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彭 圣, 祁 雨, 孙 丽, 李 丹, 王 新, 韩 江, 陈 宝, 张 媛. [Afferent baroreflex failure with hyponatremia: A case report]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2024; 56:357-361. [PMID: 38595258 PMCID: PMC11004967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Indexed: 04/11/2024]
Abstract
Afferent baroreflex failure (ABF) is a rare disease. It refers to the clinical syndrome caused by the impairment of the afferent limb of the baroreflex or its central connections at the level of the medulla. The recognized causes include trauma, surgery in related areas (radical neck tumor surgery, carotid endarterectomy), neck radiotherapy, brain stem stroke, tumor growth paraganglioma and hereditary diseases, among which the most common cause is extensive neck surgery or radiotherapy for neck cancer. The main manifestations are fluctuating hypertension, orthostatic hypotension, paroxysmal tachycardia and bradycardia. This case is a young man, whose main feature is blood pressure fluctuation, accom-panied by neurogenic orthostatic hypotension (nOH). After examination, the common causes of hypertension and nOH were ruled out. Combined with the previous neck radiotherapy and neck lymph node dissection, it was considered that the blood pressure regulation was abnormal due to the damage of carotid sinus baroreceptor after radiotherapy for nasopharyngeal carcinoma and neck lymph node dissection, which was called ABF. At the same time, the patient was complicated with chronic hyponatremia. Combined with clinical and laboratory examination, the final consideration was caused by syndrome of in- appropriate antidiuretic hormone (SIADH). Baroreceptors controlled the secretion of heart rate, blood pressure and antidiuretic hormone through the mandatory "inhibition" signal. We speculate that the carotid sinus baroreceptor was damaged after neck radiotherapy and surgery, which leads to abnormal blood pressure regulation and nOH, while the function of inhibiting ADH secretion was weakened, resulting in higher ADH than normal level and mild hyponatremia. The goal of treating ABF patients was to reduce the frequency and amplitude of sudden changes in blood pressure and heart rate, and to alleviate the onset of symptomatic hypotension. At present, drug treatment is still controversial, and non-drug treatment may alleviate some patients' symptoms, but long-term effective treatment still needs further study. The incidence of ABF is not high, but it may lead to serious cardiovascular and cerebrovascular events, and the mechanism involved is extremely complicated, and there are few related studies. The reports of relevant medical records warn that patients undergoing neck radiotherapy or surgery should minimize the da-mage to the baroreceptor in the carotid sinus in order to reduce the adverse prognosis caused by complications.
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Affiliation(s)
- 圣嘉 彭
- />北京大学第三医院心内科, 卫生部心血管分子生物学与调节肽重点实验室, 北京 100191Department of Cardiology, Peking University Third Hospital; Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptide, Ministry of Health, Beijing 100191, China
| | - 雨 祁
- />北京大学第三医院心内科, 卫生部心血管分子生物学与调节肽重点实验室, 北京 100191Department of Cardiology, Peking University Third Hospital; Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptide, Ministry of Health, Beijing 100191, China
| | - 丽杰 孙
- />北京大学第三医院心内科, 卫生部心血管分子生物学与调节肽重点实验室, 北京 100191Department of Cardiology, Peking University Third Hospital; Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptide, Ministry of Health, Beijing 100191, China
| | - 丹 李
- />北京大学第三医院心内科, 卫生部心血管分子生物学与调节肽重点实验室, 北京 100191Department of Cardiology, Peking University Third Hospital; Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptide, Ministry of Health, Beijing 100191, China
| | - 新宇 王
- />北京大学第三医院心内科, 卫生部心血管分子生物学与调节肽重点实验室, 北京 100191Department of Cardiology, Peking University Third Hospital; Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptide, Ministry of Health, Beijing 100191, China
| | - 江莉 韩
- />北京大学第三医院心内科, 卫生部心血管分子生物学与调节肽重点实验室, 北京 100191Department of Cardiology, Peking University Third Hospital; Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptide, Ministry of Health, Beijing 100191, China
| | - 宝霞 陈
- />北京大学第三医院心内科, 卫生部心血管分子生物学与调节肽重点实验室, 北京 100191Department of Cardiology, Peking University Third Hospital; Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptide, Ministry of Health, Beijing 100191, China
| | - 媛 张
- />北京大学第三医院心内科, 卫生部心血管分子生物学与调节肽重点实验室, 北京 100191Department of Cardiology, Peking University Third Hospital; Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptide, Ministry of Health, Beijing 100191, China
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Belna H, Fortrat JO, Augusto JF, Brilland B. Post-traumatic hypertension: when nerves break down. J Nephrol 2023; 36:2629-2632. [PMID: 37308776 DOI: 10.1007/s40620-023-01662-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/28/2023] [Indexed: 06/14/2023]
Affiliation(s)
- Hugo Belna
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, CHU Angers, 4 rue Larrey, 49033, Angers CEDEX 09, France
| | - Jacques-Olivier Fortrat
- Service de Médecine Vasculaire, Mitovasc UMR INSERM 1083-CNRS 6015, CHU Angers, Angers, France
| | - Jean-François Augusto
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, CHU Angers, 4 rue Larrey, 49033, Angers CEDEX 09, France
- Université d'Angers Inserm, CNRS, Nantes Université, CRCI2NA, Angers, France
| | - Benoit Brilland
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, CHU Angers, 4 rue Larrey, 49033, Angers CEDEX 09, France.
- Université d'Angers Inserm, CNRS, Nantes Université, CRCI2NA, Angers, France.
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Eisenhofer G, Pamporaki C, Lenders JWM. Biochemical Assessment of Pheochromocytoma and Paraganglioma. Endocr Rev 2023; 44:862-909. [PMID: 36996131 DOI: 10.1210/endrev/bnad011] [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: 09/28/2022] [Revised: 01/24/2023] [Accepted: 03/29/2023] [Indexed: 03/31/2023]
Abstract
Pheochromocytoma and paraganglioma (PPGL) require prompt consideration and efficient diagnosis and treatment to minimize associated morbidity and mortality. Once considered, appropriate biochemical testing is key to diagnosis. Advances in understanding catecholamine metabolism have clarified why measurements of the O-methylated catecholamine metabolites rather than the catecholamines themselves are important for effective diagnosis. These metabolites, normetanephrine and metanephrine, produced respectively from norepinephrine and epinephrine, can be measured in plasma or urine, with choice according to available methods or presentation of patients. For patients with signs and symptoms of catecholamine excess, either test will invariably establish the diagnosis, whereas the plasma test provides higher sensitivity than urinary metanephrines for patients screened due to an incidentaloma or genetic predisposition, particularly for small tumors or in patients with an asymptomatic presentation. Additional measurements of plasma methoxytyramine can be important for some tumors, such as paragangliomas, and for surveillance of patients at risk of metastatic disease. Avoidance of false-positive test results is best achieved by plasma measurements with appropriate reference intervals and preanalytical precautions, including sampling blood in the fully supine position. Follow-up of positive results, including optimization of preanalytics for repeat tests or whether to proceed directly to anatomic imaging or confirmatory clonidine tests, depends on the test results, which can also suggest likely size, adrenal vs extra-adrenal location, underlying biology, or even metastatic involvement of a suspected tumor. Modern biochemical testing now makes diagnosis of PPGL relatively simple. Integration of artificial intelligence into the process should make it possible to fine-tune these advances.
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Affiliation(s)
- Graeme Eisenhofer
- Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Christina Pamporaki
- Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Jacques W M Lenders
- Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
- Department of Internal Medicine, Radboud University Medical Centre, 6500 HB Nijmegen, The Netherlands
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Boddu SP, Goodman BP, VanderPluym JH. Headache rounds: Postural headache in a patient with squamous cell carcinoma. Headache 2023; 63:1186-1192. [PMID: 37635384 DOI: 10.1111/head.14615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 07/20/2023] [Accepted: 07/28/2023] [Indexed: 08/29/2023]
Affiliation(s)
- Sayi P Boddu
- Mayo Clinic Alix School of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
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Elkholey K, Wahba A, Paranjape SY, Saleem M, Kirabo A, Joos KM, Diedrich A, Shibao CA, Biaggioni I. Post-COVID-19 Afferent Baroreflex Failure. Hypertension 2023; 80:895-900. [PMID: 36802914 PMCID: PMC10112935 DOI: 10.1161/hypertensionaha.123.20316] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Affiliation(s)
- Khaled Elkholey
- Divisions of Clinical Pharmacology, Department of Medicine (K.E., A.W., S.P., M.S., S.K., A.D., C.A.S., I.B.), Vanderbilt University Medical Center, Nashville, TN
- Autonomic Dysfunction Center (K.E., A.W., S.Y.P., A.D., C.A.S., I.B.), Vanderbilt University Medical Center, Nashville, TN
| | - Amr Wahba
- Divisions of Clinical Pharmacology, Department of Medicine (K.E., A.W., S.P., M.S., S.K., A.D., C.A.S., I.B.), Vanderbilt University Medical Center, Nashville, TN
- Autonomic Dysfunction Center (K.E., A.W., S.Y.P., A.D., C.A.S., I.B.), Vanderbilt University Medical Center, Nashville, TN
| | - Sachin Y. Paranjape
- Divisions of Clinical Pharmacology, Department of Medicine (K.E., A.W., S.P., M.S., S.K., A.D., C.A.S., I.B.), Vanderbilt University Medical Center, Nashville, TN
- Autonomic Dysfunction Center (K.E., A.W., S.Y.P., A.D., C.A.S., I.B.), Vanderbilt University Medical Center, Nashville, TN
| | - Mohammad Saleem
- Divisions of Clinical Pharmacology, Department of Medicine (K.E., A.W., S.P., M.S., S.K., A.D., C.A.S., I.B.), Vanderbilt University Medical Center, Nashville, TN
| | - Annet Kirabo
- Divisions of Clinical Pharmacology, Department of Medicine (K.E., A.W., S.P., M.S., S.K., A.D., C.A.S., I.B.), Vanderbilt University Medical Center, Nashville, TN
- Autonomic Dysfunction Center (K.E., A.W., S.Y.P., A.D., C.A.S., I.B.), Vanderbilt University Medical Center, Nashville, TN
- and Vanderbilt Eye Institute (K.M.J.), Vanderbilt University Medical Center, Nashville, TN
| | - Karen M. Joos
- and Vanderbilt Eye Institute (K.M.J.), Vanderbilt University Medical Center, Nashville, TN
| | - André Diedrich
- Divisions of Clinical Pharmacology, Department of Medicine (K.E., A.W., S.P., M.S., S.K., A.D., C.A.S., I.B.), Vanderbilt University Medical Center, Nashville, TN
- Autonomic Dysfunction Center (K.E., A.W., S.Y.P., A.D., C.A.S., I.B.), Vanderbilt University Medical Center, Nashville, TN
| | - Cyndya A. Shibao
- Divisions of Clinical Pharmacology, Department of Medicine (K.E., A.W., S.P., M.S., S.K., A.D., C.A.S., I.B.), Vanderbilt University Medical Center, Nashville, TN
- Autonomic Dysfunction Center (K.E., A.W., S.Y.P., A.D., C.A.S., I.B.), Vanderbilt University Medical Center, Nashville, TN
| | - Italo Biaggioni
- Divisions of Clinical Pharmacology, Department of Medicine (K.E., A.W., S.P., M.S., S.K., A.D., C.A.S., I.B.), Vanderbilt University Medical Center, Nashville, TN
- Autonomic Dysfunction Center (K.E., A.W., S.Y.P., A.D., C.A.S., I.B.), Vanderbilt University Medical Center, Nashville, TN
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Clarke AJ, Swart G, Clifford AR, Milross C, Halmagyi GM, Spies J. Baroreflex failure as a long-term sequela of head and neck irradiation. J Neurol 2022; 270:2784-2788. [PMID: 36585529 DOI: 10.1007/s00415-022-11552-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/23/2022] [Accepted: 12/24/2022] [Indexed: 12/31/2022]
Affiliation(s)
- A J Clarke
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia. .,Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - G Swart
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia
| | - A R Clifford
- Department of Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - C Milross
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Department of Radiation Oncology, Chris O'Brien Lifehouse, Sydney, Australia
| | - G M Halmagyi
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - J Spies
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Golden EP, Park CJ, Vernino S. Symptomatic use of carbidopa in autonomic disorders. Auton Neurosci 2021; 236:102888. [PMID: 34610497 DOI: 10.1016/j.autneu.2021.102888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 08/30/2021] [Accepted: 09/23/2021] [Indexed: 11/30/2022]
Abstract
Carbidopa is being explored as a novel therapy for hyperadrenergic symptoms of autonomic disorders, due to its potential to decrease peripheral catecholamine levels. This study retrospectively characterized patients in our autonomic clinic who were prescribed carbidopa for open label treatment of autonomic symptoms. 23 patients were included; approximately half had postural orthostatic tachycardia syndrome. Those with documented plasma catecholamines had elevated standing norepinephrine. Patients typically had multiple comorbidities and multiple failed therapies. 19 took carbidopa (typically 25 mg three times daily); 12 continued it for longer than 3 months. 11 patients reported better symptom control with carbidopa, most commonly tremor and gastrointestinal dysfunction. 4 patients reported side effects. In this small retrospective study, carbidopa was well tolerated in patients with dysautonomia, and half reported symptomatic benefit. Larger, placebo-controlled trials are warranted for further investigation of this therapy.
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Affiliation(s)
- Elisabeth P Golden
- Department of Neurology, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, United States of America.
| | - Christine J Park
- Department of Neurology, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, United States of America
| | - Steven Vernino
- Department of Neurology, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, United States of America
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