SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The importance of neuronal reuptake for terminating the actions of noradrenaline is well established, but the role of extraneuronal uptake is less clear. This study used plasma concentrations of the extraneuronal noradrenaline metabolite, normetanephrine, to estimate rates of extraneuronal removal of noradrenaline in rats. Animals received infusions of 3H-noradrenaline, with and without inhibition of catechol-O-methyltransferase (COMT) and monoamine oxidase (MAO), to examine the extraneuronal removal of noradrenaline and formation of normetanephrine from infused and endogenous noradrenaline. Infusions of 3H-normetanephrine were also carried out to examine the plasma kinetics of normetanephrine before and after inhibition of MAO. Normetanephrine was cleared rapidly from the circulation and had a short plasma halflife (1 min). Spillover of normetanephrine into plasma (79 pmol kg-1 min-1) was a third that of noradrenaline, but increased 2.8-fold after inhibition of MAO; noradrenaline spillover remained unchanged. Combined inhibition of MAO and COMT decreased the plasma clearance of 3H-noradrenaline by 38%, reflecting removal of 3H-noradrenaline by extraneuronal uptake. Division of the rate of extraneuronal removal of 3H-noradrenaline by the specific activity of plasma 3H-normetanephrine during the 3H-noradrenaline infusion indicated that the rate of extraneuronal removal of endogenous noradrenaline was 250 pmol kg-1 min-1; this was close to the spillover of normetanephrine into plasma after inhibition of MAO (219 pmol kg-1 min-1). Forty-five% of plasma normetanephrine was derived from circulating noradrenaline and 55% from noradrenaline before entry into the circulation. Assuming that these proportions reflected the sources of noradrenaline metabolized extraneuronally indicated that the rate of extraneuronal metabolism of noradrenaline before entry into the circulation was 138 pmol kg-1 min-1. Comparison of this with the rates at which noradrenaline was recaptured by sympathetic nerves (2540 pmol kg-1 min-1) or spilled over into plasma (228 pmol kg-1 min-1), indicated that 87% of the noradrenaline released by sympathetic nerves was recaptured, 5% was metabolized extraneuronally and 8% escaped into plasma. Thus, extraneuronal uptake removes much less of the noradrenaline released by sympathetic nerves than neuronal reuptake.
Sensitive and specific radioimmunoassays of metanephrine and normetanephrine were developed by use of 125I-labeled synephrine and specific metanephrine antibody, and 125I-labeled octopamine and specific normetanephrine antibody. Specific antibody for both metanephrine and normetanephrine was raised in rabbits by immunization with bovine serum albumin conjugated with the corresponding hapten, prepared by the method of Grota and Brown (Endocrinology 1976;98:615). The detection limits of the metanephrine and the normetanephrine radioimmunoassays were 2 and 6 pg/tube, respectively. Mean plasma metanephrine and normetanephrine values for 24 normal subjects were 62 (SD 14) and 100 (SD 40) ng/L, respectively. Mean urinary metanephrine and normetanephrine values for 22 normal subjects were 154 (SD 74) and 217 (SD 109) micrograms/day. For 14 pheochromocytoma patients, plasma metanephrine and normetanephrine values ranged from 29 to 683 and from 28 to 7850 ng/L, and urinary metanephrine and normetanephrine values were 606 to 6630 and 296 to 4800 micrograms/day, respectively. The present methods are simple and suitable for routine tests or for mass screening for pheochromocytoma.
BACKGROUND: The detection of pheochromocytomas in patients at risk for these tumors, such as patients with von Hippel-Lindau disease or multiple endocrine neoplasia type 2 (MEN-2), is hindered by the inadequate sensitivity of commonly available biochemical tests. In this study we evaluated measurements of plasma normetanephrine and metanephrine for detecting pheochromocytomas in patients with von Hippel-Lindau disease or MEN-2. METHODS: We studied 26 patients with von Hippel-Lindau disease and 9 patients with MEN-2 who had histologically verified pheochromocytomas and 50 patients with von Hippel-Lindau disease or MEN-2 who had no radiologic evidence of pheochromocytoma. Von Hippel-Lindau disease and MEN-2 were diagnosed on the basis of germ-line mutations of the appropriate genes. The plasma concentrations of normetanephrine and metanephrine were compared with the plasma concentrations of catecholamines (norepinephrine and epinephrine) and urinary excretion of catecholamines, metanephrines, and vanillylmandelic acid. RESULTS: The sensitivity of measurements of plasma normetanephrine and metanephrine for the detection of tumors was 97 percent, whereas the other biochemical tests had a sensitivity of only 47 to 74 percent. All patients with MEN-2 had high plasma concentrations of metanephrine, whereas the patients with von Hippel-Lindau disease had almost exclusively high plasma concentrations of only normetanephrine. One patient with von Hippel-Lindau disease had a normal plasma normetanephrine concentration; this patient had a very small adrenal tumor (<1 cm). The high sensitivity of measurements of plasma normetanephrine and metanephrine was accompanied by a high level of specificity (96 percent). CONCLUSIONS: Measurements of plasma normetanephrine and metanephrine are useful in screening for pheochromocytomas in patients with a familial predisposition to these tumors.
Intraperitoneal administration of pargyline HCl induced a dose-dependent accumulation of 3-methoxytyramine and normetanephrine in mouse brain in vivo. As judged by the decrease of 5-hydroxyindole acetic acid levels a dose of 200 mg/kg of pargyline appeared to inhibit monoamine oxidase completely. This dose led to an approximately linear accumulation of 3-methoxytyramine and normetanephrine during the first 3 hours. gamma-Butyrolactone, 750 mg/kg i.p. reduced the accumulation of 3-methoxytyramine despite a marked increase of dopamine. (+)-Amphetamine stimulated 3-methoxytyramine as well as normetanephrine accumulation at doses of 3 and 10 mg/kg i.p. In line with the concept of receptor-mediated negative feedback control of catecholaminergic transmission the dopamine receptor agonists apomorphine, 0.3 mg/kg i.p., lisuride, 0.05--0.3 mg/kg i.p., and bromocriptine, 10 mg/kg i.p., decrease 3-methoxytyramine formation while the dopamine receptor blocking agent haloperidol, 1 mg/kg i.p., led to a 3-fold increase. The alpha-adrenoceptor agonist clonidine, 0.1 mg/kg i.p., reduced the formation of normetanephrine and the alpha-adrenoceptor antagonists yohimbine, 10 mg per kg i.p., phenoxybenzamine, 20 mg/kg i.p., and mianserine, 50 mg/kg i.p., stimulated normetanephrine accumulation 1.5- to 4-fold. 3-Methoxytyramine and normetanephrine accumulating after inhibition of monoamine oxidase appear to be reliable indicators of dopamine and noradrenaline release and metabolism.
BACKGROUND: Intravenous epinephrine (EPI) is used as a pharmacologic agent to acutely treat patients in cardiac arrest. Unfortunately, there have been several homicide cases where hospitalized patients died due to a purposeful overdose of epinephrine. We measured plasma epinephrine metabolites (metanephrine, MET, and normetanephrine, NMET) to determine if exogenous epinephrine can be distinguished from endogenous epinephrine concentrations in a controlled animal study. METHODS: Rabbits were subjected to three different protocols. In the physiologic stress group (n=8), rabbits were immobilized for 30 min in a restraining tube. In the sub-lethal dose (n=9), 0.01 mg/kg of epinephrine was injected into anesthetized rabbits. In the lethal dose group (n=8), 1.0 mg/kg of epinephrine was administered into anesthetized rabbits. Blood was collected at regular intervals for up to 480 min. The plasma metanephrine and normetanephrine concentrations were measured by liquid chromatography/mass spectrometry and the serum cortisol concentrations by immunoassay. RESULTS: Serum cortisol and plasma metanephrine and normetanephrine concentrations increased in the stressed animals during immobilization demonstrating the endogenous stress model. Following a sub-therapeutic epinephrine dose, plasma metanephrine increased while plasma normetanephrine decreased. The peak plasma metanephrine concentrations were similar to the concentrations observed in the stressed animals; however, the ratio of plasma metanephrine to normetanephrine was significantly different. In the lethal epinephrine dose, both the plasma metanephrine concentrations and ratio of metabolites were significantly greater than those observed in the endogenously stressed animals. CONCLUSIONS: The ratio of plasma metanephrine to normetanephrine is the best marker to determine the presence of exogenous therapeutic and lethal epinephrine administration. However, there were limitations to the study design that could alter these conclusions.
1. Normetanephrine was measured in small samples of plasma and urine of hypertensive patients and normal volunteers (age 20-60 years) by a specific radioenzymatic assay with bovine adrenal phenylethanolamine N-methyltransferase and tritiated S-adenosylmethionine. 2. Noradrenaline was measured simultaneously in plasma and urine. 3. Plasma normetanephrine and noradrenaline concentrations varied in direct proportion to activation or suppression of sympathetic nerve function. 4. Both plasma and urinary normetanephrine concentrations were elevated in patients with phaeochromocytoma. 5. Plasma normetanephrine concentrations were related to plasma noradrenaline concentrations of hypertensive subjects. 6. Plasma normetanephrine and noradrenaline concentrations and urinary normetanephrine excretion rates were increased in some young patients with primary hypertension, suggesting that sympathetic nerve hyperactivity is a pathogenic factor in these patients.
The development of a separation fluoroimmunoassay for urinary normetanephrine is described. Antiserum specific to normetanephrine was coupled, using cyanogen bromide, to magnetizable cellulose; and fluorescein labelled normetanephrine was synthesized from fluoresceinthiocarbamylethylene diamine and a previously described normetanephrine derivative. Using these reagents it was possible to construct a reproducible standard curve, covering a wide range of concentrations, and to accurately measure the concentration of this metabolite in acid-hydrolysed urine samples. Cross-reactivities of structurally similar compounds were low and the fluoroimmunoassay showed good correlation with an established gas-chromatographic assay. The procedure is rapid; it is possible to accurately determine the normetanephrine concentration of urine samples approximately 2 h after hydrolysis, resulting in an overall assay time of approximately 4 h. This is the first report of a non-isotopic immunoassay for normetanephrine.
BACKGROUND: Widely used HPLC methods for quantification of metanephrine and normetanephrine in urine often have long analysis times and are frequently plagued by drug interferences. We describe a gas chromatography-mass spectrometry method designed to overcome these limitations. METHODS: Metanephrine and normetanephrine conjugates were converted to unconjugated metanephrine and normetanephrine by acid hydrolysis. To avoid the rapid decomposition of the deuterated internal standards (metanephrine-d(3) and normetanephrine-d(3)) under hydrolysis conditions, the internal standards were added after hydrolysis. Solid-phase extraction was used to isolate the hydrolyzed metanephrines from urine. Samples were concentrated by evaporation, then derivatized simultaneously with N-methyl-N-(trimethylsilyl)trifluoroacetamide and N-methyl-bis-heptafluoro-butryamide at room temperature. RESULTS: The assay was linear from 25 to 7000 microg/L. The intraassay CVs were < 5 % and the interassay CVs < 12%. Comparison with a routine HPLC method (n = 192) by Deming regression yielded a slope of 1.00 +/- 0.02 microg/L, an intercept of -5.8 +/- 7.8 micro/L, and S(y/x) = 50.6 microg/L for metanephrine and a slope of 0.94 +/- 0.03, intercept of 19 +/- 11 microg/L, and S(y/x) = 60 microg/L for normetanephrine. The correlation coefficients (r) were calculated after log transformation of the data and gave r = 0.97 for metanephrine and r = 0.97 for normetanephrine. Interference from common medications or drug metabolites was seen in <1% of samples. The time between sequential injections was < 7 min. CONCLUSIONS: This new gas chromatography-mass spectrometry assay for total fractionated metanephrines is rapid, compares well with a standard HPLC assay, and avoids most drug interferences that commonly affect HPLC assays for urine metanephrines.
The metabolism of 3H-noradrenaline released by nerve stimulation in the isolated nerve-muscle preparation of the cat nictitating membrane was determined under control conditions and in the presence of hydrocortisone, 28 muM, a concentration which inhibits the high affinity extraneuronal uptake of noradrenaline in this tissue. In the controls the main fraction in the overflow elicited by stimulation at 10 Hz during 2 min was the deaminated glycol, 3H-DOPEG (3,4-dihydroxyphenylglycol), which accounted for 45.2 +/- 2.96% of the total radioactivity. Under these conditions, 3H-noradrenaline represented 30.8 +/- 1.92%, while 3H-normetanephrine accounted for 14.5 +/- 0.94% of the total overflow of radioactivity. During exposure to hydrocortisone there was a selective inhibition in 3H-normetanephrine formation from 3H-noradrenaline released by stimulation while the other fractions were not affected significantly. In contrast to these results, there were no changes in the spontaneous outflow of 3H-normetanephrine during exposure to hydrocortisone. The results obtained support the view that 3H-normetanephrine in spontaneous release originates from the activity of prejunctional catechol-O-methyltransferase. On the other hand, 3H-normetanephrine formed during transmitter release elicited by nerve stimulation is due to the activity of extraneuronal catechol-O-methyltransferase. Access of 3H-noradrenaline released by nerve stimulation to extraneuronal catechol-O-methyltransferase is mediated through the high-affinity, hydrocortisone-sensitive extraneuronal uptake mechanism.
A procedure has been developed for determining the O-methylated catecholamine metabolites, normetanephrine and metanephrine, in urine by use of radial-compression liquid chromatography followed by electrochemical detection. Normetanephrine and metanephrine are isolated from hydrolyzed urine by ion-exchange on small, commercially available, disposable columns and preconcentrated by solvent extraction. They are then separated by reversed-phase ion-pair chromatography, with use of a radial compression cartridge and radial compression module, and quantified with 3-methoxy-4-hydroxybenzylamine as internal standard. Normetanephrine, metanephrine, and the internal standard are separated from interfering peaks in about 15 min. The method is applicable to the relatively low amounts of normetanephrine (100-600 micrograms/24 h) and metanephrine (50-400 micrograms/24 h) found in normal subjects and patients with depressive disorders or hypertension. Within-day CVs ranged from 1.1 to 2.2% for normetanephrine and 1.2 to 6.9% for metanephrine; the corresponding between-day CVs were 4.9 and 5.7% over these ranges.
PURPOSE: To determine the incidence and importance of functioning tumors among incidentally discovered adrenal masses in the era of laparoscopic surgery. METHODS: We defined adrenal incidentaloma as a tumor detected during abdominal imaging for adrenal-unrelated reasons, and we reviewed 197 consecutive patients with adrenal incidentaloma diagnosed since we started laparoscopic adrenalectomy. RESULTS: Incidentaloma was discovered initially in 91 (46%) patients and pheochromocytoma was detected as an incidentaloma in 21 (39%) of 54 patients. One patient, a 21-year-old woman taking mesalamine for ulcerative colitis, had a remarkably elevated urinary normetanephrine level, which resulted in the initial misdiagnosis of a 10-cm right adrenal incidentaloma as a pheochromocytoma. Laparoscopic right adrenalectomy resulted in a pathological diagnosis of ganglioneuroma. A series of urinary normetanephrine measurements were taken in parallel with the mesalamine doses. We found that other patients medicated with mesalamine, without adrenal tumors, had elevated urinary normetanephrine levels, confirming that mesalamine metabolites interfere with urinary normetanephrine measurements. CONCLUSIONS: It is essential to diagnose the functional potential of adrenal incidentaloma preoperatively, and not to perform laparoscopic adrenalectomy for adrenal incidentaloma without careful evaluation first.
A method for quantitation of normetanephrine in human cerebrospinal fluid is described. An amine-specific reagent, sulfosuccinimidyl propionate, is used to obtain the lipid soluble N-propionyl derivative of normetanephrine, which can be separated and quantitated in presence of other biogenic amines by liquid chromatography with electrochemical detection. The method is reproducible, linear, and precise at the relatively low concentrations of unconjugated normetanephrine occurring in human cerebrospinal fluid. Hospitalized, drug-free, alcoholic patients were found to have cerebrospinal fluid unconjugated normetanephrine concentrations in the 0.5-1.5 nanomolar range. The practical limit of sensitivity for the method is about 0.025 pmole per ml of CSF.
A radioenzymatic assay for determination of normetanephrine in blood plasma is described. It was based on N-methylation of normetanephrine by phenylethanolamine-N-methyltransferase using S-adenosyl[methyl-3]methionine as the methyl donor. 2981 +/- 85 cpm (mean +/- s mean, n = 32) were obtained from 1 ng normetanephrine. Blank values corresponded to 27 +/- 3 pg (n = 7). Normetanephrine levels measured in the blood plasma of 12 persons ranged from 1.3 to 9.6 ng/ml.
The effect of desmethylimipramine, metanephrine and normetanephrine on the neuronal and extraneuronal accumulation of radiolabelled adrenaline and noradrenaline were studied in the perfused spleen of the teleost fish, Atlantic cod, Gadus morhua. Desmethylimipramine was found to be a potent inhibitor for the neuronal accumulation of both adrenaline and noradrenaline in the cod spleen, suggesting similarities with the neuronal uptake mechanism in mammals. Metanephrine was found to inhibit the extraneuronal accumulation of noradrenaline, though not that of adrenaline, while normetanephrine did not change the extraneuronal accumulation of any of the catecholamines. Both metanephrine and normetanephrine were more potent neuronal uptake blockers than extraneuronal. Metanephrine inhibited only the neuronal accumulation of adrenaline, while normetanephrine inhibited neuronal accumulation of both catecholamines. It is concluded that adrenaline and noradrenaline accumulate differently in the adrenergic neurons of the cod spleen as was suggested earlier for noradrenaline and tyramine (Nilsson & Holmgren 1976). It is also evident from the study that the uptake mechanisms or accumulation of catecholamines in lower vertebrates such as fish may be different from corresponding mechanisms in mammals.