Epinephrine urinary

Kawano Y., Kawasaki T., Kawazoe N. et al. (1990). Circadian variations of urinary dopamine, norepinephrine, epinephrine and sodium in normotensive and hypertensive subjects. Nephron 55(3), 277-82. 

The stress of cold produced increased urinary excretion of norepinephrine but not of epinephrine or vasopressin (K8). Cold in the form of accidental hypothermia also resulted in increased serum creatine phos-phokinase (M2). Mental stress (problem solving) resulted in increases of urinary vasopressin from 33 to 47.6 units, epinephrine from 5.5 to 11.3 mg, and norepinephrine from 17 to 21 mg (K8). 

K8. Konzett, H., Hortnagl, H., and Winkler, K., On the urinary output of vasopressin, epinephrine and norepinephrine during different stress situations. Psy-chopharmacologia 21, 247-256 (1971). 

Drug/Lab test interactions Isoproterenol causes false elevations of bilirubin as measured in vitro by a sequential multiple analyzer. Isoproterenol inhalation may result in enough absorption of the drug to produce elevated urinary epinephrine values. Although small with standard doses, the effect is likely to increase with larger doses. 

The initial report of sustained, lower urinary cortisol levels in PTSD highlighted the disassociation between cortisol and catecholamine levels in PTSD. Norepinephrine and epinephrine levels assayed from the same urine specimens revealed elevations in both of these catecholamines, while cortisol levels in PTSD fell within the normal range of 20-90 pg/day, indicating that the alteration was not in the hypoadrenal or endocrinopathologic range (Mason et al. 1986). This finding established the expectation that alterations in basal levels of cortisol might be subtle, and not easily differentiated from normal values (Mason et al. 1986). 

The detrusor muscle (which contains (32-adrenoceptors) in the body of the urinary bladder is relaxed by epinephrine and isoproterenol. On the other hand, the trigone and sphincter (which contain aj-receptors) are contracted by norepinephrine and epinephrine this action inhibits the voiding of urine. 

Similar to findings in animal models of early-life stress, elevated 24-hour urinary NE, epinephrine (E), and dopamine (DA) excretion as well as decreased platelet adrenergic receptors have been measured in abused children with PTSD (Perry, 1994 DeBellis et al., 1999a). Abused children with PTSD also exhibit... 

Atropine and other antimuscarinic drugs have been used to provide symptomatic relief in the treatment of urinary urgency caused by minor inflammatory bladder disorders (Table 8-3). However, specific antimicrobial therapy is essential in bacterial cystitis. In the human urinary bladder, M2 and M3 receptors are expressed predominantly with the M3 subtype mediating direct activation of contraction. As in intestinal smooth muscle, the M2 subtype appears to act indirectly by inhibiting relaxation by norepinephrine and epinephrine. 

Intravenous administration of dopamine promotes vasodilation of renal, splanchnic, coronary, cerebral, and perhaps other resistance vessels, via activation of Di receptors. Activation of the Di receptors in the renal vasculature may also induce natriuresis. The renal effects of dopamine have been used clinically to improve perfusion to the kidney in situations of oliguria (abnormally low urinary output). The activation of presynaptic D2 receptors suppresses norepinephrine release, but it is unclear if this contributes to cardiovascular effects of dopamine. In addition, dopamine activates Bj receptors in the heart. At low doses, peripheral resistance may decrease. At higher rates of infusion, dopamine activates vascular a. receptors, leading to vasoconstriction, including in the renal vascular bed. Consequently, high rates of infusion of dopamine may mimic the actions of epinephrine. 

Pheochromocytoma is a tumor of the adrenal medulla or sympathetic ganglion cells. The tumor secretes catecholamines, especially norepinephrine and epinephrine. The patient in the case study at the beginning of the chapter had a left adrenal pheochromocytoma that was identified by imaging. In addition, she had elevated plasma and urinary norepinephrine, epinephrine, and their metabolites, normetanephrine and metanephrine. 

The catecholamines are a group of hormones secreted by the adrenal medulla. The major urinary metabolite of norepinephrine and epinephrine is vanillylmandelic acid (VMA). Urinary levels of VMA are considerably higher than those of total catecholamine. From the standpoint of laboratory methodology, VMA estimation is preferable to total catecholamine estimation, although it is not a simple procedure. VMA has been shown to be elevated in some patients who had phenochromocytoma and normal urinary catecholamines, even though patients with neuroblastoma have a normal VMA level and elevated catecholamine levels. 

Two parallel groups of healthy volunteers received 20 mg of citalopram (n = 12) or placebo (n = 6) once daily for 10 d in a randomized, double-blind fashion, followed by concomitant selegiline, 10 mg once daily for 4 d. The safety of this drug combination was assessed by measurements of blood pressure, heart rate, body temperature, and inquiries for adverse events. Blood samples were taken for the analysis of serum concentrations of selegiline, citalopram, and their metabolites. In addition, plasma was obtained to measure prolactin, epinephrine, norepinephrine, and 3,4-dihydroxyphanolglycol (DHPG), the urinary excretion of norepinephrine and 5-hydroindoleacetic acid (5-HIAA), the urinary metabolite of serotonin. 

In general, ephedrine produces the same effects on smooth muscle as epinephrine. Inhibition of the intact gastrointestinal musculature and contraction of the splenic capsule and of pilomotor muscles are produced. Ephedrine has the same myometrial and urinary bladder actions as does epinephrine. 

Dalmaz, Y. and Peyrin, L., Rapid procedure for chromatographic isolation of DOPA, DOPAC, epinephrine, norepinephrine and dopamine from a single urinary sample at endogenous levels, J. Chromatogr., 145, 11, 1978 Chem. Abs., 88, 59809c, 1978. 

Dopamine. Dopamine is u.scd in the treatment of shock. It is ineffective orally, in large part because it is a substrate for both MAO and COMT. Thus, it is used intravenously. In contrast with the catecholamines NE and epinephrine, dopamine increases blood flow to the kidney in doses that have no chronotropic effect on the heart or that cause no increa.se in blood pressure, lire increased blood How to the kidneys enhances glomerular filtration rate, Na excretion, and. in turn, urinary output. The dilation of renal blood ve.s-.sels produced by dopamine is the result of its agonist action on the D -dopaminc receptor. 

Respiratory therapy should be administered. If ingested, emesis should be induced. Blood pressure and normal urinary output should be maintained. A high carbohydrate diet can assist in restoring normal liver function. Epinephrine should not be used. 

In humans, VMA and the sulfates and glucuronide conjugates of MHPG represent the main end products of norepinephrine and epinephrine metabolism (Table 29-1). HVA and conjugates of HVA are the main metabolic end products of dopamine metabolism. These end products and the other conjugates are eliminated mainly by urinary excretion. As a result, their circulatory clearance is slow and plasma concentrations high relative to those of the precursor amines. 

Peripheral Dopaminergic System Dopamine is usually thought of as a neurotransmitter in the brain or as an intermediate in the production of norepinephrine and epinephrine in the periphery. It has been presumed tliat these sources account for the large amounts of dopamine and dopamine metabolites excreted in urine. The contribution of the brain to circulating levels and urinary excretion of dopamine metabolites is, however, now known to be relatively minor. Also, in sympathetic nerves and the adrenal medulla most dopamine is converted to norepinephrine. Therefore other sources and functions of dopamine in the periphery must be considered. Emerging evidence suggests the presence of a third peripheral catecholamine system, in which dopamine functions not as a neurotransmitter or circulating hormone, but as an autocrine or paracrine substance. ... 

The high diagnostic sensitivity of measurements of plasma free or urinary fractionated normetanephrine and metanephrine makes these tests the most suitable choice for the initial work up of a patient with a suspected pheochromocytoma. Negative results by these tests virtually exclude a pheochromocytoma, whereas negative results by other tests do not. Exceptions include small or microscopic ([Pg.1047]

Interpretation of a biochemical test result as normal or abnormal depends on availability of valid reference intervals (see Chapter 16). For tests of a single analyte, such as VMA, it can be expected that at least 2.5% of patients without pheochromocytomas will have values for the analyte above the upper reference limit and 2.5% below the lower reference limit. Up to a 5% incidence of false-positive results might be expected for tests of pairs of analytes, such as norepinephrine and epinephrine in tests of urinary or plasma catecholamines or normetanephrine and metanephrine in tests of plasma free or urinary fractionated metanephrines. False-positive rates usually, however, tend to be higher than expected this is likely due to reduced control over sampling conditions and sources of interference or differences in clinical characteristics of reference and patient populations. 

Reference intervals for plasma and urinary catecholamines and catecholamine metabolites also differ according to sex and age. Females have lower plasma concentrations of epinephrine and metanephrine than males. Similarly, 24-hour urinary outputs of catecholamines and metanephrines are lower in women than men for epinephrine this difference remains significant when values are normalized for creatinine excretion Plasma levels of norepinephrine and normetanephrine increase with advancing age in adults, whereas plasma levels of epinephrine and metanephrine are little affected. Age-related increases in 24-hour urinary outputs of norepinephrine and normetanephrine have also been reported,but not consistently by all studies. In general, the influences of age... 

Earlier fluorometric methods for analysis of urinary free catecholamines have been replaced by HPLC methods that allow selective quantitation of epinephrine, norepinephrine, and dopamine. Preliminary extraction of urine is stid required and numerous preanalytical cleanup techniques are available. An alumina extraction procedure is typically coupled with ion-exchange or adsorption chromatography. Alumina pretreatment usually involves a batch extraction technique in which catechols are first adsorbed at pH 8.6 and then eluted with boric acid, which forms a complex with cis-diol groups. Purification on boric acid affinity gels provides an alternative procedure for selective adsorption of catecholamines. 

Normetanephrine andmetanephrine are metabolic products of norepinephrine and epinephrine, respectively, and are formed by the action of catechol-0-methyltransferase without deamination. As a result of active neuronal reuptake and deamination of norepinephrine, normetanephrine normally represents <5% of the total norepinephrine excretion products in urine. Metanephrine, however, even with its lower urinary concentration relative to normetanephrine, represents a major excretion product of epinephrine. The metanephrines are excreted in both conjugated and unconjugated forms. Unlike the catecholamines, total metanephrine excretion is not significantly influenced by diet. As a result, the total metanephrines are routinely measured after acid hydrolysis or sulfatase pretreatment. 

Vanillylmandehc Acid (VMAj is a major catecholamine metabolite formed by the actions of catechol-0-methyl-transferase and MAO. It is excreted by the kidney and represents an average of 40% to 50% of the urinary excretion production of norepinephrine and epinephrine. Norepinephrine is the major source of VMA, with metabolism through MHPG as the major pathway. VA4A is not significantly conjugated and therefore is measured without a hydrolysis step. VMA was first isolated and identified in the urine of a patient with a pheochromocytoma, and its analysis is commonly performed to detect the presence of pheochromocytomas and neuroblastomas. 

Gerlo EA, Schoors DF, Dupont AG. Age- and sex-related differences for the urinary excretion of norepinephrine, epinephrine, and dopamine in adults. Clin Chem 1991 37 875-8. 

Smythe GA, Edwards G, Graham P, Lazarus L. Biochemical diagnosis of pheochromocytoma by simultaneous measurement of urinary excretion of epinephrine and norepinephrine. Clin Chem 1992 38 486-92. 

E.A.M. Gerlo and C. Sevens, Urinary and plasma catecholamines and urinary catecholamine metabolites in pheochromocytoma diagnostic value in 19 cases, Clin. Chem.. 40, 250-256 (1994). T. Jan, B.E. Metzger and G. Baumann, Epinephrine-producing pheochromocytoma with hypertensive crisis after corticotrophin injection. Am. J. Med.. 89, 824-825 (1990). 

K. Oka, M. Sekiya, H. Osada, K. Fujita, T. Kato and T. Nagatsu, Simultaneous fluorometry of urinary dopamine, norepinephrine, and epinephrine compared with liquid chromatography with electrochemical detection, Clin. Chem., 28, 646-649 (1982). 

C.R. Benedict, Simultaneous measurement of urinary and plasma norepinephrine, epinephrine, dopamine, dihydroxyphenylalanine, and dihydroxyphenylacetic acid by coupled-column high-performance liquid chromatography on Cg and C g stationary phases, J. Chromatogr, 385, 369-375 (1987). 

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