Plasma neurotransmitters, blood pressure and heart rate during supine resting, orthostasis and moderate exercise in severely ill patients: a model of failing to cope with stress.
BACKGROUND
Previous clinical research has shown that severely ill (somatic) as well as many psychosomatic patients show raised noradrenaline (NA), adrenaline (AD), cortisol, free serotonin (f5HT) and platelet aggregability. Conversely, they show reduced NA/AD plasma ratio and platelet serotonin (p5HT). They also show adrenal hyperresponsiveness to an oral glucose load. These findings are opposed to those observed in depressed patients who show adrenal gland sympathetic hyporesponsiveness and neural sympathetic hyperactivity.


OBJECTIVE
To investigate adrenal gland and neural sympathetic systems as well as the other parameters in nondrepressed severely ill patients through the orthostasis exercise stress test which in normals triggers NA but no AD rise.


METHODS
We investigated 35 severely ill patients and their age- and sex-paired controls. Systolic, diastolic pulse pressure (PP), heart rate and neuroendocrine parameters were measured supine (0 min), at orthostasis (1 min) and exercise (5 min). A second test was performed 2 weeks later, after atropine injection. Multivariate analysis of variance, paired t test and Pearson product-moment test were employed.


RESULTS
The normal PP orthostasis fall was not observed in patients. At this period, an abnormal AD peak substituted the normal NA peak. The normal p5HT-f5HT orthostasis-exercise peaks were absent in patients. Cortisol and platelet aggregability were raised in patients.


CONCLUSIONS
Severely ill (somatic) patients responded to the orthostasis-exercise stress test with adrenal and corticosuprarenal but not neural sympathetic activity. They did not show the normal parasympathetic activity at orthostasis. This adrenal gland sympathetic hyperactivity registered in somatic patients is similar to that observed in mammals which fail to cope with stress and contrary to the profile registered in depressed subjects who show NA but not AD rise.
Lechin
F
F
Section of Faculty of Medicine, Central University of Venezuela, Caracas, Venezuela.
van der Dijs
B
B
Orozco
B
B
Lechin
A E
AE
Baez
S
S
Lechin
M E
ME
Benaim
M
M
Acosta
E
E
Arocha
L
L
Jimenez
V
V
Leon
G
G
Garcia
Z
Z
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D001792:Blood Platelets / Q000737:chemistry / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology*; D016022:Case-Control Studies; D002908:Chronic Disease; D003863:Depression / Q000503:physiopathology; D004298:Dopamine / Q000097:blood; D004837:Epinephrine / Q000097:blood; D005080:Exercise Test; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D018377:Neurotransmitter Agents / Q000097:blood*; D009638:Norepinephrine / Q000097:blood; D012701:Serotonin / Q000097:blood; D013312:Stress, Physiological / Q000097:blood* / Q000503:physiopathology*; D016683:Supine Position / Q000502:physiology
D018377:Neurotransmitter Agents; D012701:Serotonin; D004298:Dopamine; D006854:Hydrocortisone; D009638:Norepinephrine; D004837:Epinephrine