By Doaa Mohamed Saad

Residant in Clinical
Pathology

Hormones secreted from adrenal medulla

are called catecholamines.
These important hormones are divided to :
1. Adrenaline Primary amine .
2. Nor adrenaline
3. Dopamine
Secondary amines.

Noradrenaline &Dopamine have marked

influence on the CVS make
vasoconstriction.
2. Adrenaline influence metabolic process
especially on CHO metabolism.
a.Reactivation of inactive phosphorylase
enzymes as glucagon
stimulate
glycogenolysis
hyperglycemia.
b.Inhibit utilization by tissue lead to
hyperglycemia.
1.

Synthesis
Tyrosine

Dopa (dihydroxyphenyl

hydroxylase

alanine).

DOPA

Dopamine.

decarboxylase

Stored in form of granules which are present in

sympathetic nerve endings and adrenal medulla.

Dopamine

Oxidase

Noradrenaline
(in storage granules)

Noradrenaline .

Methyltransferase

Adrenaline .

Stress,anexity,fear,fight,flight.
Hypoglycemia,hypothyremia,hypotension
and muscular activity.
Hypercapnia.
N.B : 1.The main stimulus for noradrenaline
is Hypotension.
2. The main stimulus for adrenaline is
Hypoglycemia.
3. Plasma half life is 2 minutes.
4. More than 500 drugs can interact
with it,so any drug must be stoped before
its estimation.

When released to blood they act on different

organs and rapidly they are inactivated either by:
a.Reuptake by storage granules.
b.Small part is secreted in urine either as free
catecholamine or binding with sulphoric acid or
glucoronic acid.
c.Conversion to metabolites:
_Adrenaline & noradrenaline Catechol. Methyltransferase
metanephrine &normetanephrine which part
secreted in urine.
_The majority of metanephrine
&normetanephrine undergo oxidative
deamination to 3methoxy 4hydroxy mandelic
aldehyde.

-This intermediate product is either oxidized

to vanilyl mandilic acid (VMA) ,or reduced to
methoxyhydroxy phenylglycol (MHPG) which
excreted in urine.
So we can find in urine:
1.VMA : 2-7 mg/24hr.
2.Metanephrine : <1mg/24hr.
3.Free or conjugated catecholamines
<800ug/24hrs.

1.

Catecholamines occur in:

a.Stress,hypotension,hypoglycemia,hypoxia,
exercise anger,anxiety,drugs,Upright position,
hypovolemia ,hypothrmia,hypercapnia.
b.Tumour secreting catecholamine:
Pheochromocytoma.
2. Catecholamines occurs in :
a. Idiopathic postural hypotension.
b.Drugs.

Definition:

tumor in neurochromaffin cells in

adrenal medulla.

Characer:

90% of the cases are benign & 10% are

malignant which is common in children.

C/P:

Hypertension,wt.
loss,irritability,anxiety,palpitation,Headache and
sweat.
It is curable by surgery.

Lab. Diagnosis:
Sampling :
Morning sample after 30 min rest.

Prevent eating,smoking ,excercise,tea or coffee at least

4 hrs before sampling.
Stop medication for 3 days.
Plasma catechol. Increase 2-3 fold when supine subject
assume an upright position.
This sample are rapidly oxidized so prevent oxidation
by:
1.Transport it on ice .
2.The sample is refrigerated at 4 C within 3 min .
3.Plasma is separated and stored at -70C.
4.Heparin or EDTA can be used .
5.Urine sample 24hr. Cllected in dark bottle
contaning
HCL and refrigerated.

A.Screening tests:
1.Urinary metanephrine:
Normal value : 0.3 -0.9 mg/day.
Methods :
1.Gas chromatography.
2.HPLC.
3.Pisano technique.
a.Destroyed conjugated metanephrine by acid
hydrolysis.
b.Absorption on Amberlite CG50.
c.Elution by ammonia.
d.Oxidation by periodate to Vaniline.
e.Vaniline measured at 360nm.

2.Urinary VMA:
. Normal value in newborn :<1mg/day.
child :<2mg/day
adult: 2-9 mg/day.
Methods:
1.HPLC.
2.Gas liquid chromatography
3.pisano:
a.VMA is extracted with ethyl acetate and
reextracted into
aqueous potassium
carbonate solution.
b.The end extract potassium carbonate is oxidated
by periodate oxidation to Vaniline.
c.Vaniline is determined at 360 nm by
spectrometry.
N.B:Urinary metanephrine is more sensitive than VMA,
so the false negative result of VMA exceed 41%.

B.Diagnostic tests:
1.Plasma catecholamines:
Normal value :Adrenaline:100-300pg/ml.
Noradrenaline:300-800pg/ml.
Methods:
1.HPLC.
2.Gas chromatography.
3.Flurometric method:
a.Oxidation in acetic acid to adrenochrome and
noradrenochrome.
b.Condensation with ethylene diamine in present of
alkali to flurescent sub. Then measured.
4.Radioenzymatic method.

2.Urinary catecholamine
less than 800ug/24hr by HPLC.

C.Tests for defferantiate between

isolated pheochromocytoma and
multiple neoplasia syndrome:
Because that MENS is involving more than one
gland disorder .
Type II is associated to pheochromocytoma ,so
must defferantiate between both by
FT3,FT4,TSH,PTH &Ca.