine profiles that cause incompletely understood metabolic and physiologic changes. OBJECTIVE The objective was to evaluate relationships between plasma catecholamines, body weight, and hemoglobin A1c (HbA1c). We hypothesized that individual catecholamines would correlate negatively with weight and glucose control. DESIGN A retrospective cohort study was performed (1999-2020). Wilcoxon rank-sum tests compared nonparametric, continuous variables; mixed-effect linear modeling (MEM) evaluated relationships between catecholamines and weight or HbA1c. The median study duration was 54.2 months [interquartile range (IQR) 19.0-95.1]. SETTING Tertiary academic hospital. PATIENTS 360 patients were identified prospectively by referral to our center for management or surveillance of PCC/PGL. The median age was 59 years (IQR 45-67) and 56.4% (n = 203) were female. MAIN OUTCOME MEASURES The primary and secondary outcomes were weight and HbA1c, respectively. RESULTS On multivariable MEM, norepinephrine (P < 0.0005) negatively correlated with weight when all catecholamines and their derivatives were tried in the model, and normetanephrine (P < 0.0005) correlated when only metanephrines were included. In the surgical cohort (n = 272), normetanephrine decreased postoperatively and was inversely associated with weight (P < 0.0005). Elevated norepinephrine or normetanephrine at the study termination, indicative of metastatic and/or recurrent disease (MRD), correlated with weight loss. Norepinephrine and normetanephrine (P < 0.0005) directly correlated with HbA1c. CONCLUSION Plasma norepinephrine and its metabolite directly correlate with HbA1c and inversely correlate with weight in PCC/PGL. After resection, declining normetanephrine levels correlate with improving HbA1c despite an increase in patient body weight. Persistently elevated catecholamines and decreasing weight are observed in MRD.
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Affiliation(s)
- Lauren N Krumeich
- Hospital of the University of Pennsylvania, Department of Surgery, Philadelphia, PA, USA
- Correspondence: Lauren Krumeich, MD MS, University of Pennsylvania, 3400 Spruce Street, 4 Maloney Pavilion, Philadelphia, PA 19104, USA.
| | - Andrew J Cucchiara
- Hospital of the University of Pennsylvania, Department of Biostatistics, Philadelphia, PA, USA
| | - Katherine L Nathanson
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Hospital of the University of Pennsylvania, Division of Translational Medicine and Human Genetics, Philadelphia, PA, USA
| | - Rachel R Kelz
- Hospital of the University of Pennsylvania, Department of Surgery, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lauren Fishbein
- University of Colorado School of Medicine, Department of Medicine, Division of Endocrinology, Metabolism and Diabetes and the Division of Biomedical Informatics and Personalized Medicine, Aurora, CO, USA
| | - Douglas L Fraker
- Hospital of the University of Pennsylvania, Department of Surgery, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert E Roses
- Hospital of the University of Pennsylvania, Department of Surgery, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Debbie L Cohen
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Hospital of the University of Pennsylvania, Department of Medicine, Division of Renal, Electrolytes and Hypertension, Philadelphia, PA, USA
| | - Heather Wachtel
- Hospital of the University of Pennsylvania, Department of Surgery, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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18
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Löffler MC, Betz MJ, Blondin DP, Augustin R, Sharma AK, Tseng YH, Scheele C, Zimdahl H, Mark M, Hennige AM, Wolfrum C, Langhans W, Hamilton BS, Neubauer H. Challenges in tackling energy expenditure as obesity therapy: From preclinical models to clinical application. Mol Metab 2021; 51:101237. [PMID: 33878401 PMCID: PMC8122111 DOI: 10.1016/j.molmet.2021.101237] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/31/2021] [Accepted: 04/13/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND A chronic imbalance of energy intake and energy expenditure results in excess fat storage. The obesity often caused by this overweight is detrimental to the health of millions of people. Understanding both sides of the energy balance equation and their counter-regulatory mechanisms is critical to the development of effective therapies to treat this epidemic. SCOPE OF REVIEW Behaviors surrounding ingestion have been reviewed extensively. This review focuses more specifically on energy expenditure regarding bodyweight control, with a particular emphasis on the organs and attractive metabolic processes known to reduce bodyweight. Moreover, previous and current attempts at anti-obesity strategies focusing on energy expenditure are highlighted. Precise measurements of energy expenditure, which consist of cellular, animal, and human models, as well as measurements of their translatability, are required to provide the most effective therapies. MAJOR CONCLUSIONS A precise understanding of the components surrounding energy expenditure, including tailored approaches based on genetic, biomarker, or physical characteristics, must be integrated into future anti-obesity treatments. Further comprehensive investigations are required to define suitable treatments, especially because the complex nature of the human perspective remains poorly understood.
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Affiliation(s)
- Mona C Löffler
- Cardio Metabolic Diseases Research, Boehringer Ingelheim Pharma GmbH & Co KG, Biberach, Germany
| | - Matthias J Betz
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Basel, Basel, Switzerland
| | - Denis P Blondin
- Department of Medicine, Division of Neurology, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, QC, Canada
| | - Robert Augustin
- Cardio Metabolic Diseases Research, Boehringer Ingelheim Pharma GmbH & Co KG, Biberach, Germany
| | - Anand K Sharma
- Institute of Food, Nutrition and Health, ETH Zürich, Schwerzenbach, Switzerland
| | - Yu-Hua Tseng
- Joslin Diabetes Center, Section on Integrative Physiology and Metabolism, Harvard Medical School, Boston, MA, USA; Harvard Stem Cell Institute, Harvard University, Cambridge, MA, USA
| | - Camilla Scheele
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Denmark
| | - Heike Zimdahl
- Cardio Metabolic Diseases Research, Boehringer Ingelheim Pharma GmbH & Co KG, Biberach, Germany
| | - Michael Mark
- Cardio Metabolic Diseases Research, Boehringer Ingelheim Pharma GmbH & Co KG, Biberach, Germany
| | - Anita M Hennige
- Therapeutic Area CardioMetabolism & Respiratory, Boehringer Ingelheim International GmbH, Biberach, Germany
| | - Christian Wolfrum
- Institute of Food, Nutrition and Health, ETH Zürich, Schwerzenbach, Switzerland
| | - Wolfgang Langhans
- Physiology and Behavior Laboratory, Department of Health Sciences and Technology, ETH Zürich, Switzerland
| | - Bradford S Hamilton
- Cardio Metabolic Diseases Research, Boehringer Ingelheim Pharma GmbH & Co KG, Biberach, Germany
| | - Heike Neubauer
- Cardio Metabolic Diseases Research, Boehringer Ingelheim Pharma GmbH & Co KG, Biberach, Germany.
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19
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Wang H, Zhang X, Zhen Q, Zou W, Chen H, Luo C, Ding M. Detection of spot urinary free metanephrines and 3-methoxytyramine with internal reference correction for the diagnosis of pheochromocytomas and paragangliomas. J Chromatogr B Analyt Technol Biomed Life Sci 2020; 1156:122306. [PMID: 32829134 DOI: 10.1016/j.jchromb.2020.122306] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 07/28/2020] [Accepted: 08/04/2020] [Indexed: 11/15/2022]
Abstract
Detection of normetanephrine (NMN), metanephrine (MN) and 3-methoxytyramine (3-MT) could be used to diagnose pheochromocytomas and paragangliomas (PPGLs). The accuracy for the diagnosis of PPGLs is only 6% by virtue of the classic symptom triad. In addition, false-positive results were found using plasma free MNs as biomarkers. Spot urinary free metanephrines (MNs) presented high specificity for PPGLs diagnosis in our previous work by HPLC with the electrochemical detection. Whereas, MNs and creatinine (Cr) need to be detected separately. A simple and specific method was urgently needed for the diagnosis of PPGLs. Here, we established a new HPLC method for spot urinary free MNs and 3-MT by the fluorescence detection and Cr by the ultraviolet detection simultaneously. It was worth mentioning that Cr for the virtue of being fairly constant in a given subject was used as an internal reference correction to eliminate the effect of spot urine volume for the diagnosis of PPGLs. Thirty-seven patients with PPGLs and 164 control subjects were detected by the established method and the peak area ratios of MNs and 3-MT to Cr were used innovatively for the diagnosis of PPGLs. The results showed acceptable precisions and recoveries. The sensitivities of the method were 94.6%, 91.9% and 86.5% and the specificities were 96.3%, 93.9% and 82.3%, respectively by the peak area of NMN/Cr, MN/Cr and 3-MT/Cr for the diagnosis. The established method provides a promising way for simple, rapid and accurate diagnosis of PPGLs.
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Affiliation(s)
- Haoran Wang
- Key Laboratory of Laboratory Medical Diagnostics, Ministry of Education, School of Laboratory Medicine, Chongqing Medical University, Chongqing 400016, China
| | - Xiaoqing Zhang
- Key Laboratory of Laboratory Medical Diagnostics, Ministry of Education, School of Laboratory Medicine, Chongqing Medical University, Chongqing 400016, China
| | - Qianna Zhen
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Wenbi Zou
- Key Laboratory of Laboratory Medical Diagnostics, Ministry of Education, School of Laboratory Medicine, Chongqing Medical University, Chongqing 400016, China
| | - Hong Chen
- Key Laboratory of Laboratory Medical Diagnostics, Ministry of Education, School of Laboratory Medicine, Chongqing Medical University, Chongqing 400016, China
| | - Can Luo
- Key Laboratory of Laboratory Medical Diagnostics, Ministry of Education, School of Laboratory Medicine, Chongqing Medical University, Chongqing 400016, China
| | - Min Ding
- Key Laboratory of Laboratory Medical Diagnostics, Ministry of Education, School of Laboratory Medicine, Chongqing Medical University, Chongqing 400016, China.
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20
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Petrák O, Klímová J, Mráz M, Haluzíková D, Doležalová RP, Kratochvílová H, Lacinová Z, Novák K, Michalský D, Waldauf P, Holaj R, Widimský J, Zelinka T, Haluzík M. Pheochromocytoma With Adrenergic Biochemical Phenotype Shows Decreased GLP-1 Secretion and Impaired Glucose Tolerance. J Clin Endocrinol Metab 2020; 105:5813460. [PMID: 32222768 DOI: 10.1210/clinem/dgaa154] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 03/26/2020] [Indexed: 12/29/2022]
Abstract
CONTEXT Impaired glucose homeostasis is a common finding in pheochromocytoma (PHEO), especially with adrenergic phenotype. The possible contribution of incretin dysfunction to dysglycemia in PHEO patients has not been studied. OBJECTIVE To compare changes in pancreatic endocrine function and gut hormones' production during a liquid meal test before and 1 year after adrenalectomy. METHODS In a prospective study, we included 18 patients with PHEO (13 females) with adrenergic biochemical phenotype. A liquid meal test with predefined isocaloric enteral nutrition was performed to evaluate dynamic changes in pancreatic hormones and incretins. RESULTS During the meal test, insulin levels were significantly lower before adrenalectomy only in the early phase of insulin secretion, but changes in area under the curve (AUC) did not reach statistical significance (AUC = 0.07). Plasma glucagon (AUC < 0.01) and pancreatic polypeptide levels (AUC < 0.01) were suppressed in comparison with the postoperative state. Impaired response to the meal was found preoperatively for glucagon-like peptide-1 (GLP-1; AUC P < 0.05), but not glucose-dependent insulinotropic polypepide (GIP; AUC P = 0.21). No significant changes in insulin resistance indices were found, except for the homeostatic model assessment-beta index, an indicator of the function of islet β cells, which negatively correlated with plasma metanephrine (R = -0.66, P < 0.01). CONCLUSIONS Our study shows suppression of pancreatic α and β cell function and impaired GLP-1 secretion during a dynamic meal test in patients with PHEO, which is improved after its surgical treatment. These data demonstrate a novel and potentially significant interconnection between excessive catecholamine production and the secretion of glucoregulatory hormones.
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Affiliation(s)
- Ondřej Petrák
- Center of Hypertension, Third Department of Medicine, Charles University, First Faculty of Medicine and General Faculty Hospital, Prague, Czech Republic
| | - Judita Klímová
- Center of Hypertension, Third Department of Medicine, Charles University, First Faculty of Medicine and General Faculty Hospital, Prague, Czech Republic
| | - Miloš Mráz
- Center for Experimental Medicine and Diabetes Center, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
- Institute for Medical Biochemistry and Laboratory Diagnostics, Charles University, First Faculty of Medicine and General Faculty Hospital, Prague, Czech Republic
| | - Denisa Haluzíková
- Institute of Sport Medicine, Charles University, First Faculty of Medicine and General Faculty Hospital, Prague, Czech Republic
| | - Radka Petráková Doležalová
- Institute of Sport Medicine, Charles University, First Faculty of Medicine and General Faculty Hospital, Prague, Czech Republic
| | - Helena Kratochvílová
- Institute for Medical Biochemistry and Laboratory Diagnostics, Charles University, First Faculty of Medicine and General Faculty Hospital, Prague, Czech Republic
| | - Zdeňka Lacinová
- Institute for Medical Biochemistry and Laboratory Diagnostics, Charles University, First Faculty of Medicine and General Faculty Hospital, Prague, Czech Republic
| | - Květoslav Novák
- Department of Urology, Charles University, First Faculty of Medicine and General Faculty Hospital, Prague, Czech Republic
| | - David Michalský
- First Department of Surgery, Charles University, First Faculty of Medicine and General Faculty Hospital, Prague, Czech Republic
| | - Petr Waldauf
- Department of Anesthesiology, University Hospital Královské Vinohrady and Third Faculty of Medicine, Charles University in Prague, Czech Republic
| | - Robert Holaj
- Center of Hypertension, Third Department of Medicine, Charles University, First Faculty of Medicine and General Faculty Hospital, Prague, Czech Republic
| | - Jiří Widimský
- Center of Hypertension, Third Department of Medicine, Charles University, First Faculty of Medicine and General Faculty Hospital, Prague, Czech Republic
| | - Tomáš Zelinka
- Center of Hypertension, Third Department of Medicine, Charles University, First Faculty of Medicine and General Faculty Hospital, Prague, Czech Republic
| | - Martin Haluzík
- Center for Experimental Medicine and Diabetes Center, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
- Institute for Medical Biochemistry and Laboratory Diagnostics, Charles University, First Faculty of Medicine and General Faculty Hospital, Prague, Czech Republic
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21
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van der Heijden CDCC, Groh L, Keating ST, Kaffa C, Noz MP, Kersten S, van Herwaarden AE, Hoischen A, Joosten LAB, Timmers HJLM, Netea MG, Riksen NP. Catecholamines Induce Trained Immunity in Monocytes In Vitro and In Vivo. Circ Res 2020; 127:269-283. [PMID: 32241223 DOI: 10.1161/circresaha.119.315800] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
RATIONALE Exposure to high catecholamine levels is associated with inflammatory changes of myeloid cells and atherosclerosis, but the underlying mechanisms are only partly understood. OBJECTIVE To investigate whether the proinflammatory effects of noradrenaline and adrenaline can, in part, be explained by the induction of an immunologic memory in innate immune cells, termed trained immunity. METHODS AND RESULTS In vitro, we exposed human primary monocytes to (nor)adrenaline for 24 hours, after which cells were rested and differentiated to macrophages over 5 days. After restimulation with lipopolysaccharide on day 6, (nor)adrenaline-exposed cells showed increased TNF-α (tumor necrosis factor-α) production. This coincided with an increase in glycolysis and oxidative phosphorylation measured with Seahorse technology on day 6 before restimulation. Inhibition of the β-adrenoreceptor-cAMP signaling pathway prevented the induction of training. In vivo, we studied the functional, transcriptional, and epigenetic impact of peak-wise exposure to high catecholamine levels on monocytes isolated from pheochromocytoma/paraganglioma (PHEO) patients. In PHEO patients (n=10), the peripheral blood cell composition showed a myeloid bias and an increase of the inflammatory CD14++CD16+ (cluster of differentiation) intermediate monocyte subset compared with controls with essential hypertension (n=14). Ex vivo production of proinflammatory cytokines was higher in PHEO patients. These inflammatory changes persisted for 4 weeks after surgical removal of PHEO. Transcriptome analysis of circulating monocytes at baseline showed various differentially expressed genes in inflammatory pathways in PHEO patients; epigenetic profiling of the promoters of these genes suggests enrichment of the transcriptionally permissive chromatin mark H3K4me3 (trimethylation of lysine 4 on histone H3), indicative of in vivo training. CONCLUSIONS Catecholamines induce long-lasting proinflammatory changes in monocytes in vitro and in vivo, indicating trained immunity. Our data contribute to the understanding of pathways driving inflammatory changes in conditions characterized by high catecholamine levels and propose that trained immunity underlies the increased cardiovascular event rate in PHEO patients.
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Affiliation(s)
- Charlotte D C C van der Heijden
- From the Department of Internal Medicine (C.D.C.C.v.d.H., L.G., S.T.K., M.P.N., S.K., A.H., L.A.B.J., H.J.L.M.T., M.G.N., N.P.R.), Radboud University Medical Center, Nijmegen, the Netherlands.,Radboud Institute of Molecular Life Sciences (C.D.C.C.v.d.H., L.G., S.T.K., M.P.N., S.K., A.H., L.A.B.J., M.G.N., N.P.R.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Laszlo Groh
- From the Department of Internal Medicine (C.D.C.C.v.d.H., L.G., S.T.K., M.P.N., S.K., A.H., L.A.B.J., H.J.L.M.T., M.G.N., N.P.R.), Radboud University Medical Center, Nijmegen, the Netherlands.,Radboud Institute of Molecular Life Sciences (C.D.C.C.v.d.H., L.G., S.T.K., M.P.N., S.K., A.H., L.A.B.J., M.G.N., N.P.R.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Samuel T Keating
- From the Department of Internal Medicine (C.D.C.C.v.d.H., L.G., S.T.K., M.P.N., S.K., A.H., L.A.B.J., H.J.L.M.T., M.G.N., N.P.R.), Radboud University Medical Center, Nijmegen, the Netherlands.,Radboud Institute of Molecular Life Sciences (C.D.C.C.v.d.H., L.G., S.T.K., M.P.N., S.K., A.H., L.A.B.J., M.G.N., N.P.R.), Radboud University Medical Center, Nijmegen, the Netherlands.,Department of Human Genetics (S.K., A.H.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Charlotte Kaffa
- Centre for Molecular and Biomolecular Informatics, Radboud Institute for Molecular Life Sciences (C.K.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marlies P Noz
- From the Department of Internal Medicine (C.D.C.C.v.d.H., L.G., S.T.K., M.P.N., S.K., A.H., L.A.B.J., H.J.L.M.T., M.G.N., N.P.R.), Radboud University Medical Center, Nijmegen, the Netherlands.,Radboud Institute of Molecular Life Sciences (C.D.C.C.v.d.H., L.G., S.T.K., M.P.N., S.K., A.H., L.A.B.J., M.G.N., N.P.R.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Simone Kersten
- From the Department of Internal Medicine (C.D.C.C.v.d.H., L.G., S.T.K., M.P.N., S.K., A.H., L.A.B.J., H.J.L.M.T., M.G.N., N.P.R.), Radboud University Medical Center, Nijmegen, the Netherlands.,Radboud Institute of Molecular Life Sciences (C.D.C.C.v.d.H., L.G., S.T.K., M.P.N., S.K., A.H., L.A.B.J., M.G.N., N.P.R.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Antonius E van Herwaarden
- Department of Laboratory Medicine (A.E.v.H.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Alexander Hoischen
- Radboud Institute of Molecular Life Sciences (C.D.C.C.v.d.H., L.G., S.T.K., M.P.N., S.K., A.H., L.A.B.J., M.G.N., N.P.R.), Radboud University Medical Center, Nijmegen, the Netherlands.,Department of Human Genetics (S.K., A.H.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Leo A B Joosten
- From the Department of Internal Medicine (C.D.C.C.v.d.H., L.G., S.T.K., M.P.N., S.K., A.H., L.A.B.J., H.J.L.M.T., M.G.N., N.P.R.), Radboud University Medical Center, Nijmegen, the Netherlands.,Radboud Institute of Molecular Life Sciences (C.D.C.C.v.d.H., L.G., S.T.K., M.P.N., S.K., A.H., L.A.B.J., M.G.N., N.P.R.), Radboud University Medical Center, Nijmegen, the Netherlands.,Department of Medical Genetics, Iµliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania (L.A.B.J.)
| | - Henri J L M Timmers
- From the Department of Internal Medicine (C.D.C.C.v.d.H., L.G., S.T.K., M.P.N., S.K., A.H., L.A.B.J., H.J.L.M.T., M.G.N., N.P.R.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mihai G Netea
- From the Department of Internal Medicine (C.D.C.C.v.d.H., L.G., S.T.K., M.P.N., S.K., A.H., L.A.B.J., H.J.L.M.T., M.G.N., N.P.R.), Radboud University Medical Center, Nijmegen, the Netherlands.,Radboud Institute of Molecular Life Sciences (C.D.C.C.v.d.H., L.G., S.T.K., M.P.N., S.K., A.H., L.A.B.J., M.G.N., N.P.R.), Radboud University Medical Center, Nijmegen, the Netherlands.,Department for Genomics and Immunoregulation, Life and Medical Sciences 12 Institute, University of Bonn, Germany (M.G.N.)
| | - Niels P Riksen
- From the Department of Internal Medicine (C.D.C.C.v.d.H., L.G., S.T.K., M.P.N., S.K., A.H., L.A.B.J., H.J.L.M.T., M.G.N., N.P.R.), Radboud University Medical Center, Nijmegen, the Netherlands.,Radboud Institute of Molecular Life Sciences (C.D.C.C.v.d.H., L.G., S.T.K., M.P.N., S.K., A.H., L.A.B.J., M.G.N., N.P.R.), Radboud University Medical Center, Nijmegen, the Netherlands
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Pheochromocytoma and paraganglioma-an update on diagnosis, evaluation, and management. Pediatr Nephrol 2020; 35:581-594. [PMID: 30603807 DOI: 10.1007/s00467-018-4181-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 12/02/2018] [Accepted: 12/14/2018] [Indexed: 12/31/2022]
Abstract
Pheochromocytomas and paragangliomas (PPGLs) generally grouped together are rare catecholamine-secreting endocrine tumors. Symptoms of catecholamine excess are non-specific and therefore a high index of suspicion in children with sustained hypertension, family history of endocrine tumors, or features of syndromes associated with PPGLs leads to a timely diagnosis and treatment. Free metanephrines in the plasma or 24-h urine are the preferred tests to establish catecholamine excess. Considerations for false-positive conditions improve diagnostic yield and accuracy. Functional imaging, targeting either specific cell membrane transporters or vesicular catecholamine transport systems, is indicated for incidental lesions suspicious for PPGLs with inconclusive biochemical testing, assessment of regional extension or multifocality, and exclusion of metastases. Surgery is the mainstay of treatment for PPGLs. Preoperatively, sequential use of alpha adrenergic receptor blockade and volume expansion followed by beta blockade is mandatory to reduce intraoperative intravascular instability and blood pressure fluctuation due to tumor manipulation. Since genetic mutations have been reported in tumor susceptibility genes in nearly 50% of patients with PPGLs, genetic counselling and testing should be considered in all patients with a confirmed tumor.
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23
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Prevalence and progression of carbohydrate disorders in patients with pheochromocytoma/paraganglioma: retrospective single-center study. ANNALES D'ENDOCRINOLOGIE 2020; 81:3-10. [PMID: 32067697 DOI: 10.1016/j.ando.2020.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 12/11/2019] [Accepted: 01/09/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Carbohydrate disorders are the most frequent metabolic disorders, affecting a significant proportion of patients with pheochromocytoma. OBJECTIVE A retrospective study assessed the prevalence and progression of carbohydrate disorders in 204 patients (92 men, 112 women) with histologically proven pheochromocytoma diagnosed in a single specialized tertiary center during a 40-year period (1978-2017). One hundred were followed-up after tumor removal. RESULTS Carbohydrate disorders were diagnosed in 49.5% of cases: 30.4% with diabetes and, 19.1% prediabetes. Subjects with carbohydrate disorders had significantly greater age at diagnosis and higher 24-hour urine metanephrine and normetanephrine concentrations than those with normal glucose tolerance. One-third of patients with diabetes achieved good glycemic control under oral treatment (54% on metformin monotherapy). One-third of patients overall required preoperative insulin treatment. Postoperative follow-up (100 patients; 5-year mean duration) showed reduced prevalence of diabetes (13% vs. 33%; P=0.0007) and prediabetes (12% vs. 24%; P=0.027). Almost 60% of subjects initially diagnosed with carbohydrate disorders recovered normal glucose tolerance after surgery; these subjects had significantly higher preoperative urine metanephrine/normetanephrine levels than those with persistent diabetes/prediabetes. Correlation analysis revealed a moderate negative relationship between urine metanephrine/normetanephrine concentration and the outcome of the carbohydrate disorders (Spearmen's Rho=-0.507; P=0.013). There was no significant difference according to pre- or postoperative prevalence of obesity (15% vs. 16%; P=0.845) or dyslipidemia (46% vs. 39%; P=0.316). CONCLUSIONS Carbohydrate disorders affect approximately 50% of pheochromocytoma patients; 30% develop overt diabetes, which may be the only clinical manifestation in some rare cases. Pheochromocytoma-related diabetes is more likely to affect patients with predominant adrenaline secretion. It is often easy to control and usually requires oral antidiabetic treatment. Reversibility of carbohydrate disorders depend on severity, preoperative metanephrine level, age and weight.
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24
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Han M, Cao X, Zhao C, Yang L, Yin N, Shen P, Zhang J, Gao F, Ren Y, Liang D, Yang J, Zhang Y, Liu Y. Assessment of Glycometabolism Impairment and Glucose Variability Using Flash Glucose Monitoring System in Patients With Adrenal Diseases. Front Endocrinol (Lausanne) 2020; 11:544752. [PMID: 33101192 PMCID: PMC7546367 DOI: 10.3389/fendo.2020.544752] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 09/08/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND This study aimed to investigate the characteristics and extent of glycometabolism impairment in patients with adrenal diseases, including Cushing syndrome, primary aldosteronism, pheochromocytoma, and nonfunctional adrenal incidentaloma. METHODS This study enrolled thirty-two patients with adrenal diseases as adrenal disease groups and eight healthy individuals as healthy controls. Blood glucose levels were indicated by glucose concentration in interstitial fluid, which was documented using flash glucose monitoring system. According to flash glucose monitoring system data, parameters representing general blood glucose alterations, within-day and day-to-day glucose variability, and glucose-target-rate were calculated. Furthermore, blood glucose levels at nocturnal, fasting, and postprandial periods were analyzed. Besides, islet β-cell function and insulin resistance were assessed. RESULTS Analysis of flash glucose monitoring system-related parameters indicated impaired glycometabolism in patients with adrenal diseases compared with that of healthy controls at general blood glucose, within-day and day-to-day glucose variability, and glucose-target-rate levels. Furthermore, the dynamic glucose monitoring data revealed that significantly affected blood glucose levels compared with that of healthy controls were observed at postprandial periods in the Cushing syndrome and primary aldosteronism groups; at nocturnal, fasting and postprandial periods in the pheochromocytoma group. Significant insulin resistance and abnormal β-cell function were observed in the Cushing syndrome group compared with that in healthy controls. CONCLUSION Adrenal diseases can negatively affect glucose metabolism. Patients diagnosed with adrenal diseases should receive timely and appropriate treatment to avoid adverse cardiovascular events linked to hyperglycemia and insulin resistance.
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Affiliation(s)
- Minmin Han
- First Clinical Medical College, Shanxi Medical University, Taiyuan, China
- Department of Endocrinology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Xiaoming Cao
- Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Changjian Zhao
- Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Luyang Yang
- Department of Endocrinology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Nan Yin
- Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Pengliang Shen
- Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Jin Zhang
- Department of Endocrinology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Fei Gao
- Department of Endocrinology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yi Ren
- Department of Endocrinology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Dong Liang
- Department of Endocrinology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Jing Yang
- Department of Endocrinology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yi Zhang
- Department of Pharmacology, Shanxi Medical University, Taiyuan, China
- *Correspondence: Yi Zhang, ; Yunfeng Liu,
| | - Yunfeng Liu
- Department of Endocrinology, First Hospital of Shanxi Medical University, Taiyuan, China
- *Correspondence: Yi Zhang, ; Yunfeng Liu,
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25
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Babinska A, Kaszubowski M, Kmieć P, Sworczak K. Selected adipocytokines in patients with an incidentally discovered pheochromocytoma. MINERVA ENDOCRINOL 2019; 45:117-126. [PMID: 31738032 DOI: 10.23736/s0391-1977.19.03007-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Adipose tissue secretes many adipokines and cytokines, which may be an additional risk factor of cardiovascular and metabolic diseases in patients with an incidentally discovered pheochromocytoma (PHEO). The aim of the study was to investigate levels of selected adipocytokines in these patients. METHODS This prospective study included 12 patients with an incidentally discovered PHEO and 18 healthy participants. In all participants plasma/serum concentrations of triglycerides, HDL and LDL cholesterol, insulin, glucose, adipocytokines (adiponectin, leptin, resistin, TNFα, IL6, and MCP1) were determined, hormonal tests were performed in patients. RESULTS Patients and controls did not differ significantly in terms of age, sex, and body mass index. Among incidentally discovered PHEO patients, adiponectin levels were lower, while TNFα concentrations higher than in controls. Concentrations of adiponectin correlated with 24-hour urinary excretion of normetanephrine in women. Significantly higher TNFα concentrations were found in hypertensive than in normotensive PHEO patients as well as in non-diabetic PHEO patients than controls. Further, resistin concentration was higher in PHEO patients with diabetes than in non-diabetic ones (P<0.001). Incidentally discovered PHEO tumor size correlated with leptin and IL6 levels. Adiponectin levels were higher, while TNFα and resistin lower among five patients re-examined after tumor resection. CONCLUSIONS Among patients with an incidentally discovered pheochromocytoma, lower adiponectin, and higher resistin and TNFα levels may constitute additional factors for HT and DM. In our study, for the first time, correlations between incidentally discovered PHEO tumor size and concentrations of leptin as well as IL6 were found.
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Affiliation(s)
- Anna Babinska
- Department of Endocrinology and Internal Medicine, Medical University of Gdansk, Gdansk, Poland -
| | - Mariusz Kaszubowski
- Institute of Statistics, Department of Economic Sciences, Faculty of Management and Economics, Gdansk University of Technology, Gdansk, Poland
| | - Piotr Kmieć
- Department of Endocrinology and Internal Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Krzysztof Sworczak
- Department of Endocrinology and Internal Medicine, Medical University of Gdansk, Gdansk, Poland
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Nguyen LV, Ta QV, Dang TB, Nguyen PH, Nguyen T, Pham TVH, Nguyen THT, Baker S, Le Tran T, Yang DJ, Kim KW, Doan KV. Carvedilol improves glucose tolerance and insulin sensitivity in treatment of adrenergic overdrive in high fat diet-induced obesity in mice. PLoS One 2019; 14:e0224674. [PMID: 31682617 PMCID: PMC6827914 DOI: 10.1371/journal.pone.0224674] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 10/19/2019] [Indexed: 01/08/2023] Open
Abstract
Catecholamine excess reflecting an adrenergic overdrive of the sympathetic nervous system (SNS) has been proposed to link to hyperleptinemia in obesity and may contribute to the development of metabolic disorders. However, relationship between the catecholamine level and plasma leptin in obesity has not yet been investigated. Moreover, whether pharmacological blockade of the adrenergic overdrive in obesity by the third-generation beta-blocker agents such as carvedilol could help to prevent metabolic disorders is controversial and remains to be determined. Using the high fat diet (HFD)-induced obese mouse model, we found that basal plasma norepinephrine, the principal catecholamine as an index of SNS activity, was persistently elevated and highly correlated with plasma leptin concentration during obesity development. Targeting the adrenergic overdrive from this chronic norepinephrine excess in HFD-induced obesity with carvedilol, a third-generation beta-blocker with vasodilating action, blunted the HFD-induced hepatic glucose over-production by suppressing the induction of gluconeogenic enzymes, and enhanced the muscular insulin signaling pathway. Furthermore, carvedilol treatment in HFD-induced obese mice decreased the enlargement of white adipose tissue and improved the glucose tolerance and insulin sensitivity without affecting body weight and blood glucose levels. Our results suggested that catecholamine excess in obesity might directly link to the hyperleptinemic condition and the therapeutic targeting of chronic adrenergic overdrive in obesity with carvedilol might be helpful to attenuate obesity-related metabolic disorders.
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Affiliation(s)
- Linh V. Nguyen
- School of Medicine, Tan Tao University, Long An, Viet Nam
| | - Quang V. Ta
- School of Biotechnology, Tan Tao University, Long An, Viet Nam
| | - Thao B. Dang
- School of Medicine, Tan Tao University, Long An, Viet Nam
| | | | - Thach Nguyen
- School of Medicine, Tan Tao University, Long An, Viet Nam
| | | | - Trang HT. Nguyen
- Oxford University Clinical Research Unit in Viet Nam, Ho Chi Minh, Viet Nam
| | - Stephen Baker
- Oxford University Clinical Research Unit in Viet Nam, Ho Chi Minh, Viet Nam
| | - Trung Le Tran
- Division of Physiology, Department of Oral Biology, BK21 PLUS, Yonsei University College of Dentistry, Seoul, South Korea
| | - Dong Joo Yang
- Division of Physiology, Department of Oral Biology, BK21 PLUS, Yonsei University College of Dentistry, Seoul, South Korea
| | - Ki Woo Kim
- Division of Physiology, Department of Oral Biology, BK21 PLUS, Yonsei University College of Dentistry, Seoul, South Korea
- * E-mail: (KWK); (KVD)
| | - Khanh V. Doan
- School of Medicine, Tan Tao University, Long An, Viet Nam
- * E-mail: (KWK); (KVD)
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Lee SH, Kwak MK, Ahn SH, Kim H, Cho YY, Suh S, Song KH, Koh JM, Kim JH, Kim BJ. Change of skeletal muscle mass in patients with pheochromocytoma. J Bone Miner Metab 2019; 37:694-702. [PMID: 30238430 DOI: 10.1007/s00774-018-0959-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 09/07/2018] [Indexed: 01/21/2023]
Abstract
The effects of catecholamine excess due to pheochromocytoma on body composition, including skeletal muscle mass, are unknown. Here, we investigated the effects of catecholamine metabolites on body composition in subjects with pheochromocytoma. After body compositions using bioelectrical impedance analysis, urinary metanephrine (UM), and urinary normetanephrine (UNM) were measured in 16 patients with pheochromocytoma and 224 patients with nonfunctioning adrenal incidentaloma (NFAI), we compared skeletal muscle mass and fat mass (FM) between the two groups. After adjustments for confounders, UM (β = - 0.171, P = 0.006) and UNM (β = - 0.249, P < 0.001) levels were correlated inversely with skeletal muscle mass index (SMI), but not FM or percentage FM (pFM), in all subjects. Patients with pheochromocytoma had lower ASM by 7.7% (P = 0.022) and SMI by 6.6% (P = 0.001) than patients with NFAI. Conversely, FM and pFM were not statistically different between the two groups. The odds ratio for low skeletal muscle mass in the presence of pheochromocytoma was 10.33 (95% confidence interval, 2.65-40.22). Our results indicate that patients with pheochromocytoma have a reduced skeletal muscle mass and suggest that catecholamine excess has adverse effects on skeletal muscle metabolism.
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Affiliation(s)
- Seung Hun Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Mi Kyung Kwak
- Division of Endocrinology and Metabolism, Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Seong Hee Ahn
- Division of Endocrinology and Metabolism, Department of Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, South Korea
| | - Hyeonmok Kim
- Department of Medicine, Seoul Medical Center, Seoul, South Korea
| | - Yoon Young Cho
- Division of Endocrinology and Metabolism, Department of Medicine, Gyeongsang National University School of Medicine, Jinju, South Korea
| | - Sunghwan Suh
- Division of Endocrinology and Metabolism, Department of Medicine, Dong-A University Medical Center, Dong-A, University College of Medicine, Busan, South Korea
| | - Kee-Ho Song
- Division of Endocrinology and Metabolism, Department of Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea
| | - Jung-Min Koh
- Division of Endocrinology and Metabolism, Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
| | - Beom-Jun Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
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Bisogni V, Petramala L, Oliviero G, Bonvicini M, Mezzadri M, Olmati F, Concistrè A, Saracino V, Celi M, Tonnarini G, Iannucci G, De Toma G, Ciardi A, La Torre G, Letizia C. Analysis of Short-term Blood Pressure Variability in Pheochromocytoma/Paraganglioma Patients. Cancers (Basel) 2019; 11:E658. [PMID: 31083609 PMCID: PMC6562701 DOI: 10.3390/cancers11050658] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/06/2019] [Accepted: 05/10/2019] [Indexed: 12/24/2022] Open
Abstract
Data on short-term blood pressure variability (BPV), which is a well-established cardiovascular prognostic tool, in pheochromocytoma and paraganglioma (PPGL) patients is still lack and conflicting. We retrospectively evaluated 23 PPGL patients referred to our unit from 2010 to 2019 to analyze 24 h ambulatory blood pressure monitoring (24-h ABPM)-derived markers of short-term BPV, before and after surgical treatment. PPGL diagnosis was assessed according to guidelines and confirmed by histologic examination. The 24-h ABPM-derived markers of short-term BPV included: circadian pressure rhythm; standard deviation (SD) and weighted SD (wSD) of 24-h, daytime, and night-time systolic and diastolic blood pressure (BP); average real variability (ARV) of 24-h, daytime, and night-time systolic and diastolic BP. 7 males and 16 females of 53 ± 18 years old were evaluated. After surgical resection of PPGL we found a significant decrease in 24-h systolic BP ARV (8.8 ± 1.6 vs. 7.6 ± 1.3 mmHg, p < 0.001), in 24-h diastolic BP ARV (7.5 ± 1.6 vs. 6.9 ± 1.4 mmHg, p = 0.031), and in wSD of 24-h diastolic BP (9.7 ± 2.0 vs 8.8 ± 2.1 mmHg, p = 0.050) comparing to baseline measurements. Moreover, baseline 24-h urinary metanephrines significantly correlated with wSD of both 24-h systolic and diastolic BP. Our study highlights as PPGL patients, after proper treatment, show a significant decrease in some short-term BPV markers, which might represent a further cardiovascular risk factor.
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Affiliation(s)
- Valeria Bisogni
- Department of Translational and Precision Medicine, Unit of Secondary Arterial Hypertension, "Sapienza" University of Rome, Viale del Policlinico 155, 00165 Rome, Italy.
| | - Luigi Petramala
- Department of Translational and Precision Medicine, Unit of Secondary Arterial Hypertension, "Sapienza" University of Rome, Viale del Policlinico 155, 00165 Rome, Italy.
| | - Gaia Oliviero
- Department of Translational and Precision Medicine, Unit of Secondary Arterial Hypertension, "Sapienza" University of Rome, Viale del Policlinico 155, 00165 Rome, Italy.
| | - Maria Bonvicini
- Department of Translational and Precision Medicine, Unit of Secondary Arterial Hypertension, "Sapienza" University of Rome, Viale del Policlinico 155, 00165 Rome, Italy.
| | - Martina Mezzadri
- Department of Translational and Precision Medicine, Unit of Secondary Arterial Hypertension, "Sapienza" University of Rome, Viale del Policlinico 155, 00165 Rome, Italy.
| | - Federica Olmati
- Department of Translational and Precision Medicine, Unit of Secondary Arterial Hypertension, "Sapienza" University of Rome, Viale del Policlinico 155, 00165 Rome, Italy.
| | - Antonio Concistrè
- Department of Translational and Precision Medicine, Unit of Secondary Arterial Hypertension, "Sapienza" University of Rome, Viale del Policlinico 155, 00165 Rome, Italy.
| | - Vincenza Saracino
- Department of Translational and Precision Medicine, Unit of Secondary Arterial Hypertension, "Sapienza" University of Rome, Viale del Policlinico 155, 00165 Rome, Italy.
| | - Monia Celi
- Department of Translational and Precision Medicine, Unit of Secondary Arterial Hypertension, "Sapienza" University of Rome, Viale del Policlinico 155, 00165 Rome, Italy.
| | - Gianfranco Tonnarini
- Department of Translational and Precision Medicine, Unit of Secondary Arterial Hypertension, "Sapienza" University of Rome, Viale del Policlinico 155, 00165 Rome, Italy.
| | - Gino Iannucci
- Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, Viale del Policlinico 155, 00165 Rome, Italy.
| | - Giorgio De Toma
- "Pietro Valdoni" Surgery Department, "Sapienza" University of Rome, Viale del Policlinico 155, 00165 Rome, Italy.
| | - Antonio Ciardi
- Department of Radiological, Oncological and Anatomy-Pathological Sciences, "Sapienza" University of Rome, Viale del Policlinico 155, 00165 Rome, Italy.
| | - Giuseppe La Torre
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Viale del Policlinico 155, 00165 Rome, Italy.
| | - Claudio Letizia
- Department of Translational and Precision Medicine, Unit of Secondary Arterial Hypertension, "Sapienza" University of Rome, Viale del Policlinico 155, 00165 Rome, Italy.
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FGF21 Levels in Pheochromocytoma/Functional Paraganglioma. Cancers (Basel) 2019; 11:cancers11040485. [PMID: 30959789 PMCID: PMC6520899 DOI: 10.3390/cancers11040485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 03/29/2019] [Accepted: 04/02/2019] [Indexed: 01/16/2023] Open
Abstract
Fibroblast growth factor 21 (FGF21) is a hepatokine with beneficial effects on metabolism. Our aim was to evaluate the relationship between the serum FGF21, and energy and glucose metabolism in 40 patients with pheochromocytoma/functional paraganglioma (PPGL), in comparison with 21 obese patients and 26 lean healthy controls. 27 patients with PPGL were examined one year after tumor removal. Basic anthropometric and biochemical measurements were done. Energy metabolism was measured by indirect calorimetry (Vmax-Encore 29N). FGF21 was measured by ELISA. FGF21 was higher in PPGL than in controls (174.2 (283) pg/mL vs. 107.9 (116) pg/mL; p < 0.001) and comparable with obese (174.2 (283) pg/mL vs. 160.4 (180); p = NS). After tumor removal, FGF21 decreased (176.4 (284) pg/mL vs. 131.3 (225) pg/mL; p < 0.001). Higher levels of FGF21 were expressed, particularly in patients with diabetes. FGF21 positively correlated in PPGL with age (p = 0.005), BMI (p = 0.028), glycemia (p = 0.002), and glycated hemoglobin (p = 0.014). In conclusion, long-term catecholamine overproduction in PPGL leads to the elevation in serum FGF21, especially in patients with secondary diabetes. FGF21 levels were comparable between obese and PPGL patients, despite different anthropometric indices. We did not find a relationship between FGF21 and hypermetabolism in PPGL. Tumor removal led to the normalization of FGF21 and the other metabolic abnormalities.
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Prakash P, Ramachandran R, Tandon N, Kumar R. Changes in blood pressure, blood sugar, and quality of life in patients undergoing pheochromocytoma surgery: a prospective cohort study. INDIAN JOURNAL OF UROLOGY : IJU : JOURNAL OF THE UROLOGICAL SOCIETY OF INDIA 2019; 35:34-40. [PMID: 30692722 PMCID: PMC6334590 DOI: 10.4103/iju.iju_190_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Pheochromocytoma surgery is associated with significant hemodynamic and metabolic changes that require post-operative monitoring. We prospectively evaluated the trends of blood pressure, blood sugar, body mass index (BMI), and quality of life (QoL) changes in a cohort of patients undergoing pheochromocytoma surgery to determine the minimum duration of monitoring and assess factors that could predict these changes. Materials and Methods: Consecutive patients undergoing surgery for pheochromocytoma over a 20-month period were included in this ethics review board-approved, prospective cohort study. Blood pressure and sugar levels were serially monitored using a fixed protocol in the perioperative period and subsequently at 3 months after surgery. BMI and QoL (using World Health Organization Quality of Life [WHOQOL-BREF] questionnaire) were recorded at baseline and 3 months. Changes were compared and assessed for the predictive factors. Results: Twenty-six patients undergoing 31 procedures were included in the study of whom 8 (30%) developed hypotension and 4 (15%) developed hypoglycemia after surgery. All hypotension episodes occurred within 6 hours of surgery. However, while 3 of the 4 patients who developed hypoglycemia manifest in the first 4 h after surgery, one occurred after 12 h. Occurrence of hypotension correlated with preoperative 24-h urinary vanillylmandelic acid (VMA) levels (P = 0.02) and the total daily dose of prazosin (P = 0.04). Out of 21 hypertensive patients, 7 (33%) had persistent hypertension (HTN) at 3 months and this was associated with age (P = 0.04) and diabetes mellitus (DM) at presentation (P = 0.04). Among six diabetic patients, 1 (16%) had persistent DM. There was significant increase in the BMI (P < 0.0001) and in WHOQOL-BREF scores postoperatively. Conclusions: Hypotension occurs in 30% patients and hypoglycemia in 15% after pheochromocytoma surgery. Hypotension occurs immediately but hypoglycemia may manifest upto 12h after surgery. Older, diabetic patients are more likely to have persistent HTN. Surgery results in increase in BMI and improvement in QoL.
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Affiliation(s)
- Pradeep Prakash
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Rashmi Ramachandran
- Department of Anesthesiology and Intensive Care, All India Institute of Medical Sciences, New Delhi, India
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Kumar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
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Futtrup J, Nordentoft M, Elfving B, Krogh J. The association between norepinephrine and metabolism in patients with major depression. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.npbr.2018.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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An Y, Reimann M, Masjkur J, Langton K, Peitzsch M, Deutschbein T, Fassnacht M, Rogowski-Lehmann N, Beuschlein F, Fliedner S, Stell A, Prejbisz A, Januszewicz A, Lenders J, Bornstein SR, Eisenhofer G. Adrenomedullary function, obesity and permissive influences of catecholamines on body mass in patients with chromaffin cell tumours. Int J Obes (Lond) 2018; 43:263-275. [PMID: 29717268 DOI: 10.1038/s41366-018-0054-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 01/10/2018] [Accepted: 01/31/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Obesity-associated activation of sympathetic nervous outflow is well documented, whereas involvement of dysregulated adrenomedullary hormonal function in obesity is less clear. This study assessed relationships of sympathoadrenal function with indices of obesity and influences of circulating catecholamines on body mass. METHODS Anthropometric and clinical data along with plasma and 24-h urine samples were collected from 590 volunteers and 1368 patients tested for phaeochromocytoma and paraganglioma (PPGL), among whom tumours were diagnosed in 210 individuals. RESULTS Among patients tested for PPGL, those with tumours less often had a body mass index (BMI) above 30 kg/m2 (12 vs. 31%) and more often a BMI under 25 kg/m2 (56 vs. 32%) than those without tumours (P < 0.0001). Urinary outputs of catecholamines in patients with PPGL were negatively related to BMI (r = -0.175, P = 0.0133). Post-operative weight gain (P < 0.0001) after resection of PPGL was positively related to presurgical tumoural catecholamine output (r = 0.257, P = 0.0101). Higher BMI in men and women and percent body fat in women of the volunteer group were associated with lower plasma concentrations and urinary outputs of adrenaline and metanephrine, the former indicating obesity-related reduced adrenaline secretion and the latter obesity-related reduced adrenomedullary adrenaline stores. Daytime activity was associated with substantial increases in urinary adrenaline and noradrenaline excretion, with blunted responses in obese subjects. CONCLUSIONS The findings in patients with PPGL support an influence of high circulating catecholamines on body weight. Additional associations of adrenomedullary dysfunction with obesity raise the possibility of a permissive influence of the adrenal medulla on the regulation of body weight.
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Affiliation(s)
- Yaxin An
- Department of Medicine III, Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Manja Reimann
- Department of Neurology, Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Jimmy Masjkur
- Department of Medicine III, Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Katharina Langton
- Department of Medicine III, Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Mirko Peitzsch
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Timo Deutschbein
- Department of Internal Medicine, Division of Endocrinology, University Hospital, University of Würzburg, Würzburg, Germany
| | - Martin Fassnacht
- Department of Internal Medicine, Division of Endocrinology, University Hospital, University of Würzburg, Würzburg, Germany
| | - Natalie Rogowski-Lehmann
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany
| | - Felix Beuschlein
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany.,Department of Endocrinology, Diabetology and Clinical Nutrition, UnviersitätsSpital Zürich, Zurich, Switzerland
| | - Stephanie Fliedner
- Department of Medicine, University Medical Center Schleswig-Holstein, Luebeck, Germany
| | - Anthony Stell
- Department of Computing and Information, University of Melbourne, Melbourne, Australia
| | | | | | - Jacques Lenders
- Department of Medicine III, Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Department of Internal Medicine, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Stefan R Bornstein
- Department of Medicine III, Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Graeme Eisenhofer
- Department of Medicine III, Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany. .,Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
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Komada H, Hirota Y, So A, Nakamura T, Okuno Y, Fukuoka H, Iguchi G, Takahashi Y, Sakaguchi K, Ogawa W. Insulin Secretion and Insulin Sensitivity Before and After Surgical Treatment of Pheochromocytoma or Paraganglioma. J Clin Endocrinol Metab 2017; 102:3400-3405. [PMID: 28666346 DOI: 10.1210/jc.2017-00357] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 06/21/2017] [Indexed: 11/19/2022]
Abstract
CONTEXT Pheochromocytoma and paraganglioma are catecholamine-producing tumors that often impair glucose tolerance. The effects of these tumors on insulin sensitivity and insulin secretion in patients have remained unclear, however. OBJECTIVE To characterize the influence of pheochromocytoma or paraganglioma on glucose tolerance, we comprehensively analyzed various parameters related to insulin secretion or insulin sensitivity in patients with these tumors. DESIGN Hyperglycemic and hyperinsulinemic-euglycemic clamps, as well as an oral glucose tolerance test (OGTT), were performed in patients before and after tumor excision. SETTING Patients underwent metabolic analyses on admission to Kobe University Hospital. PATIENTS Eleven patients with pheochromocytoma and two with paraganglioma were examined. INTERVENTION None. MAIN OUTCOME MEASURES We evaluated various parameters related to insulin secretion or insulin sensitivity as determined by an OGTT and by hyperglycemic and hyperinsulinemic-euglycemic clamp analyses. RESULTS Surgical treatment of the tumor reduced urinary catecholamine excretion and improved glucose tolerance. The insulinogenic index, but not total insulin secretion, measured during the OGTT as well as the first phase, but not the second phase, of insulin secretion during the hyperglycemic clamp were improved after surgery. The insulin sensitivity index determined during the hyperinsulinemic-euglycemic clamp remained unchanged after surgery. CONCLUSION These results suggest pheochromocytoma and paraganglioma impair glucose tolerance primarily through impairment of insulin secretion-in particular, that of the early phase of the insulin secretory response. A prospective study with more patients is warranted to further confirm these results.
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Affiliation(s)
- Hisako Komada
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Yushi Hirota
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Anna So
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Tomoaki Nakamura
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Yoko Okuno
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Hidenori Fukuoka
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Genzo Iguchi
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Yutaka Takahashi
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Kazuhiko Sakaguchi
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Wataru Ogawa
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
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Sedhai YR, Reddy K, Patel D, Lozada JA. Unusual case of pheochromocytoma presenting with diabetic ketoacidosis. BMJ Case Rep 2016; 2016:bcr-2016-216961. [PMID: 27790975 DOI: 10.1136/bcr-2016-216961] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Pheochromocytoma is a rare catecholamine-secreting tumour that arises from chromaffin cells in the adrenal medulla or extra-adrenal sympathetic ganglia. It classically presents with paroxysmal headaches, hypertension, palpitations and sweating related to catecholamine excess. Diabetes is reported to be present in approximately one-third of patients with pheochromocytoma; however, diabetic ketoacidosis is an extremely rare complication. We present a case of an African-American male aged 30 years who initially presented with diabetic ketoacidosis and hypertensive urgency whose blood pressure and glycaemic control improved remarkably following tumour excision. We will discuss this unusual presentation of pheochromocytoma along with a management approach for such adrenal incidentalomas.
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Affiliation(s)
- Yub Raj Sedhai
- Department of Internal Medicine, Mercy Catholic Medical Center, Darby, Pennsylvania, USA
| | - Kruthika Reddy
- Department of Internal Medicine, Mercy Catholic Medical Center, Darby, Pennsylvania, USA
| | - Dhruvan Patel
- Department of Internal Medicine, Mercy Catholic Medical Center, Darby, Pennsylvania, USA
| | - James A Lozada
- Department of Internal Medicine, Mercy Catholic Medical Center, Darby, Pennsylvania, USA
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Lee IS, Lee TW, Chang CJ, Chien YM, Lee TI. Pheochromocytoma presenting as hyperglycemic hyperosmolar syndrome and unusual fever. Intern Emerg Med 2015; 10:753-5. [PMID: 25732254 DOI: 10.1007/s11739-015-1217-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 02/15/2015] [Indexed: 11/28/2022]
Affiliation(s)
- I-Shuan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, 111 Shin Lung Road Section 3, Taipei, Taiwan
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Okamura T, Nakajima Y, Satoh T, Hashimoto K, Sapkota S, Yamada E, Okada S, Fukuda J, Higuchi T, Tsushima Y, Yamada M. Changes in visceral and subcutaneous fat mass in patients with pheochromocytoma. Metabolism 2015; 64:706-12. [PMID: 25819736 DOI: 10.1016/j.metabol.2015.03.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 01/21/2015] [Accepted: 03/09/2015] [Indexed: 01/18/2023]
Abstract
CONTEXT Overproduction of catecholamine induces not only hypertension but also glucose intolerance and hyperlipidemia. However, little is known about its effect on visceral and subcutaneous fat. OBJECTIVE Our objective was to investigate changes of metabolic factors including visceral and subcutaneous fat areas in patients with pheochromocytoma (Pheo). DESIGN AND PATIENTS This was a cross-sectional and longitudinal follow-up study of cases collected from Gunma University Hospital between 2002 and 2013. Forty-two patients with Pheo and 23 with non-functioning adrenal adenoma (NFA) were analyzed before and after adrenalectomy. RESULTS Multivariate logistic-regression analysis adjusted by age and gender revealed that glucose intolerance was more common in patients with Pheo than in patients with NFA (21/42, 51% vs. 4/23, 17%, p<0.05). Abdominal visceral fat area (VFA) and subcutaneous fat area (SFA) were significantly lower in patients with Pheo than in those with NFA (80.2±38.7 vs. 124.3±61.8cm(2), p<0.05; 114.6±58.9 vs. 164.3±40.3cm(2), p<0.05, respectively). Significant correlations were observed between fractionated urine noradrenaline level and serum HDL-cholesterol level (r = 0.36, p<0.05), urine normetanephrine level and tumor size (r=0.57, p<0.01), and urine adrenaline level and systolic blood pressure (r=0.35, p<0.05) in Pheo. However, there were no significant correlations between adrenaline and noradrenaline levels and other parameters, including serum LDL-cholesterol and triglyceride levels, and HbA1c. Furthermore, both VFA and SFA, body weight, and BMI were significantly increased, and serum HbA1c as well as HDL-cholesterol levels were decreased after adrenalectomy in Pheo. CONCLUSION These findings suggest for the first time that catecholamines might regulate the serum HDL-cholesterol level and both abdominal visceral and subcutaneous fat mass in men.
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Affiliation(s)
- Takashi Okamura
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Yasuyo Nakajima
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan.
| | - Tetsurou Satoh
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Koshi Hashimoto
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Santosh Sapkota
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Eijiro Yamada
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Shuichi Okada
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Junya Fukuda
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Tetsuya Higuchi
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Yoshito Tsushima
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Masanobu Yamada
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
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Nagano G, Ohno H, Oki K, Kobuke K, Shiwa T, Yoneda M, Kohno N. Activation of classical brown adipocytes in the adult human perirenal depot is highly correlated with PRDM16-EHMT1 complex expression. PLoS One 2015; 10:e0122584. [PMID: 25812118 PMCID: PMC4374757 DOI: 10.1371/journal.pone.0122584] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 02/18/2015] [Indexed: 12/22/2022] Open
Abstract
Brown fat generates heat to protect against cold and obesity. Adrenergic stimulation activates the thermogenic program of brown adipocytes. Although the bioactivity of brown adipose tissue in adult humans had been assumed to very low, several studies using positron emission tomography-computed tomography (PET-CT) have detected bioactive brown adipose tissue in adult humans under cold exposure. In this study, we collected adipose tissues obtained from the perirenal regions of adult patients with pheochromocytoma (PHEO) or non-functioning adrenal tumors (NF). We demonstrated that perirenal brown adipocytes were activated in adult patients with PHEO. These cells had the molecular characteristics of classical brown fat rather than those of beige/brite fat. Expression of brown adipose tissue markers such as uncoupling protein 1 (UCP1) and cell death-inducing DFFA-like effector A (CIDEA) was highly correlated with the amounts of PRD1-BF-1-RIZ1 homologous domain-containing protein-16 (PRDM16) - euchromatic histone-lysine N-methyltransferase 1 (EHMT1) complex, the key transcriptional switch for brown fat development. These results provide novel insights into the reconstruction of human brown adipocytes and their therapeutic application against obesity and its complications such as type 2 diabetes.
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Affiliation(s)
- Gaku Nagano
- Department of Molecular and Internal Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Haruya Ohno
- Department of Molecular and Internal Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
- * E-mail:
| | - Kenji Oki
- Department of Molecular and Internal Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazuhiro Kobuke
- Department of Molecular and Internal Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tsuguka Shiwa
- Department of Molecular and Internal Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masayasu Yoneda
- Department of Molecular and Internal Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobuoki Kohno
- Department of Molecular and Internal Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
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Søndergaard E, Gormsen LC, Christensen MH, Pedersen SB, Christiansen P, Nielsen S, Poulsen PL, Jessen N. Chronic adrenergic stimulation induces brown adipose tissue differentiation in visceral adipose tissue. Diabet Med 2015; 32:e4-8. [PMID: 25252000 DOI: 10.1111/dme.12595] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 06/26/2014] [Accepted: 09/09/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Recruitment of brown adipose tissue is a promising strategy to treat obesity and Type 2 diabetes, but the physiological effects of a large amount of metabolically active brown adipose tissue in humans are unknown. CASE REPORT In the present paper, we report a case of massive brown adipose tissue infiltration of the visceral adipose tissue depot in a person with Type 2 diabetes with a catecholamine-secreting paraganglioma. The patient was evaluated with [18F]-fludeoxyglucose positron emission tomography/computed tomography on three occasions: pre-therapy, during α-blockade and postoperatively. During surgery, biopsies of visceral and subcutaneous adipose tissue were obtained and evaluated for brown adipose tissue. At diagnosis, brown adipose tissue glucose uptake, assessed by [18F]-fludeoxyglucose-positron emission tomography, was massively increased. [18F]-fludeoxyglucose uptake was confined to known locations for brown adipose tissue, with additional uptake in the visceral adipose tissue. As a result of increased thermogenesis, resting energy expenditure was doubled. After surgical removal of the tumour, antidiabetic medicine was no longer needed, despite an 8.2-kg weight gain. CONCLUSION These results show that human visceral adipose tissue holds an unprecedented potential for brown adipogenic differentiation; however, a detrimental effect on glucose metabolism persisted despite massive brown adipose tissue activity, with a doubling of resting energy expenditure.
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Affiliation(s)
- E Søndergaard
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark; The Danish Diabetes Academy, Aarhus, Denmark
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Abstract
Since 2009, the presence of brown adipose tissue (BAT) in adult humans has been irrefutably proven. It is estimated that active BAT can contribute up to 2.5-5% of resting metabolic rate in humans, suggesting that sustained activation of BAT may alleviate obesity and associated disorders. In the current chapter, the discovery of BAT in adult humans will be discussed. Furthermore, the characteristics of human BAT, methods to visualize the tissue as well as physiological and pharmacological methods to enhance its activity will be stressed.
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Devlin MJ. The “Skinny” on brown fat, obesity, and bone. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2014; 156 Suppl 59:98-115. [DOI: 10.1002/ajpa.22661] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Maureen J. Devlin
- Department of Anthropology; University of Michigan; Ann Arbor MI 48104
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Bauwens M, Wierts R, van Royen B, Bucerius J, Backes W, Mottaghy F, Brans B. Molecular imaging of brown adipose tissue in health and disease. Eur J Nucl Med Mol Imaging 2014; 41:776-91. [PMID: 24509875 DOI: 10.1007/s00259-013-2611-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 10/07/2013] [Indexed: 12/25/2022]
Abstract
PURPOSE Brown adipose tissue (BAT) has transformed from an interfering tissue in oncological (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) to an independent imaging research field. This review takes the perspective from the imaging methodology on which human BAT research has come to rely on heavily. METHODS This review analyses relevant PubMed-indexed publications that discuss molecular imaging methods of BAT. In addition, reported links between BAT and human diseases such as obesity are discussed, and the possibilities for imaging in these fields are highlighted. Radiopharmaceuticals aiming at several different biological mechanisms of BAT are discussed and evaluated. RESULTS Prospective, dedicated studies allow visualization of BAT function in a high percentage of human subjects. BAT dysfunction has been implicated in obesity, linked with diabetes and associated with cachexia and atherosclerosis. Presently, (18)F-FDG PET/CT is the most useful tool for evaluating therapies aiming at BAT activity. In addition to (18)F-FDG, other radiopharmaceuticals such as (99m)Tc-sestamibi, (123)I-metaiodobenzylguanidine (MIBG), (18)F-fluorodopa and (18)F-14(R,S)-[(18)F]fluoro-6-thia-heptadecanoic acid (FTHA) may have a potential for visualizing other aspects of BAT activity. MRI methods are under continuous development and provide the prospect of functional imaging without ionizing radiation. CONCLUSION Molecular imaging of BAT can be used to quantitatively assess different aspects of BAT metabolic activity.
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Affiliation(s)
- Matthias Bauwens
- Department of Medical Imaging, Division of Nuclear Medicine, MUMC, Maastricht, Netherlands
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