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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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Ronen JA, Gavin M, Ruppert MD, Peiris AN. Glycemic Disturbances in Pheochromocytoma and Paraganglioma. Cureus 2019; 11:e4551. [PMID: 31275775 PMCID: PMC6592834 DOI: 10.7759/cureus.4551] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
In this review article, we aimed to analyze the available data on pheochromocytomas and paragangliomas as it pertains to their not as well-recognized association with significant glycemic abnormalities in the preoperative, perioperative, and postoperative settings as well as how they should be managed clinically. Pheochromocytomas are rare adrenal tumors that account for about 0.1% of hypertension. Paragangliomas, on the other hand, are even less common and have fewer clinical manifestations. Both types of tumors may have unusual modes of presentation which can challenge even the most experienced clinicians and are easy to overlook, resulting in post-mortem diagnosis. We wish to draw further attention to the life-threatening effects on glucose and insulin homeostasis that can occur in the form of hyperglycemic and hypoglycemic states. Hyperglycemia is a result of a glucose intolerant state created in the setting of catecholamine excess, which can present in the form of resistant diabetes, diabetic ketoacidosis (DKA), or even hyperglycemic hyperosmolar states (HHS). In many reported cases, these abnormalities resolve with resection of the tumor. However, past clinicians have also described a state of "reactive hypoglycemia" that can occur following tumor resection, further emphasizing the need for very close perioperative and postoperative monitoring. Severe hypoglycemia may also occur with inherited diseases linked to pheochromocytoma such as von Hippel-Lindau (VHL) disease as well as predominantly epinephrine-producing tumors, given some of the dramatic downstream effects of alpha and beta adrenoceptor agonization. While much of the data remains anecdotal, clinicians will benefit from the awareness of the protean manifestations of these tumors and the varied and lesser-known effects on glucose and insulin homeostasis.
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Affiliation(s)
- Joshua A Ronen
- Internal Medicine, Texas Tech University Health Sciences Center, Odessa, USA
| | - Meredith Gavin
- Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Misty D Ruppert
- Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Alan N Peiris
- Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
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Suzuki T, Muramatsu T, Morioka K, Goda T, Mochizuki K. ChREBP binding and histone modifications modulate hepatic expression of the Fasn gene in a metabolic syndrome rat model. Nutrition 2015; 31:877-83. [PMID: 25933497 DOI: 10.1016/j.nut.2015.01.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 12/25/2014] [Accepted: 01/14/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Although the expression of hepatic lipogenic genes is enhanced in insulin resistance, the underlying mechanism is unclear. To reveal the details, the aim of this study was to investigate whether the expression of hepatic lipogenic genes are mediated by epigenetic regulation and specific transcription factors in an insulin resistance model of rats. METHODS Using a rat model of insulin resistance (SHR/NDmc-cp), we investigated the relationship between hepatic expression of the lipogenic gene fatty-acid synthase (Fasn), binding of the transcription factor carbohydrate-responsive element-binding protein (ChREBP) to the Fasn gene, and histone modifications in the region of the Fasn gene by real-time reverse transcriptase polymerase chain reaction, immunoblotting, and chromatin immunoprecipitation assay. RESULTS Compared with control rats, Fasn mRNA expression and protein levels were higher in the livers of SHR/NDmc-cp rats, as were protein expression levels and Fasn binding of ChREBP and RNA polymerase II. Moreover, compared with the livers of control rats, levels of mono-methylated histone H3 lysine (K) 4 and acetylated histone H4 were higher in the promoter/enhancer region of the Fasn gene in the livers of SHR/NDmc-cp rats. Levels of trimethylated histone H3K4 and acetylated histone H3 were higher in the transcribed region. CONCLUSION The results of this study indicate that expression of the Fasn gene in the livers of insulin-resistant rats is associated with increased H3K4 methylation, increased histone H3 acetylation, and increased H4 acetylation, and also, binding levels of ChREBP to promoter/enhancer region of Fasn gene is involved in the Fasn gene expression caused by hyperglycemia.
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Affiliation(s)
- Takuji Suzuki
- Laboratory of Nutritional Physiology, Graduate School of Nutritional and Environmental Sciences, Global COE Program, University of Shizuoka, Shizuoka, Japan; Food Environmental Design Course, Faculty of Education, Art and Science, Yamagata University, Yamagata, Japan
| | - Takeshi Muramatsu
- Laboratory of Nutritional Physiology, Graduate School of Nutritional and Environmental Sciences, Global COE Program, University of Shizuoka, Shizuoka, Japan
| | - Kousuke Morioka
- Laboratory of Nutritional Physiology, Graduate School of Nutritional and Environmental Sciences, Global COE Program, University of Shizuoka, Shizuoka, Japan
| | - Toshinao Goda
- Laboratory of Nutritional Physiology, Graduate School of Nutritional and Environmental Sciences, Global COE Program, University of Shizuoka, Shizuoka, Japan
| | - Kazuki Mochizuki
- Laboratory of Nutritional Physiology, Graduate School of Nutritional and Environmental Sciences, Global COE Program, University of Shizuoka, Shizuoka, Japan; Laboratory of Food and Nutritional Sciences, Faculty of Life and Environmental Sciences, University of Yamanashi, Yamanashi, Japan.
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Eisenhofer G, Rivers G, Rosas AL, Quezado Z, Manger WM, Pacak K. Adverse drug reactions in patients with phaeochromocytoma: incidence, prevention and management. Drug Saf 2008; 30:1031-62. [PMID: 17973541 DOI: 10.2165/00002018-200730110-00004] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The dangers of phaeochromocytomas are mainly due to the capability of these neuroendocrine tumours to secrete large quantities of vasoactive catecholamines, thereby increasing blood pressure and causing other related adverse events or complications. Phaeochromocytomas are often missed, sometimes only becoming apparent during therapeutic interventions that provoke release or interfere with the disposition of catecholamines produced by the tumours. Because phaeochromocytomas are rare, evidence contraindicating use of specific drugs is largely anecdotal or based on case reports. The heterogeneous nature of the tumours also makes adverse reactions highly variable among patients. Some drugs, such as dopamine D(2) receptor antagonists (e.g. metoclopramide, veralipride) and beta-adrenergic receptor antagonists (beta-blockers) clearly carry high potential for adverse reactions, while others such as tricyclic antidepressants seem more inconsistent in producing complications. Other drugs capable of causing adverse reactions include monoamine oxidase inhibitors, sympathomimetics (e.g. ephedrine) and certain peptide and corticosteroid hormones (e.g. corticotropin, glucagon and glucocorticoids). Risks associated with contraindicated medications are easily minimised by adoption of appropriate safeguards (e.g. adrenoceptor blockade). Without such precautions, the state of cardiovascular vulnerability makes some drugs and manipulations employed during surgical anaesthesia particularly dangerous. Problems arise most often when drugs or therapeutic procedures are employed in patients in whom the tumour is not suspected. In such cases, it is extremely important for the clinician to recognise the possibility of an underlying catecholamine-producing tumour and to take the most appropriate steps to manage and treat adverse events and clinical complications.
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Affiliation(s)
- Graeme Eisenhofer
- Department of Clinical Chemistry and Laboratory Medicine, University of Dresden, Dresden, Germany.
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