Pattern of elevation of urine catecholamines in intracerebral haemorrhage

Abstract

Autonomic nervous system dysfunction is a common complication of severe intracranial disease. The aim of this study was to reveal the autonomic changes in patients suffering from acute intracerebral haemorrhage (ICH). 25 patients with spontaneous ICH within 24 hours of onset of symptoms were included. All patients were treated with standardised medical management and the meta- and normetanephrines were detected by high performance liquid chromatography (HPLC) in 24-hour urine every day. The mean level of normetanephrine (709 +/- 579 micrograms/day) and metanephrine (244 +/- 161 mg/day) were significantly elevated in comparison with a control group, p < or = 0.01. The norepinephrine elevation was of greater diagnostic and prognostic importance. Maximum urinary catecholamine metabolite levels occurred between day 3 to 10 after the bleeding. Normetanephrines correlated with the prognosis and the complications of ICH: intraventricular involvement resulted in significantly elevated normetanephrine levels (896 +/- 520 micrograms/day versus 311 +/- 78 micrograms/day) p < or = 0.01. Patients with a great volume of haematoma developed severe autonomic dysregulation (normetanephrines 1114 +/- 493 micrograms/day), whereas patients with smaller haematoma did not (339 +/- 125 micrograms/day) p < or = 0.0001; patients with bad outcome (1014 +/- 620 mg/day) had higher levels of normetanephrines than those with a good prognosis (322 +/- 110 micrograms/day) p < or = 0.001. A close relationship to elevated intracranial pressure was established. This study demonstrated the feasibility of detecting autonomic nervous system dysfunction in neurological intensive care patients by means of examination of the metabolites of the catecholamines in the urine.(ABSTRACT TRUNCATED AT 250 WORDS)

Primary Aldosteronism Presenting with an Atypical Aldosterone-renin Ratio in the Acute Phase of Cerebral Hemorrhage

“…In the present case, the morning plasma catecholamine and urinary normetanephrine levels were elevated on days 2 and day 7, respectively, and remained within two-fold of the upper limit of normal, although the urinary normetanephrine value normalized on day 12. These findings are significant and may have affected the ARR, although they were relatively mild compared with those of previous reports (15,16,18).…”

“…In that case, the plasma norepinephrine and urinary metanephrine levels were elevated to approximately five times above the upper limit of normal at presentation and normalized on day 23. In the acute phase of intracranial hemorrhage, sympathetic nerve activation occurs secondary to an elevated intracranial pressure (16), which stimulates renin secretion (17). Leow et al (18) reported an excessive amount of catecholamines and metanephrine triggered by sympathetic dysautonomia in the setting of acute intracranial hemorrhage, describing this phenomena as "biochemically pseudopheochromocytoma," as the plasma catecholamine and urinary metabolite levels mimic the endocrinological laboratory findings of pheochromocytoma.…”

“…Leow et al (18) reported an excessive amount of catecholamines and metanephrine triggered by sympathetic dysautonomia in the setting of acute intracranial hemorrhage, describing this phenomena as "biochemically pseudopheochromocytoma," as the plasma catecholamine and urinary metabolite levels mimic the endocrinological laboratory findings of pheochromocytoma. Patients with a large hematoma volume develop significantly elevated urinary catecholamine metabolite levels (16). In most cases of acute cerebral hemorrhage without pheochromocytoma, however, the increase in plasma catecholamines and urinary metabolites is slight to moderate and the levels remain within three-to five-fold of the upper limit of normal (15)(16)(17).…”

“…Patients with a large hematoma volume develop significantly elevated urinary catecholamine metabolite levels (16). In most cases of acute cerebral hemorrhage without pheochromocytoma, however, the increase in plasma catecholamines and urinary metabolites is slight to moderate and the levels remain within three-to five-fold of the upper limit of normal (15)(16)(17). Therefore, it is not generally difficult to make the differential diagnosis of pheochromocytoma.…”

Autonomic Effects of Intraventricular Extension in Intracerebral Hemorrhage

“…Autonomic changes also underlie the poststroke immunodepression syndrome with increased susceptibility to infection after ICH [10]. Indeed, several studies confirmed negative outcome effects of autonomic impairment after intracerebral or subarachnoid hemorrhage [1,32,33]. Interestingly, we found that both IVH score and BRS were associated with admission hyperglycemia, blood pressure elevations, and leukocytosis at admission.…”