Abstract
Unexplained episodic hypertension, hypotension, or orthostatic intolerance, tachycardia, anxiety, and flushing in 21 patients were investigated for the possibility of hypovolemia by blood volume and individual plasma catecholamines (including autocrine paracrine-born dopamine), determinations baseline, in response to upright posture and catecholamines only during the episodic blood pressure swings. Blood volume was determined by Cr51 fixed to patients' hemoglobin, free norepinephrine, epinephrine, and dopamine with dopamine sulfate following sulfatase hydrolysis, radioenzymatically. The recumbent mean 27.4±3% (SE) blood volume decrease from predicted values accentuating to 33.5±4% upright was associated with normal baseline plasma free norepinephrine, epinephrine, dopamine, dopamine sulfate, plasma renin activity, and aldosterone with normal mean postural responses from all patients except a hyperresponsive compared to controls (p<0.04), plasma renin activity increase from 0.657±0.1 to 4.47±1.8 ng/mL/hr. During the hypertensive, hypotensive, or tachycardic episodes the moderate increase of free norepinephrine and epinephrine (p<0.04) (but not free dopamine) contrasted with an increase of dopamine sulfate from 2.5±0.9 to clearly pathological values of 16.8±8.3 ng/mL (p<0.0003 on % increase of individual values).
We conclude that the normal (but to the degree of hypovolemia inappropriately low orthostatism- and episodes-associated sympathetic arousal) is outpaced by considerable episodic dopamine sulfate surges, reflecting extraneuronal dopamine discharge. Whether this increase contributes to the increased natriuresis directly or by inhibiting aldosterone response to renin-angiotensin, perpetuating hypovolemia, remains to be established.
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References
Cohn JN. Paroxysmal Hypertension and Hypovolemia.N Engl J Med 1966; 275:643–6.
Fouad FM, Tadena-Thome L, Bravo EL, Tarazi RC. Idiopathic Hypovolemia.Ann Int Med 1986; 104:298–303.
Streeten DH, Kerr CB, Kerr LP, Prior JC, Dalakos TG. Hyperbradykininism: a new orthostatic syndrome.Lancet 1972; 2:1048–53.
Schondorf R, Low PA. Idiopathic postural orthostatic tachycardia syndrome: An attenuated form of acute pandysautonomia?Neurology 1993; 43:132–7.
Goldstein DS, Mezey E, Yamamoto T, Aneman A, Friberg P, Eisenhofer G. Is There a Third Peripheral Catecholaminergic System? Endogenous Dopamine as an Autocrine/Paracrine Substance Derived from Plasma DOPA and Inactivated by Conjugation.Hypertens Res 1995; 18:S93-S99.
Wang PC, Buu NT, Kuchel O, Genest J. Conjugation patterns of endogenous plasma catecholamines in human and rat: A new specific method for analysis of glucuronide conjugated catecholamines.J Lab Clin Med 1983; 101:141–51.
Melby JC. Plasma renin activity and mineralocorticoid assays in hypertension.Radioassay: Clinical concepts. Hunter OB Jr., ed., Skokie, IL: Searle; 1974:45–52.
Small WJ, Verloop MC. Determination of blood volume using radioactive Cr51 modifications from original technique.J Lab Clin Med 1956; 47:255–60.
Roberts LJ II. Recurrent Syncope Due to Systemic Mastocytosis.Hypertension 1984; 6:285–94.
Ratge D, Kohse KP, Steegmuller U, Wisser H. Distribution of free and conjugated catecholamines between plasma, platelets and erythrocytes: different effects of intravenous and oral catecholamine administrations.J Pharmacol Exper Ther 1991; 257(1): 232–8.
Faraj BA, Camp VM, Davis DC, Kutner M, Cotsonis GA, Holloway T. Elevated concentrations of dopamine sulfate in plasma of cocaine abusers.Biochem Pharmacol 1993; 46:1453–7.
Kuchel O, Buu NT, Larochelle P, Hamet P, Genest J, Jr. Episodic Dopamine Discharge in Paroxysmal Hypertension. Page's Syndrome Revisited.Arch Intern Med 1986; 146:1315–20.
Kuchel O, Buu NT, Hamet P et al., Orthostatic Hypotension: A Posture-Induced Hyperdopaminergic State.Am J Med Sci 1985; 289:3–11.
Dobnig H, Leb G, Lipp R, Porta S, Dusleag J, Eber B, Klein W, Krejs GJ. Sulfoconjugated and free plasma catecholamine levels at rest and during exercise in patients with idiopathic dilated cardiomyopathy.Eur J Endocrin 1995; 132:181–91.
Yoshizumi M, Ohuchi T, Masuda Y, Katch I, Oka M. Deconjugating activity for sulfoconjugated dopamine in homogenates of organs from dogs.Biochem Pharmacol 1992; 44:2263–5.
Yoshizumi M, Nakaya Y, Hibino T, et al. Changes in plasma free and sulfoconjugated catecholamines before and after acute physical exercise: experimental and clinical studies.Life Sci 1992; 51:227–234.
Carey RM, Drake CR Jr. Dopamine Selectively Inhibits Aldosterone Responses to Angiotensin II in Man.J Hyper 1984; 2:267–9.
Kuchel O, Cusson JR, Larochelle P, Buu NT, Genest J. Posture- and Emotion-Induced Severe Hypertensive Paroxysms with Baroreceptor Dysfunction.J Hyper 1987; 5:277–83.
Robertson D, Hollister AS, Biaggioni I, Netterville JL, Mosqueda-Garcia R, Robertson RM. The diagnosis and treatment of baroreflex failure.N Engl J Med 1993; 329:1449–55.
Bissler JJ, Welch TR, Loggie JMH. Paradoxical hypertension in hypovolemic children.Pediatr Emerg Care 191; 7:350–352.
Kuchel O, Buu NT, Gutkowska J, Genest J. Treatment of severe orthostatic hypotension by metoclopramide.Ann Intern Med 1980; 93:841–3.
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Kuchel, O., Léveillé, J. Idiopathic hypovolemia: a self-perpetuating autonomic dysfunction?. Clinical Autonomic Research 8, 341–346 (1998). https://doi.org/10.1007/BF02309625
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DOI: https://doi.org/10.1007/BF02309625