DMCS G. Patrassi, Internal Medicine 4, University Hospital, University of Padua, via Giustiniani 2, 35126 Padova, Italy.
Eur J Endocrinol. 2011 Jul;165(1):85-90. doi: 10.1530/EJE-11-0246. Epub 2011 Apr 13.
Adrenal vein sampling (AVS) is the gold standard for identifying the surgically curable forms of primary aldosteronism. Dopamine modulates adrenocortical steroidogenesis and tonically inhibits aldosterone secretion via D(2) receptor. However, whether it could also affect the release of cortisol and chromogranin A (ChA), which can be used to assess the selectivity of AVS, is unknown.
To investigate whether metoclopramide increased the release of cortisol and ChA and could thereby improve assessment of the selectivity at AVS.
We investigated the effect of acute D(2) antagonism with metoclopramide on cortisol and ChA release from the adrenal gland by comparing the adrenal vein and infrarenal inferior vena cava (IVC) hormone levels at baseline and after metoclopramide administration in 34 consecutive patients undergoing AVS.
Metoclopramide increased plasma aldosterone in the IVC (P<0.00001) and in the adrenal vein blood (P<0.002) but failed to increase plasma cortisol concentration or ChA levels. Therefore, it did not increase the selectivity index based on the measurement of either hormone.
This study shows that the release of cortisol and ChA is not subjected to tonic D(2) dopaminergic inhibition. Therefore, these findings lend no evidence for the usefulness of acute metoclopramide administration for enhancing the assessment of the selectivity of blood sampling during AVS with the use of either cortisol or ChA assay.
肾上腺静脉采样（AVS）是确定原发性醛固酮增多症可手术治疗形式的金标准。多巴胺通过 D2 受体调节肾上腺皮质甾体生成，并通过抑制作用抑制醛固酮分泌。然而，它是否也会影响皮质醇和嗜铬粒蛋白 A（ChA）的释放，这可以用来评估 AVS 的选择性尚不清楚。
研究甲氧氯普胺是否会增加皮质醇和 ChA 的释放，从而改善 AVS 选择性的评估。
我们通过比较 34 例连续接受 AVS 的患者在基线和甲氧氯普胺给药后的肾上腺静脉和肾下下腔静脉（IVC）激素水平，研究了急性 D2 拮抗作用甲氧氯普胺对肾上腺皮质激素释放的影响。
甲氧氯普胺增加了 IVC（P<0.00001）和肾上腺静脉血中的血浆醛固酮（P<0.002），但未能增加血浆皮质醇浓度或 ChA 水平。因此，它没有增加基于这两种激素测量的选择性指数。
本研究表明，皮质醇和 ChA 的释放不受紧张性 D2 多巴胺能抑制的影响。因此，这些发现没有证据表明急性甲氧氯普胺给药有助于使用皮质醇或 ChA 测定法增强 AVS 期间血液采样选择性的评估。
