Chemical screening methods for the diagnosis of pheochromocytoma

Goldenberg, Marcel; Serlin, Irving; Edwards, Theodora; Rapport, Maurice M.

doi:10.1016/0002-9343(54)90349-6

Cited by 133 publications

(21 citation statements)

References 27 publications

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“…Urinary NE excretion of hypertensive patients was previously found to be slightly elevated (11,12), reduced (15), and normal (16). It is there- fore interesting that the mean VMA excretions of normal and hypertensive subjects were the same in the present study.…”

Section: Resultssupporting

confidence: 72%

“…On the other hand, Goodall and co-workers (13), found high C14_ labeled VMA excretion from the first to the twenty-fourth hour after giving a normal subject NE-2-C14 intravenously. These findings suggest that the VMA excretion of a patient with a pheochromocytoma and paroxysmal hypertension may catechol determinations done by bioassay (11). be more consistently elevated than the NE excretion.…”

Section: Resultsmentioning

confidence: 84%

“…When 4 mg. of isopropylarterenol was administered by inhalation and when 37.5 mg. was given sublingually, the VMA excretion of two normal subjects remained at control levels. DISCUSSION Previous studies demonstrated that no more than 1.5 to 4 per cent of parenterally administered NE appeared unchanged in the urine (11,12). More recently Goodall, Kirshner and Rosen (13) confirmed these findings by recovering only 4 per cent of parenterally administered NE-2-C4 in the unchanged form in the urine.…”

Section: Resultsmentioning

confidence: 87%

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The Diagnosis of Pheochromocytoma by Determination of Urinary 3-Methoxy,4-Hydroxymandelic Acid*†

Gitlow¹,

Mendlowitz²,

Khassis³

et al. 1960

J. Clin. Invest.

118

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In 1957, Armstrong, McMillan and Shaw demonstrated a metabolite of epinephrine (E) and norepinephrine (NE) in normal human urine (2, 3). This substance, 3-methoxy,4-hydroxymandelic acid (VMA, for vanillylmandelic acid), was excreted in abnormally large amounts in three patients with pheochromocytomas (3). Recent studies of sympathomimetic amine metabolism (Figure 1) (4-7) suggested that the urinary excretion of the degradation products of E and NE, such as their 3-methylated derivatives (M and NM respectively) and VMA, might exceed E and NE excretion by some 10-or 20-fold. The diagnosis of pheochromocytoma might therefore be facilitated by analysis of urine for these phenolic compounds.Armstrong, Shaw and Wall's chromatographic technique for determination of urinary VMA (8, 9) was modified and used for the quantitative determination of VMA excretion in the urines of OH

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Section: Resultssupporting

confidence: 72%

Section: Resultsmentioning

confidence: 84%

Section: Resultsmentioning

confidence: 87%

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The Diagnosis of Pheochromocytoma by Determination of Urinary 3-Methoxy,4-Hydroxymandelic Acid*†

Gitlow¹,

Mendlowitz²,

Khassis³

et al. 1960

J. Clin. Invest.

118

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“…contained up to 18 per cent nor-epinephrine was confirmed by Tullar (3) and Auerbach and Angell (4). Subsequently, nor-epinephrine was found in varying proportions in the adrenal medullary extracts of several mammalian species, including man, and it has been shown that the majority of pheochromocytomas contain larger amounts of nor-epinephrine than of epinephrine (5).…”

mentioning

confidence: 88%

A Comparison of the Metabolic and Circulatory Effects of Epinephrine, Nor-Epinephrine and Insulin Hypoglycemia With Observations on the Influence of Autonomic Blocking Agents 1

Disalvo¹,

Bloom²,

Brust³

et al. 1956

J. Clin. Invest.

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Interest in adrenal medullary function has been revived in recent years by the demonstration that the adrenal medulla produces two hormones, epinephrine and nor-epinephrine. Nor-epinephrine, which is also produced by adrenergic nerves (1), differs in its chemical structure from epinephrine by the absence of an N-methyl group, and is the probable precursor of epinephrine. The observation by Goldenberg, Faber, Alston, and Chargaff (2) that adrenal medullary extract from cattle (natural epinephrine, U.S.P.) contained up to 18 per cent nor-epinephrine was confirmed by Tullar (3) and Auerbach and Angell (4). Subsequently, nor-epinephrine was found in varying proportions in the adrenal medullary extracts of several mammalian species, including man, and it has been shown that the majority of pheochromocytomas contain larger amounts of nor-epinephrine than of epinephrine (5).Although the cardiovascular effects of these hormones in man have been well established (6), there are few studies concerning their comparative metabolic effects. It is highly probable that in many of the early studies of the circulatory and metabolic effects of epinephrine, mixtures which contained varying proportions of nor-epinephrine were used, since it was demonstrated in 1948 that adrenal medullary extract from cattle produced a rise in blood sugar in the rabbit comparable to that obtained with a mixture of 75 per cent epinephrine and 25 per cent nor-epinephrine, rather than that obtained with pure epinephrine (7).The similarity of the responses which occur during insulin hypoglycemia to those produced 'The work described in this paper was aided in part by grants from the Life Insurance Medical Research Fund and the Georgia Heart Association. by the administration of epinephrine, and the presence of increased amounts of epinephrine in the blood and urine during hypoglycemia (8, 9), have led to the general belief that increased adrenal medullary secretion during insulin hypoglycemia is in part responsible for the symptoms produced and for spontaneous recovery of the blood glucose level. This is further suggested by the observation in rats that a rise in blood lactic acid, similar to that which results from the administration of epinephrine, also occurs during insulin hypoglycemia. The lactic acidemia induced by hypoglycemia can be prevented by adrenal medullectomy (10).This study was undertaken 1) to evaluate certain metabolic and circulatory effects of pure epinephrine and nor-epinephrine in man and to compare these effects with those induced by insulin hypoglycemia, and 2) to determine the effect of an autonomic blocking agent on certain circulatory and metabolic changes which occur during insulin hypoglycemia in order to throw light on the mechanisms involved in these changes. MATERIAL AND METHODSAll subjects were free of metabolic or cardiovascular disease and fasted for at least 12 hours without physical activity or sedation. Throughout the study, blood pressure was measured at one-minute intervals by the auscultatory method. Pulse rate wa...

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“…This may signify similar rapid turnover of the amine in sympathetic nerves. Considering the fact that only a small percentage of norepinephrine entering the blood is excreted in the urine (17,18), it can be concluded from the amounts of norepinephrine in the urines and tumors in Cases 5 and 6 that release of an amount equivalent to the entire tumor pool over a period of 24 hours would be required to produce the amount of urinary norepinephrine found daily in each case. This is entirely consistent with the experimentally determined turnover rates for tumor norepinephrine.…”

Section: Discussionmentioning

confidence: 99%

Studies on the Biogenesis and Metabolism of Norepinephrine in Patients With Pheochromocytoma*

Sjoerdsma¹,

Leeper²,

Terry³

et al. 1959

J. Clin. Invest.

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Chemical screening methods for the diagnosis of pheochromocytoma

Cited by 133 publications

References 27 publications

The Diagnosis of Pheochromocytoma by Determination of Urinary 3-Methoxy,4-Hydroxymandelic Acid*†

The Diagnosis of Pheochromocytoma by Determination of Urinary 3-Methoxy,4-Hydroxymandelic Acid*†

A Comparison of the Metabolic and Circulatory Effects of Epinephrine, Nor-Epinephrine and Insulin Hypoglycemia With Observations on the Influence of Autonomic Blocking Agents 1

Studies on the Biogenesis and Metabolism of Norepinephrine in Patients With Pheochromocytoma*

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