Noradrenaline, Plasma

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1. What are catecholamines : Dopamine, Nor epinephrine and Epinephrine are catecholamines. These are organic compounds having catechol ring and a side chain amine, secreted from adrenal glands and nervous tissue and can act as both hormone and neurotransmitter. They are derived from amino acid Tyrosine and Phenylalanine.
    
2. What are functions of catecholamines : Nor epinephrine and dopamine act as neurotransmitter in CNS and as hormone in circulation. Nor epinephrine is neuromodulator in PNS.
    
3. What is fight or flight response : it is an automatic physiological response triggered by stressful or dangerous situation which is carried out by sympathetic nervous system and prepares person to fight or flee from dangerous situation.
    
4. What is Pheochromocytoma : It is a neuroendocrine tumour of medullary part of Adrenal gland leading to release of massive amount of catecholamines in circulation.
    
5. Which genetic syndromes are associated with Pheochromocytoma : VHL,MEN2,NF are the syndromes associated with pheochromocytoma.
    
6. What are Adrenal glands: Also known as Suprarenal glands, they are present at the top of kidneys. It has two parts, cortex and medulla. Cortex secretes Mineralocorticoides, glucocoricoides and androgen whereas medullary part secrets catecholamines.
    
7. Which age group is affected? : Mostly pheochromocytoma occurs between 30 to 50 age group but can occur at any age.
    
8. What are symptoms of high Nor epinephrine and other catecholamines : Signs and symptoms are related to hyperactivity of sympathetic nervous system. Headach due to hypertension, Tachycardia and excessive sweating, anxiety are the classic symptoms. Apart from this, heat intolerance, weight loss, nausea, constipation , orthostatic hypertension can also be seen.
    
9. Is there any difference between nor epinephrine and nor adrenaline: They are same.
    
10. Is this condition treatable: this condition is mostly treatable by surgery by complete adrenalectomy.
     
11. How to collect urine sample: Laboratory personnel will give you special kind of urine container with preservative. Discard the early morning first urine, start collecting from second one till the next morning first sample. Keep the container in refridgerator till sample is delivered to the laboratory.
     
12. Is fasting required for blood sample: No it is not required.
     
13. Is there chance of false positive result : Any kind of anxiety may lead to release of catecholamines in circulation. While collecting blood sample if the patient is anxious, this might give false positive result. Hence 24 hour urine sample is preferred method to test catecholamines.
     
14. How catecholamines are metabolized : They have half life of few minutes in circulation and are degraded by Catechol O Methyl Transferase or Monoamine oxidase.The end product of epinephrine and nor epinephrine is VMA i.e. Vanillylmandelic acid which is excreted in urine. Dopamine catabolism leads to production of Homovanillic acid.
     
15. Conditions that mimics Pheochromocytoma: Thyrotoxicosis, Hypoglycemia can mimic like pheochromocytoma.
     
16. Is pheochromocytoma malignant : mostly this is a benign tumour, chances of Malignacy are 10 percent.
     
17. Is it a genetic condition: most often it is sporadic in nature but genetic syndrome is found in almost one third cases.
     
18. Which specialist should be consulted? : This condition needs a multidisciplinary approach. Endocrinologist to manage hormone imbalance, surgeon and anaesthetist for adrenalectomy, Radiotherapist for radioablation of tumour and also primary care physician.
     
19. Which tests should be done along with Nor epinephrine? :Ct scan and MRI are required for localization of tumour. Urine nor metanehrine Which is an end product of Norepinephrine metabolization is also important test.
     
20. Can this condition be present without symptoms? : Almost 10 percent of cases are detected incidentally and patient have subclinical pheochromocytoma.
     
21. What is Paraganglioma : Paraganglioma is tumour arising from special type of nerve cells called Chromaffin cells.  If this tumour occurs in Adrenal gland it is called as Pheochromocytoma and in rest of the body it is reffered as Paraganlioma.
     
22. What is Prognosis or chances of recovery of Pheochromocytoma : In case of sporadic disease chances of recovery are good but if the lesion is malignant or matastatised then survival are reduced significantly.

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