Exercise induces excessive normetanephrine responses in hypertensive diabetic patients

Raber, Wolfgang; Raffesberg, Wolfgang; Waldhäusl, W.; Gasić, S; Roden, Michael

doi:10.1046/j.1365-2362.2003.01155.x

Cited by 22 publications

(9 citation statements)

References 29 publications

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“…, 16 cycling exercise led to significantly elevated plasma normetanephrine. Similarly, Raber showed significant increases in normetanephrine during cycling exercise, but almost negligible raises in metanephrine 22 . These findings were confirmed by Bracken et al.…”

Section: Discussionsupporting

confidence: 61%

Influence of various confounding variables and storage conditions on metanephrine and normetanephrine levels in plasma

Deutschbein

Unger

Jaeger

et al. 2010

Clinical Endocrinology

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Section: Discussionsupporting

confidence: 61%

Influence of various confounding variables and storage conditions on metanephrine and normetanephrine levels in plasma

Deutschbein

Unger

Jaeger

et al. 2010

Clinical Endocrinology

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“…Plasma metanephrines are stable markers of catecholamine secretion and have previously been reported to reflect physiological stress and the sympathoadrenal response to cycling exercise (Raber et al 2003). The fact that PNORMET increased under all experimental conditions with exercise suggests that the protocol was sufficiently provocative to induce the required physiological stress.…”

Section: Discussionmentioning

confidence: 99%

Markers of physiological stress during exercise under conditions of normoxia, normobaric hypoxia, hypobaric hypoxia, and genuine high altitude

et al. 2017

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PurposeTo investigate whether there is a differential response at rest and following exercise to conditions of genuine high altitude (GHA), normobaric hypoxia (NH), hypobaric hypoxia (HH), and normobaric normoxia (NN).MethodMarkers of sympathoadrenal and adrenocortical function [plasma normetanephrine (PNORMET), metanephrine (PMET), cortisol], myocardial injury [highly sensitive cardiac troponin T (hscTnT)], and function [N-terminal brain natriuretic peptide (NT-proBNP)] were evaluated at rest and with exercise under NN, at 3375 m in the Alps (GHA) and at equivalent simulated altitude under NH and HH. Participants cycled for 2 h [15-min warm-up, 105 min at 55% Wmax (maximal workload)] with venous blood samples taken prior (T0), immediately following (T120) and 2-h post-exercise (T240).ResultsExercise in the three hypoxic environments produced a similar pattern of response with the only difference between environments being in relation to PNORMET. Exercise in NN only induced a rise in PNORMET and PMET.ConclusionBiochemical markers that reflect sympathoadrenal, adrenocortical, and myocardial responses to physiological stress demonstrate significant differences in the response to exercise under conditions of normoxia versus hypoxia, while NH and HH appear to induce broadly similar responses to GHA and may, therefore, be reasonable surrogates.

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“…Moreover, the physiologic cause for the observed relationship of normetanephrine measurements with age is unclear. Of note, Raber et al have noted exaggerated increases in plasma normetanephrine after exercise in hypertensive individuals with type 2 diabetes, compared to normotensive individuals with or without diabetes [20]. Furthermore, Raber et al have suggested that the excessive response of plasma normetanephrine to exercise may serve as a marker of exaggerated sympathoadrenal function in hypertensive type 2 diabetics [20].…”

Section: Discussionmentioning

confidence: 99%

“…Of note, Raber et al have noted exaggerated increases in plasma normetanephrine after exercise in hypertensive individuals with type 2 diabetes, compared to normotensive individuals with or without diabetes [20]. Furthermore, Raber et al have suggested that the excessive response of plasma normetanephrine to exercise may serve as a marker of exaggerated sympathoadrenal function in hypertensive type 2 diabetics [20]. Fractionated plasma metanephrine measurements were performed only at rest in our study and we did not examine any potential relationship with diabetes.…”

Section: Discussionmentioning

confidence: 99%

Measurement of fractionated plasma metanephrines for exclusion of pheochromocytoma: Can specificity be improved by adjustment for age?

et al. 2005

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BackgroundBiochemical testing for pheochromocytoma by measurement of fractionated plasma metanephrines is limited by false positive rates of up to 18% in people without known genetic predisposition to the disease. The plasma normetanephrine fraction is responsible for most false positives and plasma normetanephrine increases with age. The objective of this study was to determine if we could improve the specificity of fractionated plasma measurements, by statistically adjusting for age.MethodsAn age-adjusted metanephrine score was derived using logistic regression from 343 subjects (including 33 people with pheochromocytoma) who underwent fractionated plasma metanephrine measurements as part of investigations for suspected pheochromocytoma at Mayo Clinic Rochester (derivation set). The performance of the age-adjusted score was validated in a dataset of 158 subjects (including patients 23 with pheochromocytoma) that underwent measurements of fractionated plasma metanephrines at Mayo Clinic the following year (validation dataset). None of the participants in the validation dataset had known genetic predisposition to pheochromocytoma.ResultsThe sensitivity of the age-adjusted metanephrine score was the same as that of traditional interpretation of fractionated plasma metanephrine measurements, yielding a sensitivity of 100% (23/23, 95% confidence interval [CI] 85.7%, 100%). However, the false positive rate with traditional interpretation of fractionated plasma metanephrine measurements was 16.3% (22/135, 95% CI, 11.0%, 23.4%) and that of the age-adjusted score was significantly lower at 3.0% (4/135, 95% CI, 1.2%, 7.4%) (p < 0.001 using McNemar's test).ConclusionAn adjustment for age in the interpretation of results of fractionated plasma metanephrines may significantly decrease false positives when using this test to exclude sporadic pheochromocytoma. Such improvements in false positive rate may result in savings of expenditures related to confirmatory imaging.

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Exercise induces excessive normetanephrine responses in hypertensive diabetic patients

Abstract: The excessive response of plasma unconjugated normetanephrine to cycling may serve as a marker of exaggerated sympathoadrenal function in hypertensive type-2 diabetic patients.

Cited by 22 publications

References 29 publications

Influence of various confounding variables and storage conditions on metanephrine and normetanephrine levels in plasma

Influence of various confounding variables and storage conditions on metanephrine and normetanephrine levels in plasma

Markers of physiological stress during exercise under conditions of normoxia, normobaric hypoxia, hypobaric hypoxia, and genuine high altitude

Measurement of fractionated plasma metanephrines for exclusion of pheochromocytoma: Can specificity be improved by adjustment for age?

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