Vetter H, Vetter W, Warnholz C, Bayer J M, Käser H, Vielhaber K, Krück F
Am J Med. 1976 May 31;60(6):866-71. doi: 10.1016/0002-9343(76)90906-2.
Patients suffering from pheochromocytoma characterized by an exclusive or almost exclusive excess of norepinephrine showed no (one patient) or only a moderate increase (two patients) in renin and aldosterone secretion. In those three patients with concomitant distinct hypersecretion of epinephrine, renin release (and aldosterone secretion except in one patient) was markedly enhanced. Similar results were obtained in a patient with excess norepinephrine and dopamine secretion. Renin release was markedly reduced in all patients during preoperative long-term alpha-adrenergic receptor blockade. With the exception of one patient, increased renin and aldosterone secretion was abolished. The results indicate that augmentation in renin release depends on the ratio of the different catecholamines secreted by the pheochromocytoma and their different effe-tiveness in stimulating beta-adrenergic receptors. Even in the presence of excess catecholamine secretion, there is evidence that renin secretion is predominantly mediated by beta receptors rather than by renal vascular alpha-adrenergic receptors. Normalization of catecholamine-induced enhanced renin release in patients with pheochromocytoma during chronic alpha-adrenergic receptor blockade supports the assumption that (alpha-) adrenergic blocking agents inhibit renin secretion distal to their blockade of specific adrenergic receptors. However, contrary to beta-adrenergic blockade, circadian rhythm of renin release seems to remain intact during alpha-adrenergic blockade.
以去甲肾上腺素单独或几乎单独过量为特征的嗜铬细胞瘤患者，肾素和醛固酮分泌无增加（1例患者）或仅中度增加（2例患者）。在另外3例伴有明显肾上腺素分泌过多的患者中，肾素释放（除1例患者外，醛固酮分泌也）显著增强。在1例去甲肾上腺素和多巴胺分泌过多的患者中也得到了类似结果。术前长期α-肾上腺素能受体阻滞期间，所有患者的肾素释放均显著减少。除l例患者外，肾素和醛固酮分泌增加均被消除。结果表明，肾素释放的增加取决于嗜铬细胞瘤分泌的不同儿茶酚胺的比例及其刺激β-肾上腺素能受体的不同效力。即使在儿茶酚胺分泌过多的情况下，也有证据表明肾素分泌主要由β受体介导，而非肾血管α-肾上腺素能受体。嗜铬细胞瘤患者在慢性α-肾上腺素能受体阻滞期间，儿茶酚胺诱导的肾素释放增强恢复正常，这支持了以下假设：α-肾上腺素能阻滞剂在阻断特定肾上腺素能受体后，在其远端抑制肾素分泌。然而，与β-肾上腺素能阻滞相反，在α-肾上腺素能阻滞期间，肾素释放的昼夜节律似乎保持完整。
