title: [Bilateral pheochromocytoma. Is there stimulation of an extra-adrenal adrenaline liberation after bilateral adrenalectomy?].
abstract: BACKGROUND
  In order to determine plasma and urine epinephrine levels after bilateral adrenalectomy, we examined a 16 year old young man with bilateral pheochromocytoma. Bilateral removal of the adrenals was performed because of a left sided pheochromocytoma relapse. An extra-adrenal pheochromocytoma could be excluded by scintigraphy. Macroscopically all adrenal tissue was removed during surgery.
  
  
  METHODS
  A modified radioenzymatic determination of the free catecholamines epinephrine, norepinephrine and dopamine was used according to Peuler and Johnson. Sulfoconjugated catecholamines were measured after addition of 60 microU arylsulfatase type VI. Urine catecholamine levels were determined fluorometrically.
  
  
  RESULTS
  The elevated plasma andurine norepinephrine levels before surgery returned to normal after surgery. In contrast, plasma epinephrine levels returned to subnormal values thereafter but increases 5-fold at the end of anesthesia suggesting an extra-adrenal source of epinephrine. Urine epinephrine levels remained in the lower normal range. An insulin induced hypoglycemia was performed resulting in adrenergic symptoms of hypoglycemia and a subnormal increase of epinephrine.
  
  
  CONCLUSIONS
  We conclude, that epinephrine mediated physiological regulations occur inspite of bilateral adrenalectomy probably by a regulated extra-adrenal source of epinephrine. The kidney could be the site of extra-adrenal epinephrine production.
authors: Universitäts-Kinderklinik Würzburg.
authors: K O
authors: KO
authors: Schwab
authors: M
authors: M
authors: Krause
mesh_terms: D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000097:blood / Q000601:surgery*; D000315:Adrenalectomy; D001786:Blood Glucose / Q000378:metabolism; D002940:Circadian Rhythm / Q000502:physiology; D004298:Dopamine / Q000097:blood; D004837:Epinephrine / Q000097:blood*; D006801:Humans; D007328:Insulin; D008297:Male; D016609:Neoplasms, Second Primary / Q000097:blood / Q000601:surgery*; D009638:Norepinephrine / Q000097:blood; D010673:Pheochromocytoma / Q000097:blood / Q000601:surgery*; D011183:Postoperative Complications / Q000097:blood*
chemical_list: D001786:Blood Glucose; D007328:Insulin; D004298:Dopamine; D009638:Norepinephrine; D004837:Epinephrine
vernacular_title: Beidseitiges Phäochromozytom. Gibt es eine stimulierbare extraadrenale Adrenalinfreisetzung nach beidseitiger Adrenalektomie?