血浆儿茶酚胺、体重与嗜铬细胞瘤和副神经节瘤中糖尿病的相关性。
Correlation Between Plasma Catecholamines, Weight, and Diabetes in Pheochromocytoma and Paraganglioma.
机构信息
Hospital of the University of Pennsylvania, Department of Surgery, Philadelphia, PA, USA.
Hospital of the University of Pennsylvania, Department of Biostatistics, Philadelphia, PA, USA.
出版信息
J Clin Endocrinol Metab. 2021 Sep 27;106(10):e4028-e4038. doi: 10.1210/clinem/dgab401.
CONTEXT
Pheochromocytomas and paragangliomas (PCC/PGL) are neuroendocrine tumors with discrete catecholamine profiles that cause incompletely understood metabolic and physiologic changes.
OBJECTIVE
The objective was to evaluate relationships between plasma catecholamines, body weight, and hemoglobin A1c (HbA1c). We hypothesized that individual catecholamines would correlate negatively with weight and glucose control.
DESIGN
A retrospective cohort study was performed (1999-2020). Wilcoxon rank-sum tests compared nonparametric, continuous variables; mixed-effect linear modeling (MEM) evaluated relationships between catecholamines and weight or HbA1c. The median study duration was 54.2 months [interquartile range (IQR) 19.0-95.1].
SETTING
Tertiary academic hospital.
PATIENTS
360 patients were identified prospectively by referral to our center for management or surveillance of PCC/PGL. The median age was 59 years (IQR 45-67) and 56.4% (n = 203) were female.
MAIN OUTCOME MEASURES
The primary and secondary outcomes were weight and HbA1c, respectively.
RESULTS
On multivariable MEM, norepinephrine (P < 0.0005) negatively correlated with weight when all catecholamines and their derivatives were tried in the model, and normetanephrine (P < 0.0005) correlated when only metanephrines were included. In the surgical cohort (n = 272), normetanephrine decreased postoperatively and was inversely associated with weight (P < 0.0005). Elevated norepinephrine or normetanephrine at the study termination, indicative of metastatic and/or recurrent disease (MRD), correlated with weight loss. Norepinephrine and normetanephrine (P < 0.0005) directly correlated with HbA1c.
CONCLUSION
Plasma norepinephrine and its metabolite directly correlate with HbA1c and inversely correlate with weight in PCC/PGL. After resection, declining normetanephrine levels correlate with improving HbA1c despite an increase in patient body weight. Persistently elevated catecholamines and decreasing weight are observed in MRD.
背景
嗜铬细胞瘤和副神经节瘤（PCC/PGL）是具有离散儿茶酚胺特征的神经内分泌肿瘤，导致不完全了解的代谢和生理变化。
目的
评估血浆儿茶酚胺、体重和糖化血红蛋白（HbA1c）之间的关系。我们假设个体儿茶酚胺与体重和葡萄糖控制呈负相关。
设计
进行了回顾性队列研究（1999-2020 年）。非参数、连续变量的 Wilcoxon 秩和检验进行比较；混合效应线性模型（MEM）评估儿茶酚胺与体重或 HbA1c 之间的关系。中位研究持续时间为 54.2 个月[四分位间距（IQR）19.0-95.1]。
地点
三级学术医院。
患者
通过转介到我们中心管理或监测 PCC/PGL，前瞻性地确定了 360 名患者。中位年龄为 59 岁（IQR 45-67），56.4%（n=203）为女性。
主要观察指标
主要和次要观察指标分别为体重和 HbA1c。
结果
在多变量 MEM 中，当尝试在模型中加入所有儿茶酚胺及其衍生物时，去甲肾上腺素（P<0.0005）与体重呈负相关，当仅包括间甲肾上腺素时，间甲肾上腺素（P<0.0005）与体重呈负相关。在手术队列（n=272）中，间甲肾上腺素术后下降，与体重呈负相关（P<0.0005）。研究结束时升高的去甲肾上腺素或间甲肾上腺素，提示转移性和/或复发性疾病（MRD），与体重减轻相关。去甲肾上腺素和间甲肾上腺素（P<0.0005）与 HbA1c 直接相关。
结论
PCC/PGL 患者的血浆去甲肾上腺素及其代谢物与 HbA1c 直接相关，与体重呈负相关。切除后，尽管患者体重增加，但间甲肾上腺素水平下降与 HbA1c 改善相关。在 MRD 中观察到持续升高的儿茶酚胺和体重减轻。
Zotero 插件