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Pathophysiology and Diagnosis of Disorders of the Adrenal Medulla: Focus on Pheochromocytoma

Jacques W. M. Lenders, Graeme Eisenhofer

10.1002/cphy.c130034

Source: Volume 4, Issue 2, April 2014

Published online: March 2014

Full Article on Wiley Online Library



Abstract

The principal function of the adrenal medulla is the production and secretion of catecholamines. During stressful challenging conditions, catecholamines exert a pivotal homeostatic role. Although the main adrenomedullary catecholamine, epinephrine, has a wide array of adrenoreceptor‐mediated effects, its absence does not cause life‐threatening problems. In contrast, excess production of catecholamines due to an adrenomedullary tumor, specifically pheochromocytoma, results in significant morbidity and mortality. Despite being rare, pheochromocytoma has a notoriously bad reputation because of its potential devastating effects if undetected and untreated. The paroxysmal signs and symptoms and the risks of missing or delaying the diagnosis are well known for most physicians. Nevertheless, even today the diagnosis is still overlooked in a considerable number of patients. Prevention and complete cure are however possible by early diagnosis and appropriate treatment but these patients remain a challenge for physicians. Yet, biochemical proof of presence or absence of catecholamine excess has become more easy and straightforward due to developments in assay methodology. This also applies to radiological and functional imaging techniques for locating the tumor. The importance of genetic testing for underlying germline mutations in susceptibility genes for patients and relatives is increasingly recognized. Yet, the effectiveness of genetic testing, in terms of costs and benefits to health, has not been definitively established. Further improvement in knowledge of genotype‐phenotype relationships in pheochromocytoma will open new avenues to a more rationalized and personalized diagnostic approach of affected patients. © 2014 American Physiological Society. Compr Physiol 4:691‐713, 2014.

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Figure 1. Figure 1. Diagram showing the major metabolic pathways of norepinephrine (NE), epinephrine (EPI), and dopamine (DA). The main metabolic pathway for NE is deamination by monoamine oxidase (MAO) within sympathetic nerves to dihydroxyphenylglycol (DHPG) which is the basis for the final metabolite vanillylmandelic acid (VMA). A small part of NE is converted by catechol‐O‐methyltransferase (COMT) extra‐neuronally and intra‐adrenally into normetanephrine (NMN). Epinephrine is mainly converted in the adrenal medulla to metanephrine (MN). Extra‐neuronal conversion of EPI contributes to a minor degree to MN formation. Dopamine is O‐methylated by COMT to 3‐methoxytyramine (3‐MT). Both metanephrines and 3‐MT are conjugated by gut sulphotransferase type 1A3 (Sult1A3) to sulfates (‐SO4).


Figure 1. Diagram showing the major metabolic pathways of norepinephrine (NE), epinephrine (EPI), and dopamine (DA). The main metabolic pathway for NE is deamination by monoamine oxidase (MAO) within sympathetic nerves to dihydroxyphenylglycol (DHPG) which is the basis for the final metabolite vanillylmandelic acid (VMA). A small part of NE is converted by catechol‐O‐methyltransferase (COMT) extra‐neuronally and intra‐adrenally into normetanephrine (NMN). Epinephrine is mainly converted in the adrenal medulla to metanephrine (MN). Extra‐neuronal conversion of EPI contributes to a minor degree to MN formation. Dopamine is O‐methylated by COMT to 3‐methoxytyramine (3‐MT). Both metanephrines and 3‐MT are conjugated by gut sulphotransferase type 1A3 (Sult1A3) to sulfates (‐SO4).
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Article Title: Pathophysiology and Diagnosis of Disorders of the Adrenal Medulla: Focus on Pheochromocytoma
 

How to Cite

Jacques W. M. Lenders, Graeme Eisenhofer. Pathophysiology and Diagnosis of Disorders of the Adrenal Medulla: Focus on Pheochromocytoma. Compr Physiol 2014, 4: 691-713. doi: 10.1002/cphy.c130034