18 Aug Question: A 21-year-old Male Visits With His Family Doctor At The Urging Of His Parents When Home For Spring Break. The Parents Are Concerned Because Their Son Has Lost A Significant Amount Of Weight. The Young Man Is Concerned Because He Is Experiencing A Heart Rate Of 120bpm While At Rest And Much Higher When Exercising. Additionally, His Blood Pressure Averages …
A 21-year-old male visits with his family doctor at the urging of his parents when home for Spring Break. The parents are concerned because their son has lost a significant amount of weight. The young man is concerned because he is experiencing a heart rate of 120bpm while at rest and much higher when exercising. Additionally, his blood pressure averages 137/82 based upon four recordings. He has a recurring headache, tremors in his hands and suffers dyspnea.
This individual has been generally health for his entire life, eats a reasonably good diet and is very active, thus the above symptoms are concerning. Standard blood tests show normal levels of blood cells, however there is an elevated amount of metadrenalines (metabolite by-product of adrenaline) and the urinalysis also shows an elevated amount of metabolites of catecholamines. The physician then orders a 24-hour urine test where the patient collects urine at regular intervals for a 24-hour period. The patient is warned to avoid stimulants such as cocoa and caffeine during this time period. The results of this test confirm elevated metabolites of catecholamines. The physician suspects a condition called pheochromocytoma, which is a (usually) non-cancerous tumor of the adrenal gland. This tumor causes the excess secretion of catecholamines. To confirm this suspicion, the physician orders a specialized type of CT scan, called MBIG. This type of scan utilizes radioactive iodine as a contrast agent for visualization of masses as described above. A sample of MIBG results is shown below:
The MIBG confirms the presence of a tumor on the adrenal gland and the young man is scheduled for surgery to remove the mass. It is non-cancerous and he resumes his life. As a side note, current estimates are that only about 10% of adrenal tumors are cancerous.
1. What are the two primary catecholamines discussed in class? In which part of the adrenal glands are they produced? Are they considered neurohormones or endocrine hormones? Amino acid derivatives or steroid hormones? Hydrophilic or hydrophobic hormones?
2. Which division of the autonomic nervous system are catecholamines synergistic with? If they were produced by the nervous system as neurotransmitters, how would they interact with the body differently than they do as hormones? In your comparison, make sure to include: how the chemical signals travel to their target cells, how quickly the signaling occurs, how long the signaling is sustained, and whether the signaling occurs locally or systemically (throughout the body).
3. Identify four possible side effects of catecholamines on the body.
4. Based upon your answers in #1, do you think that catecholamines would bind to extracellular or intracellular receptors in their target cells? Why? Describe how catecholamines would effect a cellular change inside their target cells based on where their receptors are located. Do you think that many of the body’s cells would be targets for these hormones? Why or why not?
5. Why would the doctor want to perform a 24-hour urinalysis? In other words, why would a single urinalysis not be adequate to confirm that the elevated levels of catecholamine metabolites are indicative of pathology? Why would stimulants interfere with the results of urinalysis?
6. The MIBG is an FDA approved test, however there are severe warnings of thyroid damage as a result of this test. What is iodine normally used for in the thyroid? Based on the normal use of iodine by the thyroid, which type of cells in the thyroid might be damaged by radioactive iodine?
7. What is normal heart rate and blood pressure for a healthy, active 21-year-old male? How do the heart rate and blood pressure of this patient compare? Explain the mechanism by which catecholamines modify blood pres
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