Plasma catecholamines in Buerger's disease: effects of cigarette smoking and surgical sympathectomy.
OBJECTIVE
to study the influence of tobacco exposure and sympathectomy on basal sympathoadrenal function of patients with Buerger's disease.


METHODS
plasma catecholamines were measured before and after smoking, in patients with Buerger's disease (n=13), in patients with Buerger's disease submitted to surgical bilateral lumbar sympathectomy (n=13), and in healthy volunteers (n=16).


METHODS
venous blood samples were collected before and 2h after smoking one cigarette (0.9mg nicotine). Plasma concentrations (pg/ml) of dihydroxiphenylalanine (pL-DOPA), noradrenalin (pNA), adrenalin (pAD) and 3,4-dihydroxiphenylacetic acid (pDOPAC) were determined.


RESULTS
Buerger's patients have low basal plasma catecholamines compared to volunteers: pNA (501 (196-927) vs 1858 (968-3663)) and pAD (71 (31-109) vs 193 (116-334)). Sympathectomy increased pL-DOPA, pAD and pDOPAC, but not pNA. After smoking, pNA only decreased in volunteers (1858 (968-3663) vs 1064 (535-2393)). In Buerger+sympathectomy group, smoking lowered pAD (700 (58-3379) vs 278 (54-429)).


CONCLUSIONS
in Buerger's disease there is an impairment of sympathoadrenal function with an altered peripheral adrenergic response to cigarette smoking. Patients submitted to sympathectomy have high pAD, but this benefit is reversed after smoking. This might be clinically relevant given the association between cigarette smoking and the manifestations of Buerger's disease and the controversy on the effectiveness of sympathectomy in the management of the disease.
D000311:Adrenal Glands / Q000187:drug effects* / Q000378:metabolism*; D000328:Adult; D000367:Age Factors; D002395:Catecholamines / Q000097:blood*; D005260:Female; D005731:Ganglionic Stimulants / Q000494:pharmacology*; D006801:Humans; D008160:Lumbosacral Plexus / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009538:Nicotine / Q000494:pharmacology*; D012907:Smoking / Q000009:adverse effects*; D013562:Sympathectomy; D013564:Sympathetic Nervous System / Q000187:drug effects* / Q000378:metabolism*; D013919:Thromboangiitis Obliterans / Q000097:blood* / Q000601:surgery*
D002395:Catecholamines; D005731:Ganglionic Stimulants; D009538:Nicotine