Adrenomedullary function, obesity and permissive influences of catecholamines on body mass in patients with chromaffin cell tumours
Adrenomedullary function, obesity and permissive influences of catecholamines on body mass in patients with chromaffin cell tumours
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DOI：
10.1038/s41366-018-0054-9
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发表时间：
2019-02-01
影响因子：
4.9
通讯作者：
Eisenhofer, Graeme
中科院分区：
文献类型：
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作者：
An, Yaxin;Reimann, Manja;Eisenhofer, Graeme
背景肥胖相关的交感神经流出激活已被充分证实，而肾上腺髓质激素功能失调与肥胖的关系尚不清楚。本研究评估了交感肾上腺功能与肥胖指数的关系以及循环中儿茶酚胺对体重的影响。方法收集了590名志愿者和1368名接受嗜铬细胞瘤和副神经节瘤（PPGL）检测的患者的人体测量和临床数据沿着血浆和24小时尿液样本，其中210名患者被诊断为肿瘤。与无肿瘤的患者相比，肿瘤患者的体重指数（BMI）高于30 kg/m2的患者较少（12 vs. 31%），BMI低于25 kg/m2的患者较多（56 vs. 32%）（P < 0.0001）。PPGL患者尿中儿茶酚胺排出量与BMI呈负相关（r =-0.175，P = 0.0133）。PPGL切除后的术后体重增加（P < 0.0001）与术前肿瘤儿茶酚胺分泌量呈正相关（r = 0.257，P = 0.0101）。男性和女性的较高BMI以及志愿者组女性的体脂百分比与肾上腺素和代谢物的较低血浆浓度和尿排出量相关，前者表明肥胖相关的肾上腺素分泌减少，后者表明肥胖相关的肾上腺髓质肾上腺素储存减少。白天活动与尿肾上腺素和去甲肾上腺素排泄的大幅增加，与迟钝的反应在肥胖subjects.Conclusions PPGL患者的研究结果支持高循环儿茶酚胺对体重的影响。肾上腺髓质功能障碍与肥胖的其他关联增加了肾上腺髓质对体重调节的容许影响的可能性。
Background Obesity-associated activation of sympathetic nervous outflow is well documented, whereas involvement of dysregulated adrenomedullary hormonal function in obesity is less clear. This study assessed relationships of sympathoadrenal function with indices of obesity and influences of circulating catecholamines on body mass.Methods Anthropometric and clinical data along with plasma and 24-h urine samples were collected from 590 volunteers and 1368 patients tested for phaeochromocytoma and paraganglioma (PPGL), among whom tumours were diagnosed in 210 individuals.Results Among patients tested for PPGL, those with tumours less often had a body mass index (BMI) above 30 kg/m(2) (12 vs. 31%) and more often a BMI under 25 kg/m(2) (56 vs. 32%) than those without tumours (P < 0.0001). Urinary outputs of catecholamines in patients with PPGL were negatively related to BMI (r = -0.175, P = 0.0133). Post-operative weight gain (P < 0.0001) after resection of PPGL was positively related to presurgical tumoural catecholamine output (r = 0.257, P = 0.0101). Higher BMI in men and women and percent body fat in women of the volunteer group were associated with lower plasma concentrations and urinary outputs of adrenaline and metanephrine, the former indicating obesity-related reduced adrenaline secretion and the latter obesity-related reduced adrenomedullary adrenaline stores. Daytime activity was associated with substantial increases in urinary adrenaline and noradrenaline excretion, with blunted responses in obese subjects.Conclusions The findings in patients with PPGL support an influence of high circulating catecholamines on body weight. Additional associations of adrenomedullary dysfunction with obesity raise the possibility of a permissive influence of the adrenal medulla on the regulation of body weight.