Miocardiopatía de Tako-Tsubo: una manifestación inusual de feocromocitoma / Takotsubo cardiomyopathy: rare manifestation of pheochromocytoma

Takotsubo cardiomyopathy (MTT) is an acute ventricular dysfunction and reversible in absence of coronary disease. It is a rare presentation of pheochromocytoma and paraganglioma (FPGL). It was described for the first time in 1990 by Sato et al, the physiopathology is not clear yet. It is associated with high levels of catecholamines, vasospasm in the micro vascularization, rupture of atheromatous plaque and myiocarditis. The clinical presentation is similar to an acute myocardial infarction because of that the FPGL must be considered in patients without obstructive coronary lesions. We present a case of a 50 years old women with history of Arterial Hypertension, active smoking and Neurofibromatosis, who is admitted to emergency room with an acute myocardial pain.

Risk of catecholamine crisis in patients undergoing resection of unsuspected pheochromocytoma

PURPOSE: To report the risk of catecholamine crisis in patients undergoing resection of unsuspected pheochromocytoma. MATERIALS AND METHODS: Over a four-year period, we retrospectively identified four patients who underwent resection of adrenal pheochromocytoma in whom the diagnosis was unsuspected based on preoperative clinical, biochemical, and imaging evaluation. RESULTS: None of the patients exhibited preoperative clinical features of catecholamine excess. Preoperative biochemical screening in two patients was normal. CT scan performed in all patients demonstrated a nonspecific enhancing adrenal mass. During surgical resection of the adrenal mass, hemodynamic instability was observed in two of four patients, and one of these two patients also suffered a myocardial infarct. CONCLUSION: Both surgeons and radiologists should maintain a high index of suspicion for pheochromocytoma, as the tumor can be asymptomatic, biochemically negative, and have nonspecific imaging features. Resection of such unsuspected pheochromocytomas carries a substantial risk of intraoperative hemodynamic instability.

Pheochromocytoma: a long-term follow-up of 24 patients undergoing laparoscopic adrenalectomy

Purpose: Pheochromocytomas are tumors derived from chromaffin cells that often secrete catecholamines and cause hypertension. The clinical diagnosis of pheochromocytoma depends on the presence of excessive production of catecholamines. Conventional imaging modalities that have been used in the preoperative evaluation include CT, MRI, and 131I-MIBG scintigraphy. Surgical resection is the definitive treatment for patients with pheochromocytoma. The goal of this study was to evaluate the long-term follow-up of 24 patients undergoing laparoscopic adrenalectomy for pheochromocytoma. Materials and Methods: From January 1995 to September 2006, 24 patients underwent laparoscopic adrenalectomy for adrenal pheochromocytoma. Twenty (83.3 percent) patients had arterial hypertension. The inclusion criteria of patients in this retrospective study were laparoscopic approach, unilateral or bilateral adrenal tumor, pathological diagnosis of pheochromocytoma and a minimum follow-up of 18 months. Results: Intra-operative complications occurred in 4 (16.7 percent) patients. Two (8.3 percent) patients had postoperative complications. Two patients (8.3 percent) had blood transfusion. The mean postoperative hospital stay was 3.8 days (range 1 to 11). Eighteen (90 percent) of the twenty patients who had symptomatic hypertension, returned to normal blood pressure immediately after surgery, during the hospital stay. In one patient, the high blood pressure levels remained unchanged. Another patient persisted with mild hypertension, well controlled by a single antihypertensive drug. Conclusions: Our results confirmed that laparoscopic adrenalectomy for pheochromocytoma is a safe and effective procedure, providing the benefits of a minimally invasive approach. In our study, the initial positive results obtained in the treatment of 24 patients were confirmed after a mean follow-up of 74 months.

Cardiomiopatia de takotsubo como causa de disfunção ventricular transitória / Takotsubo cardiomyopathy causing transitory ventricular dysfunction

Relato do caso de mulher de 74 anos, com hipertensão arterial sistêmica e insuficiência vascular periférica, que apresentou sintomas de síndrome coronariana aguda. A angiografia coronariana demonstrou artérias sem obstruções significativas. A ventriculografia e a ecocardiografia demonstraram acinesia dos segmentos médios e apicais, e hipercinesia dos segmentos basais do ventrículo esquerdo. A paciente evoluiu com recuperação completa da função global e motilidade segmentar em ecocardiografia realizada duas semanas após o início dos sintomas. Esse padrão incomum e reversível de disfunção sistólica e comprometimento segmentar dando ao ventrículo esquerdo forma semelhante a um takotsubo é hoje conhecido como cardiomiopatia do estresse.

This is the report of a 74-year-old female patient with a history of systemic hypertension and peripheral vascular disease who presented acute coronary syndrome symptoms. Coronary angiography showed coronary arteries with no significant obstructions. Ventriculography and echocardiography showed akinesia in mid and apical segments; and hyperkinesia of left ventricle basal segments. Two weeks after the onset of symptoms, a new echocardiogram demonstrated normal global and regional systolic function. The uncommon, reversible pattern for systolic dysfunction and segmental compromising that gives left ventricle a takostubo-like shape is known today as stress cardiomyopathy.

role of pulmonary surfactants [protein A and phospholipids], catecholamines and myoglobin in the diagnosis of the cause of death

An important and often one of the most difficult tasks of a medical practitioner or pathologist is the investigation of the cause of death. The aim of this work is to assess the post mortem levels of serum protein A [SP-A], pulmonary as well as serum phospholipids, catecholamines and myoglobin in forensic autopsies as a guide to diagnose the cause of death. This study was done on 120 cadavers 75 males and 45 females with ranging age from newborn up to 62 years old. They included 2 groups: the first group consisted of 110 cases died from various types of trauma or due to some diseases [experimental group] and the second group consists of 10 cases died without trauma or disease [control group]. The experimental group subdivided into eleven subgroups of various types of trauma or disease. Each was 10 cases for each of the followings:- strangulation, hanging, drowning, blunt head injuries, burns, sharp weapon injuries, heat stroke, electrical fatalities, hemorrhagic shock, myocardial infarction and interstitial pneumonia. It was found that the level of serum protein A [SP-A] showed a very highly significant increase in cases of interstitial pneumonia and highly significant increase in cases of drowning burns and sharp weapon injuries. Also it showed a significant increase in cases of strangulation hanging, blunt head injuries and electrical injuries, while insignificant increase in, heat stroke hemorrhagic shock and myocardial infarction as compared to the control had been shown. Serum phospholipids showed a very highly significant increase in strangulation, hanging, drowning, electrical injuries and interstitial pneumonia and highly significant increase in blunt head injuries, burn, sharp weapon injuries and heat stroke. Also it showed a significant increase in hemorrhagic shock and myocardial infarction as compared to the control. Lung surfactant phospholipids showed insignificant, increase in different cases of death as compared to the control. Adrenaline and noradrenoline showed highly significant increase in case of strangulation, hanging, drowning, myocardial infarction and interstitial pneumonia respectively. Adrencline showed a significant increase in blunt head injuries, burns, sharp weapon injuries, heat stroke and hemorrhagic shock as compared to the control. Noradrenaline showed insignificant increase in heat stroke as compared to the control. Myoglobin showed a significant increase in cases of blunt head injuries, burns, sharp weapon injuries, heat stroke and electrical injuries. While insignificant increase in cases of strangulation, hanging, drowning, hemorrhagic shock, myocardial infarction and interstitial pneumonia, as compared to the control

Mínimas alterações hormonais em paciente com grande feocromocitoma / Slight hormonal alterations in a patient with a large pheochromocytoma

Relatamos caso clínico no qual o paciente apresentou sintomas sugestivos de feocromocitoma, grande tumor (maior que 50 g) e mínima alteração laboratorial, exemplificando uma armadilha diagnóstica. Um homem de 31 anos apresentou dois episódios de abdômen agudo, sendo o último acompanhado por cefaléia, hipertensão arterial, rubor facial, sudorese e palidez cutânea. Em outra internação, o paciente apresentava hipertensão arterial sustentada e arritmia cardíaca. Em relação aos testes laboratoriais, apenas o ácido vanil-mandélico foi levemente alterado. Cintilografia com MIBG foi realizada e sugeriu a presença de grande massa adrenal compatível com feocromocitoma. Uma amostra histopatológica da peça foi obtida após cirurgia e confirmou esta hipótese. Esse caso sugere que em pacientes que possuem sintomas sugestivos de feocromocitoma, mesmo com valores normais de catecolaminas plasmáticas e metanefrinas urinárias, devemos considerar as possibilidades de um grande tumor metabolizando catecolaminas em seu interior ou que sofreu necrose hemorrágica.

Niveles de catecolaminas bajo el efecto del HEPB en diferentes regiones del SNC de ratón adulto: estudio preliminar / Preliminary study of the effect of HEPB on catecholamine levels in different regions of the brain

Diversos estudios han demostrado que la norepinefrina (NE) y la dopamina (DA) participan en la regulación del umbral convulsivo en diferentes modelos de epilepsia experimental a través de una estrecha relación entre la concentración y la predisposición para desarrollar crisis convulsivas. También, se ha demostrado que el mecanismo de acción de algunos anticonvulsionantes conocidos, se realiza bajo una regulación de la neurotransmisión a nivel sináptico. Por otro lado, los derivados de las butiramidas presentan una importante actividad anticonvulsionante en algunos animales de experimentación. Por lo que en el presente trabajo se investigó el efecto de un derivado de las butiramidas, la 4-hidroxi, 4-etil, 4-fenil butiramida (HEPB) sobre la concentración de NE y DA en diferentes regiones cerebrales como son: la corteza cerebral, el núcleo caudado y el hipocampo. Se utilizaron ratones adultos Balb/c tratados con solución salina fisiológica (testigo), propilenglicol al 10 por ciento como vehículo (testigo) y HEPB (experimental). Las regiones cerebrales se ontuvieron previa decapacitación de los animales y la concentración de NE y DA se realizó por cromatografía de líquidos de alta resolución con detección electroquímica. Los resultados muestran que el HEPB induce un incremento de NE (70 por ciento) en el núcleo caudado a la dosis de 20 mg/kg de peso corporal. Mientras que la DA sólo se incremento en 38 por ciento en esta misma región. En la corteza cerebral y el hipocampo no se encontró diferencia significativa respecto a los grupos testigo. Con estos resultados es difícil explicar el efecto del HEPB sobre el sistema catecolaminérgico en el núcleo caudado, no obstante, es necesario continuar con estudios complementarios que permitan precisar el posible mecanismo de acción del HEPB como anticonvulsionante y en particular su efecto sobre el transporte de DA en el núcleo caudado

Feocromocitoma: informe de un caso clínico y discusión de los procedimientos diagnósticos / Pheochromocytoma: a clinical case and revision of diagnostic procedures

Introducción. Los feocromocitomas son tumores que se originan en las células cromofines del sistema nervioso simpático y que se localizan en la médula suprarrenal. Liberan a la circulación epinefrina, norepinefrina o ambas, causando sintomatología adrenérgica. Caso clínico. Se presenta el caso de un escolar masculino con manifestaciones de hipersecreción adrenérgica caracterizada por cefalea, diaforesis, palpitaciones e hipertensión arterial severa. El laboratorio mostró niveles elevados de catecolaminas séricas y sus metabolitos urinarios. El ultrasonograma, la tomografía axial computada y la gamagrafía con I -MIBG demostraron tumores localizados en ambas suprarrenales, los cuales fueron extirpados exitosamente. Conclusiones. El diagnóstico de feocromocitoma debe sospecharse en base a los hallazgos clínicos y debe confirmarse con las determinaciones de catecolaminas y sus metabolismos urinarios. La extirpación quirúrgica del tumor no debe intentarse hasta no corroborar la localización exacta del mismo. Actualmente el método de localización específico y sensible es la gamagrafía con I -MIBG

Sexual differences in the brain catecholamine content in four species of tropical bats

Se estudieron las catecolaminas -dopamina, norepinefrina y epinefrina- en el cerebro de machos y hembras de cuatro especies de murciélagos tropicales, con diferentes hábitos de alimentación (insectívero, frugívoro, omnívero y polinívero). Estos fueron capturados cerca del Túnel del Arco, estructura de un acueducto que corre en un bosque tropical caducifolio cuya temperatura anual media es 25.8-C. Las tres catecolaminas se encuentran presentes en el cerebro de todas las especies estudiadas y muestran diferencias estadísticamente significativas tanto entre especies, como entre sexos. Mientras la dopamina y la norepinefrina son consistentemente más elevadas en los machos, la epinefrina lo es en las hembras. Estos hallazgos sugieren que los cambios en los niveles de las catecolaminas se encuentran intimamente ligados al patrón reproductivo de cada especie e involucrados en funciones cerebrales importantes, tales como la conducta, la integración endocrina y la diferenciación sexual del cerebro. El ambiente, la dieta y el sexo posiblemente participan en los mecanismos de adaptación de estas especies a su entorno

Effect of amygdaloid kindled seizures during pregnancy on neonatal brain biogenic amines

The effects of amygdaloid kindled seizures during pregancy on the concentrations of noradrenaline (NE), dopamine (DA) and serotonin (5HT) and of their repective metabolites, 3-methoxy-4-hydroxyphenylglycol (MHPG), normetanephrine (NMN), homovanilic acid (HVA) and 5-hydroxy-indoleacetic acid (5HIAA), have been studied in the cerebral cortex, brain stem and cerebellum of rat offspring at bith. The levels of DA and NE were invreased and those of HVA and MHPG wee not modified in the cortex. The levels of DA, NE, 5HT, MHPG and 5HIAA were increased in the cerebellum. The brain stem presented a decrease in DA and 5HT levels, but increased MHPG and HVA levels. It is suggested that, in order to investigate possible changes in the biogenic amine loevels on the postnatal period, carefully planned prospective studies are needed

Hipotensión ortostática, disautonomia y signos neurologicos centrales / Orthostatic hypotension, dysautonomia and central neurologic signs

Se presenta el caso de una mujer de 68 años afectada de hipotensión ortostática, disfunción pupilar, sudoral y vesical, y respuestas hemodinámicas anormales a la maniobra de Valsalva, además de signos piramidales, extrapiramidales, disartria y amiotrofias distales, compatible con atrofia multisistémica (AMS), discutiendo la relación de este cuadro con la enfermedad o síndrome de Shy y Drager, del cual parece tratarse de una variante un tanto atípica por: 1) La ausencia de signos cerebelosos, 2) La preservación de respuestas parasimpáticas y 3) La rareza de los hallazgos neuroquímicos.

Effect of graded distension of urinary bladder on arterial blood pressure and neurohumors in rabbits.

Effect of graded distension of urinary bladder has been observed on the circulating level of catecholamine, cortisol and serotonin along with arterial blood pressure in rabbits. Simultaneously adrenal catecholamine has been also investigated. Similar pattern of increase has been observed in the levels of catecholamine, cortisol, serotonin and arterial blood pressure after bladder distension at 20 ml, 40 ml and 60 ml volumes. On this basis, it may be inferred that there is some role of the vasoconstrictor humors released during bladder distension in pressor response. At the same time, decrease in adrenal catecholamine level also supports this.

O diagnóstico das síndromes depressivas na clínica geral / Depressive syndromes diagnosis in general practice

Säo exploradas as vantagens e desvantagens de se ter as síndromes depressivas diagnosticadas e tratadas pelo clínico geral. O tratamento das depressöes requer conhecimentos de psiquiatria clínica e de psicofarmacologia por parte do médico näo psiquiatra. O critério diagnóstico é fundamental para o planejamento e sucesso da terapia. A escolha de um critério diagnóstico nem sempre é fácil, mas esforços rumo a uma padronizaçäo de critérios por parte dos psiquiatras, estäo facilitando o trabalho clínico. O autor também aborda o impacto dos marcadores biológicos no diagnóstico das depressöes. O clínico geral deve ser estimulado a adquirir noçöes básicas de psiquiatria para poder diagnosticar e tratar o paciente deprimido

Cardiac Catecholamines in Rabbits: Seasonal Changes and Norepinephrine Effect

In an attempt to determine whether myocardial catecholamines vary from season to season, their concentration in rabbits was measured throughout the whole year by the spectrophotofluorometric method. The highest concentration of cardiac catecholamine was observed in summer. Measurement of the atrial response to norepinephrine revealed no significant alteration during the entire period of the experiment.