Abstract
Epinephrine is the prototypical stress hormone. Its stimulation of all α and β adrenergic receptors elicits short-term systolic hypertension, hyperglycemia, and other aspects of the metabolic syndrome. Acute epinephrine infusion increases cardiac output and induces insulin resistance, but removal of the adrenal medulla has no consistent effect on blood pressure. Epinephrine is the most effective endogenous agonist at the β2 receptor. Transgenic mice that cannot make epinephrine and mice that lack the β2 receptor become hypertensive during exercise, presumably owing to the absence of β2-mediated vasodilatation. Epinephrine-deficient mice also have cardiac remodeling and poor cardiac responses to stress, but do not develop resting hypertension. Mice that cannot make epinephrine have a normal metabolism on a regular 14% fat diet but become hyperglycemic and insulin resistant when they eat a high fat diet. Vigorous exercise prevents diabetes in young mice and humans that overeat. However, exercise is a less effective treatment in older type 2 human diabetics and had no effect on glucose or insulin responses in older, diabetic mice. Sensitivity of the β2 receptor falls sharply with advancing age, and adrenal epinephrine release also decreases. However, treatment of older diabetic mice with a β2 adrenergic agonist improved insulin sensitivity, indicating that β2 subsensitivity can be overcome pharmacologically. Recent studies show that over the long term, epinephrine prevents hypertension during stress and improves glucose tolerance. The hyperglycemic influence of epinephrine is short-lived. Chronic administration of epinephrine and other β2 agonists improves cellular glucose uptake and metabolism. Overall, epinephrine counteracts the metabolic syndrome.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance
Ebert SN, Rong Q, Boe S, Thompson RP, Grinberg A, Pfeifer K. Targeted insertion of the Cre-recombinase gene at the phenylethanolamine n-methyltransferase locus: a new model for studying the developmental distribution of adrenergic cells. Dev Dyn. 2004;231:849–58.
Kennedy B, Ziegler MG. Cardiac epinephrine synthesis. Regulation by a glucocorticoid. Circulation. 1991;84:891–5.
Clutter WE, Bier DM, Shah SD, Cryer PE. Epinephrine plasma metabolic clearance rates and physiologic thresholds for metabolic and hemodynamic actions in man. J Clin Invest. 1980;66:94–101.
Kjaer M, Howlett K, Langfort J, Zimmerman-Belsing T, Lorentsen J, Bulow J, Ihlemann J, Feldt-Rasmussen U, Galbo H. Adrenaline and glycogenolysis in skeletal muscle during exercise: a study in adrenalectomised humans. J Physiol. 2000;528(Pt 2):371–8.
Ashkar E. Cardiovascular effects of adrenal medullectomy in dogs during rest and exercise. Acta Physiol Lat Am. 1971;20:299–307.
Harakal C, Reidenberg MM, Sevy RW, Ohler EA. Hemodynamic effects of adrenal medullectomy in the dog. Am J Physiol. 1966;210:5–6.
Kennedy B, Bigby TD, Ziegler MG. Nonadrenal epinephrine-forming enzymes in humans. Characteristics, distribution, regulation, and relationship to epinephrine levels. J Clin Invest. 1995;95:2896–902.
Bao X, Lu CM, Liu F, Gu Y, Dalton ND, Zhu BQ, Foster E, Chen J, Karliner JS, Ross Jr J, Simpson PC, Ziegler MG. Epinephrine is required for normal cardiovascular responses to stress in the phenylethanolamine N-methyltransferase knockout mouse. Circulation. 2007;116:1024–31.
Tidgren B, Hjemdahl P, Theodorsson E, Nussberger J. Renal neurohormonal and vascular responses to dynamic exercise in humans. J Appl Physiol. 1991;70:2279–86.
Celander O. The range of control exercised by the sympathico-adrenal system; a quantitative study on blood vessels and other smooth muscle effectors in the cat. Acta Physiol Scand Suppl. 1954;32:1–132.
Chruscinski AJ, Rohrer DK, Schauble E, Desai KH, Bernstein D, Kobilka BK. Targeted disruption of the beta2 adrenergic receptor gene. J Biol Chem. 1999;274:16694–700.
Singh JP, Larson MG, Manolio TA, O’Donnell CJ, Lauer M, Evans JC, Levy D. Blood pressure response during treadmill testing as a risk factor for new-onset hypertension. The Framingham heart study. Circulation. 1999;99:1831–6.
Seematter G, Binnert C, Tappy L. Stress and metabolism. Metab Syndr Relat Disord. 2005;3:8–13.
Selye H. The stress of life. 2nd ed. New York: McGraw-Hill; 1976.
Kjeldsen SE, Eide I, Aakesson I, Leren P. Influence of body weight on plasma catecholamine patterns in middle-aged, normotensive men. Scand J Clin Lab Invest. 1983;43:339–42.
Tataranni PA, Young JB, Bogardus C, Ravussin E. A low sympathoadrenal activity is associated with body weight gain and development of central adiposity in Pima Indian men. Obes Res. 1997;5:341–7.
Tuck ML. Obesity, the sympathetic nervous system, and essential hypertension. Hypertension. 1992;19:I67–77.
Young JB, Troisi RJ, Weiss ST, Parker DR, Sparrow D, Landsberg L. Relationship of catecholamine excretion to body size, obesity, and nutrient intake in middle-aged and elderly men. Am J Clin Nutr. 1992;56:827–34.
Schutz Y, Bessard T, Jequier E. Diet-induced thermogenesis measured over a whole day in obese and nonobese women. Am J Clin Nutr. 1984;40:542–52.
Schwartz RS, Jaeger LF, Veith RC. The importance of body composition to the increase in plasma norepinephrine appearance rate in elderly men. J Gerontol. 1987;42:546–51.
Baron AD, Wallace P, Olefsky JM. In vivo regulation of non-insulin-mediated and insulin-mediated glucose uptake by epinephrine. J Clin Endocrinol Metab. 1987;64:889–95.
Lithell HO. Effect of antihypertensive drugs on insulin, glucose, and lipid metabolism. Diabetes Care. 1991;14:203–9.
Lee ZS, Critchley JA, Tomlinson B, Young RP, Thomas GN, Cockram CS, Chan TY, Chan JC. Urinary epinephrine and norepinephrine interrelations with obesity, insulin, and the metabolic syndrome in Hong Kong Chinese. Metabolism. 2001;50:135–43.
Ward KD, Sparrow D, Landsberg L, Young JB, Vokonas PS, Weiss ST. The relationship of epinephrine excretion to serum lipid levels: the Normative Aging Study. Metabolism. 1994;43:509–13.
Troisi RJ, Weiss ST, Parker DR, Sparrow D, Young JB, Landsberg L. Relation of obesity and diet to sympathetic nervous system activity. Hypertension. 1991;17:669–77.
Jensen J, Ruzzin J, Jebens E, Brennesvik EO, Knardahl S. Improved insulin-stimulated glucose uptake and glycogen synthase activation in rat skeletal muscles after adrenaline infusion: role of glycogen content and PKB phosphorylation. Acta Physiol Scand. 2005;184:121–30.
Bao X, Mills PJ, Rana BK, Dimsdale JE, Schork NJ, Smith DW, Rao F, Milic M, O’Connor DT, Ziegler MG. Interactive effects of common beta2-adrenoceptor haplotypes and age on susceptibility to hypertension and receptor function. Hypertension. 2005;46:301–7.
Loomba R, Rao F, Zhang L, Khandrika S, Ziegler MG, Brenner DA, O’Connor DT. Genetic covariance between gamma-glutamyl transpeptidase and fatty liver risk factors: role of beta2-adrenergic receptor genetic variation in twins. Gastroenterology. 2010; 139:836–45, 845 e1.
Seals DR, Esler MD. Human ageing and the sympathoadrenal system. J Physiol. 2000;528:407–17.
Bowie MW, Slattum PW. Pharmacodynamics in older adults: a review. Am J Geriatr Pharmacother. 2007;5:263–303.
Docherty JR. Age-related changes in adrenergic neuroeffector transmission. Auton Neurosci. 2002;96:8–12.
• Ziegler MG, Milic M, Sun P, Tang CM, Elayan H, Bao X, Cheung WW, O’Connor DT. Endogenous epinephrine protects against obesity induced insulin resistance. Auton Neurosci. 2011; 162:32–4. PNMT knockout mice developed worse diabetes.
• Marques CM, Motta VF, Torres TS, Aguila MB, Mandarim-de-Lacerda CA. Beneficial effects of exercise training (treadmill) on insulin resistance and nonalcoholic fatty liver disease in high-fat fed C57BL/6 mice. Braz J Med Biol Res. 2010; 43:467–75. Exercise prevented diabetes in young mice.
Ringseis R, Mooren FC, Keller J, Couturier A, Wen G, Hirche F, Stangl GI, Eder K. Kruger K. Mol Nutr Food Res: Regular endurance exercise improves the diminished hepatic carnitine status in mice fed a high-fat diet; 2011.
Steinberg GR, Jorgensen SB. The AMP-activated protein kinase: role in regulation of skeletal muscle metabolism and insulin sensitivity. Mini Rev Med Chem. 2007;7:519–26.
Kelly M, Gauthier MS, Saha AK, Ruderman NB. Activation of AMP-activated protein kinase by interleukin-6 in rat skeletal muscle: association with changes in cAMP, energy state, and endogenous fuel mobilization. Diabetes. 2009;58:1953–60.
Miura S, Kawanaka K, Kai Y, Tamura M, Goto M, Shiuchi T, Minokoshi Y, Ezaki O. An increase in murine skeletal muscle peroxisome proliferator-activated receptor-gamma coactivator-1alpha (PGC-1alpha) mRNA in response to exercise is mediated by beta-adrenergic receptor activation. Endocrinology. 2007;148:3441–8.
Kirsch DM, Baumgarten M, Deufel T, Rinninger F, Kemmler W, Haring HU. Catecholamine-induced insulin resistance of glucose transport in isolated rat adipocytes. Biochem J. 1983;216:737–45.
Mulder AH, Tack CJ, Olthaar AJ, Smits P, Sweep FC, Bosch RR. Adrenergic receptor stimulation attenuates insulin-stimulated glucose uptake in 3 T3-L1 adipocytes by inhibiting GLUT4 translocation. Am J Physiol Endocrinol Metab. 2005;289:E627–33.
Chakraborty C. Biochemical and molecular basis of insulin resistance. Curr Protein Pept Sci. 2006;7:113–21.
Sanz C, Gautier JF, Hanaire H. Physical exercise for the prevention and treatment of type 2 diabetes. Diabetes Metab. 2010;36:346–51.
Marwick TH, Hordern MD, Miller T, Chyun DA, Bertoni AG, Blumenthal RS, Philippides G, Rocchini A. Exercise training for type 2 diabetes mellitus: impact on cardiovascular risk: a scientific statement from the American Heart Association. Circulation. 2009;119:3244–62.
Gill JM. Physical activity, cardiorespiratory fitness and insulin resistance: a short update. Curr Opin Lipidol. 2007;18:47–52.
Haram PM, Kemi OJ, Lee SJ, Bendheim MO, Al-Share QY, Waldum HL, Gilligan LJ, Koch LG, Britton SL, Najjar SM, Wisloff U. Aerobic interval training vs. continuous moderate exercise in the metabolic syndrome of rats artificially selected for low aerobic capacity. Cardiovasc Res. 2009;81:723–32.
Rutledge DR, Steinberg JD. Effect of age on lymphocyte beta 2-adrenergic responsiveness. DICP. 1991;25:532–8.
Ebstein RP, Stessman J, Eliakim R, Menczel J. The effect of age on beta-adrenergic function in man: a review. Isr J Med Sci. 1985;21:302–11.
Begin-Heick N. Beta-adrenergic receptors and G-proteins in the ob/ob mouse. Int J Obes Relat Metab Disord. 1996;20 Suppl 3:S32–5.
• Umpierre D, Ribeiro PA, Kramer CK, Leitao CB, Zucatti AT, Azevedo MJ, Gross JL, Ribeiro JP, Schaan BD. Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis. JAMA. 2011; 305:1790–9. The effect of exercise on diabetes in older diabetics.
Innes KE, Vincent HK, Taylor AG. Chronic stress and insulin resistance-related indices of cardiovascular disease risk, part I: neurophysiological responses and pathological sequelae. Altern Ther Health Med. 2007;13:46–52.
Weidmann P, de Courten M, Boehlen L, Shaw S. The pathogenesis of hypertension in obese subjects. Drugs. 1993;46 Suppl 2:197–208. discussion 208–9.
Moan A, Eide IK, Kjeldsen SE. Metabolic and adrenergic characteristics of young men with insulin resistance. Blood Press Suppl. 1996;1:30–7.
Zhang J, Niaura R, Dyer JR, Shen BJ, Todaro JF, McCaffery JM, Spiro 3rd A, Ward KD. Hostility and urine norepinephrine interact to predict insulin resistance: the VA Normative Aging Study. Psychosom Med. 2006;68:718–26.
Acknowledgments
This work was supported by NIH grants HL58120, M01RR00827, and 1UL1RR0319800.
Disclosure
No potential conflicts of interest relevant to this article were reported.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ziegler, M.G., Elayan, H., Milic, M. et al. Epinephrine and the Metabolic Syndrome. Curr Hypertens Rep 14, 1–7 (2012). https://doi.org/10.1007/s11906-011-0243-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11906-011-0243-6