Plasma catecholamines in diabetes

Cryer, Philip E.; Silverberg, Alan B.; Santiago, Julio V.; Shah, Suresh D.

doi:10.1016/0002-9343(78)90220-6

Cited by 160 publications

(30 citation statements)

References 18 publications

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“…The average norepinephrine level we obtained in nondiabetic subjects was virtually identical to average levels measured by others (including Cryer et al [37]) under similar circumstances (13). Moreover, the depressed baseline norepinephrine levels we measured in diabetic patients were associated with other evidence for sympathetic dysfunction, including lack of baroreflex modulation of norepinephrine levels and supranormal pressor responses to phenylephrine.…”

Section: Discussionsupporting

confidence: 88%

“…Subnormal baseline plasma norepinephrine levels have been found in diabetic patients previously, but usually in subsets of patients selected because they had other evidence for neuropathy (3,5,7,35,36). For example, Christensen (7) found subnormal total plasma catecholamine levels at rest in a group of nine diabetic patients who had diminished vibratory sensation, but Cryer, Silverberg, Santiago, and Shah (37) found normal average norepinephrine levels in a large group of patients who were unselected. We cannot explain fully the disparity between Cryer's findings and our own.…”

Section: Discussionmentioning

confidence: 99%

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Baroreflex control of plasma norepinephrine and heart period in healthy subjects and diabetic patients.

Eckberg¹,

Harkins²,

Fritsch³

et al. 1986

J. Clin. Invest.

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Resting diabetic patients may have excessively rapid heart rates, reduced heart rate variability, and subnormal plasma catecholamine levels. Although all of these abnormalities may relate in some way to baroreceptor reflex function, there have been surprisingly few attempts to evaluate systematically baroreflex mechanisms in diabetic patients. Accordingly, we studied autonomic responses over a range of pharmacologically induced arterial pressure changes in 10 unselected young adult insulindependent diabetic patients who had no symptoms of autonomic neuropathy, and 12 age-matched nondiabetic subjects. Sympathetic responses were estimated from antecubital vein plasma norepinephrine levels, and parasympathetic responses were estimated from electrocardiographic R-R intervals and their variability (standard deviation). Both were correlated with other noninvasive indexes of peripheral and central nervous system function. Multiple derangements of baroreflex function were found in the diabetic patients studied. Sympathetic abnormalities included subnormal baseline norepinephrine levels, virtual absence of changes of norepinephrine levels during changes of arterial pressure, and supranormal pressor responses to phenylephrine infusions. Parasympathetic abnormalities included subnormal baseline standard deviations of R-R intervals, and R-R interval prolongations during elevations ofarterial pressure which were unmistakably present, but subnormal. Our data suggest that in diabetic patients, subnormal baseline plasma norepinephrine levels may signify profound, possibly structural defects of sympathetic pathways. Subnormal resting levels of respiratory sinus arrhythmia may have different implications, however, since vagal, unlike sympathetic reflex abnormalities, can be reversed partly by arterial pressure elevations.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Baroreflex control of plasma norepinephrine and heart period in healthy subjects and diabetic patients.

Eckberg¹,

Harkins²,

Fritsch³

et al. 1986

J. Clin. Invest.

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“…The same investigator found normal basal plasma noradrenaline levels but impaired release during exercise in six juvenile diabetics with autonomic neuropathy [18]. In the study of non-ketotic diabetic patients by Cryer et al [12], seven of ten patients with postural hypotension had low plasma noradrenaline at rest and after standing. Beretta-Piccoli et al [1] reported that the incidence of postural hypotension was equally distributed between their diabetic patients with low and normal plasma noradrenaline.…”

Section: Discussionmentioning

confidence: 92%

“…While the results obtained from these studies indicate that plasma catecholamine levels in uncomplicated diabetes are normal, the frequency of sympathetic deficiency, as reflected by subnormal plasma noradrenaline concentrations, in diabetic autonomic neuropathy and its possible importance in relation to symptoms, such as postural hypotension, is less clear [1,9,10,12,19]. This uncertainty could be due, at least in part, to difficulties in the accurate measurement of catecholamine responses and also in the characterization of diabetic autonomic neuropathic syndromes.…”

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confidence: 88%

Plasma adrenaline and noradrenaline concentrations in diabetic patients with and without autonomic neuropathy at rest and during sympathetic stimulation

Caviezel

Picotti

Margonato³

et al. 1982

Diabetologia

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Summary. Plasma concentrations of adrenaline and noradrenaline were measured radio-enzymatically in nine patients with diabetic autonomic neuropathy, seven diabetic patients without autonomic neuropathy and nine normal subjects, in the recumbent position and after standing. Furthermore, in six patients with autonomic neuropathy and in the normal subjects, plasma noradrenaline and adrenaline concentrations were determined during and after cyclo-ergometer exercise. No differences in plasma adrenaline concentrations were found at any time in the study. Basal plasma noradrenaline levels were significantly lower in diabetic patients with autonomic neuropathy than in the non-neuropathic diabetics or healthy control subjects. After standing, plasma noradrenaline rose to significantly higher levels in both control and diabetic subjects without neuropathy than in the patients with autonomic neuropathy. During exercise (up to 100 W load), plasma noradrenaline rose to similar levels in healthy controls and in patients with diabetic neuropathy. These data indicate that in diabetic autonomic neuropathy there is reduced peripheral neurosympathetic tone at rest but a normal response to moderate exercise. Blunted neurosympathetic responses to standing seem to be a consistent feature of diabetic autonomic neuropathy, particularly in those patients with severe postural hypotension.Key words: Plasma catecholamines, adrenaline, noradrenaline, sympathetic nervous activity, diabetes mellitus, autonomic neuropathy, postural stimulation, orthostatic hypotension, muscular exercise.Autonomic neuropathy in diabetes mellitus produces a variety of different symptoms and signs due to variable involvement of the sympathetic and parasympathetic branches of the autonomic nervous system [6,14,16].Plasma catecholamine levels have been investigated in only a few studies in recent years, as a possible humoral index of sympathetic function in complicated or uncomplicated diabetes. While the results obtained from these studies indicate that plasma catecholamine levels in uncomplicated diabetes are normal, the frequency of sympathetic deficiency, as reflected by subnormal plasma noradrenaline concentrations, in diabetic autonomic neuropathy and its possible importance in relation to symptoms, such as postural hypotension, is less clear [1,9,10,12,19]. This uncertainty could be due, at least in part, to difficulties in the accurate measurement of catecholamine responses and also in the characterization of diabetic autonomic neuropathic syndromes.The present investigation was aimed at evaluating peripheral sympathetic function and reactivity to appropriate stimuli, such as standing and muscular exercise, in diabetic patients with autonomic neuropathy, compared with diabetics without neuropathy and normal subjects. For this purpose, the presence of diabetic autonomic neuropathy was ascertained from a series of clinical and instrumental evaluations. Plasma adrenaline and noradrenaline concentrations, measured by a sensitive and specific radio-enzymatic me...

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“…In the assessment of NE levels in elderly subjects in whom the overall prevalence of various organic diseases is relatively high, care must be taken to eliminate the possible role of multiple conditions associated with established or possible alterations in plasma NE levels. These include thyroid disease, 30 iron deficiency ane- mia, 31 congestive heart failure, 32 depression, 33 chronic obstructive lung disease, 34 diabetes, 35 orthostatic hypotension, 36 duodenal ulcer, 37 chronic renal failure, 38 liver dysfunction, 39 and alcohol abuse. 40 These considerations, in conjunction with the need to avoid concomitant drug therapy, led to the exclusion of the majority of the 179 elderly men initially screened for this study.…”

Section: Discussionmentioning

confidence: 99%

Dissociation of 24-hour catecholamine levels from blood pressure in older men.

Stern¹,

Beahm²,

McGinty³

et al. 1985

Hypertension

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SUMMARY Increased plasma norepinephrine levels have been observed in some persons with early essential hypertension. Although both plasma norepinephrine level and mean arterial blood pressure rise with age, little is known about the state of catecholamine secretion in elderly patients with essential hypertension. We studied the 24-hour cycle levels of plasma norepinephrine, epinephrine, and dopamine in 12 elderly hypertensive subjects and 13 age-matched normotensive controls (mean ages, 63.8 ± 1.2 yr and 64.8 ± 1.8 yr [SEM] respectively). Blood samples were obtained at bihourly intervals from 0900 to 2100 hours and every 30 minutes from 2100 to 0900 hours, during which time sleep and breathing were continuously monitored. A circadian rhythm was displayed in both groups by plasma epinephrine levels (mesor, 49 ± 2 pg/ml and 38 ± 1 pg/ml; amplitude, 15 ± 2 pg/ml and 11 ± 1 pg/ml; acrophase, 12.20 ± 0.40 hr and 14.41 ± 0.34 hr in the normotensive and hypertensive groups respectively) but not by plasma norepinephrine or dopamine levels. During the 24-hour cycle plasma epinephrine, but not norepinephrine or dopamine, levels were positively related to mean arterial blood pressure (r = 0.60 for the normotensive subjects, r = 0.57 for the hypertensive subjects, p < 0.01 for both). Mean 24-hour plasma norepinephrine (377 ± 9 pg/ml vs 455 ± 9 pg/ml; p < 0.001), epinephrine (34 ± 2 pg/ml vs 45 ± 2 pg/ml; p < 0.01), and dopamine (40 ± 2 pg/ml vs 62 ± 3 pg/ml; p < 0.01) levels were lower in the hypertensive group, although groups did not differ in parameters known to affect catecholamine secretion such as body weight, sodium intake, sleep efficiency, or sleeprelated breathing disorders. Mean 24-hour plasma norepinephrine level was inversely related to the 24-hour mean arterial blood pressure (r = -0.48, p < 0.05). High norepinephrine levels in the elderly may reflect decreased baroreceptor sensitivity as well as compensatory response to decreased /3-adrenergic receptor sensitivity. It is unclear why elderly hypertensive persons, unlike younger hypertensive persons, have lower plasma catecholamine levels than do elderly normotensive persons. Whereas increased sympathetic outflow has been implicated in the induction of early "neurogenic" essential hypertension, 4 the age-dependent increase in NE is observed in normotensive subjects. Whether the ob- served increment in circulating NE is related to the age-associated rise in blood pressure or to the increased incidence of hypertension in aging humans is unclear. 5 The increase in NE with advancing age instead could reflect a compensatory mechanism to a declining peripheral response to adrenergic stimuli 6 -7 or an age-related decrease in clearance of NE. 8 Moreover, a recent study based on single NE samples obtained from a large number of subjects with a wide age range concluded that NE increases with age in normotensive subjects but not in subjects with essential hypertension. 9 However, there is relatively little direct information about the state of plasma catecholamines in...

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Plasma catecholamines in diabetes

Cited by 160 publications

References 18 publications

Baroreflex control of plasma norepinephrine and heart period in healthy subjects and diabetic patients.

Baroreflex control of plasma norepinephrine and heart period in healthy subjects and diabetic patients.

Plasma adrenaline and noradrenaline concentrations in diabetic patients with and without autonomic neuropathy at rest and during sympathetic stimulation

Dissociation of 24-hour catecholamine levels from blood pressure in older men.

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