Correspondence decreased intracellular calcium availability which is necessary for the secretion of kallikrein [2].The exact mechanisms whereby adrenaline causes the release of kallikrein is unknown, but it is known that it acts via adrenoceptors [3]. If adrenaline acts via cyclic AMP as a second messenger it would suggest that adrenaline is safer when given with somatostatin than when given alone. In the case described, when there was difficulty weaning the patient from cardiopulmonary bypass, it may have been the somatostatin itself which gave rise t o the need for adrenaline, for it has recently been shown that in an animal model [4], somatostatin is a negative inotrope.The use of adrenaline, and particularly an adrenaline infusion, should be considered part of a rational approach to weaning from cardiopulmonary bypass in those patients with the carcinoid syndrome who are also receiving somatostatin. Northwick Park Hospital, Harrow, Middlesex HA1 3UJ M.H. CROSS ReferencesLEVINE J, SJOERDSMA A. Pressor amines and the carcinoid flush.
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