Abstract
Extract: Catecholamine excretion in urine was assessed in a group of unstressed acyanotic infants and children and in a comparable group of children with cyanotic forms of congenital heart disease. Twenty-four hour excretion of epinephrine (E), norepineph-(NE), 3-methoxy-4-hydroxymandelic acid (VMA), dopamine (DA), and metanephrine and normetanephrine combined (MN + NMN) was measured in all individuals. Significant elevations of DA were found in the cyanotic patients when compared with the controls, with control values being 8.53 μg/kg/24 hr compared with values in the cyanotic subjects of 17.09 μg/kg/24 hr (P < 0.001). Likewise, MN + NMN values were significantly elevated in the cyanotic subjects, control values being 43.25 μg/kg/24 hr and those of the cyanotic patients 90.51 μg/kg/24 hr (P < 0.025). The E, NE, and VMA values showed no significant differences, although in the cyanotic patients the tendency was of elevation over control values. The presence of elevated amounts of DA in the urines of cyanotic individuals indicates an increased release of this neurohormone in the stressed individuals. The presence of elevated amounts of MN + NMN in the urine of cyanotic patients further supports this finding and indicates that secretion of E and NE is in actuality also increased.
Speculation: Hypoxemia as the only demonstrable stressful stimulus is capable of eliciting an increase in the secretion of the catecholamines. This increase in circulating neurohormones and their attendant pharmacologic influences may seriously affect the course of the child with hypoxemia secondary to cyanotic forms of congenital heart disease by promoting the occurrence of metabolic acidemia and causing a decrease in pulmonary blood flow.
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Folger, G., Hollowell, J. Excretion of Catecholamine in Urine by Infants and Children with Cyanotic Congenital Heart Disease. Pediatr Res 6, 151–157 (1972). https://doi.org/10.1203/00006450-197203000-00002
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DOI: https://doi.org/10.1203/00006450-197203000-00002
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