Schwab K O, Krause M
Universitäts-Kinderklinik Würzburg.
Monatsschr Kinderheilkd. 1992 Nov;140(11):828-31.
In order to determine plasma and urine epinephrine levels after bilateral adrenalectomy, we examined a 16 year old young man with bilateral pheochromocytoma. Bilateral removal of the adrenals was performed because of a left sided pheochromocytoma relapse. An extra-adrenal pheochromocytoma could be excluded by scintigraphy. Macroscopically all adrenal tissue was removed during surgery.
A modified radioenzymatic determination of the free catecholamines epinephrine, norepinephrine and dopamine was used according to Peuler and Johnson. Sulfoconjugated catecholamines were measured after addition of 60 microU arylsulfatase type VI. Urine catecholamine levels were determined fluorometrically.
The elevated plasma andurine norepinephrine levels before surgery returned to normal after surgery. In contrast, plasma epinephrine levels returned to subnormal values thereafter but increases 5-fold at the end of anesthesia suggesting an extra-adrenal source of epinephrine. Urine epinephrine levels remained in the lower normal range. An insulin induced hypoglycemia was performed resulting in adrenergic symptoms of hypoglycemia and a subnormal increase of epinephrine.
We conclude, that epinephrine mediated physiological regulations occur inspite of bilateral adrenalectomy probably by a regulated extra-adrenal source of epinephrine. The kidney could be the site of extra-adrenal epinephrine production.
为了确定双侧肾上腺切除术后血浆和尿液中的肾上腺素水平，我们对一名患有双侧嗜铬细胞瘤的16岁青年男性进行了检查。由于左侧嗜铬细胞瘤复发，实施了双侧肾上腺切除术。通过闪烁扫描可排除肾上腺外嗜铬细胞瘤。手术中肉眼可见所有肾上腺组织均被切除。
根据Peuler和Johnson的方法，采用改良的放射酶法测定游离儿茶酚胺肾上腺素、去甲肾上腺素和多巴胺。加入60微单位的VI型芳基硫酸酯酶后测量硫酸化结合儿茶酚胺。采用荧光法测定尿儿茶酚胺水平。
术前升高的血浆和尿液去甲肾上腺素水平术后恢复正常。相比之下，血浆肾上腺素水平术后降至低于正常的值，但在麻醉结束时升高了5倍，提示肾上腺素存在肾上腺外来源。尿肾上腺素水平维持在较低的正常范围内。进行了胰岛素诱发的低血糖试验，结果出现了低血糖的肾上腺素能症状，且肾上腺素升高未达正常水平。
我们得出结论，尽管进行了双侧肾上腺切除术，但肾上腺素介导的生理调节可能仍通过受调节的肾上腺外肾上腺素来源发生。肾脏可能是肾上腺外肾上腺素产生的部位。
