Volume 02 Issue 06-2022
15
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
02
I
SSUE
06
Pages:
15-21
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
OCLC
–
1121105677
METADATA
IF
–
5.654
Publisher:
Oscar Publishing Services
Servi
ABSTRACT
The article presents the results of surgical treatment of 40 patients with pheochromocytoma. Patients have a
significant increase in the level of metanephrine in the urine. The study determined the relationship between the
course of hypertension and the size of the tumor, the concentration of metanephrines and the duration of the disease.
KEYWORDS
Arterial hypertension, pheochromocytoma, metanephrine, normetanephrine.
Research Article
THE ROLE OF METANEPHRINS IN ARTERIAL HYPERTENSION CAUSED BY
MALIGNANT PHEOCHROMOCYTOMA
Submission Date:
June 10, 2022,
Accepted Date:
June 20, 2022,
Published Date:
June 30, 2022
Crossref doi:
https://doi.org/10.37547/ijmscr/Volume02Issue06-04
M.D. Juraev
Samarkand branch of the Republican Specialized Scientific and Practical Medical Center of Oncology and
Radiology, Uzbekistan
D.Yu. Mamarizaev
Samarkand branch of the Republican Specialized Scientific and Practical Medical Center of Oncology and
Radiology, Uzbekistan
Raximov N.M
Samarkand branch of the Republican Specialized Scientific and Practical Medical Center of Oncology and
Radiology, Uzbekistan
Shaxanova Sh.Sh
Samarkand branch of the Republican Specialized Scientific and Practical Medical Center of Oncology and
Radiology, Uzbekistan
Journal
Website:
https://theusajournals.
com/index.php/ijmscr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
Volume 02 Issue 06-2022
16
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
02
I
SSUE
06
Pages:
15-21
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
OCLC
–
1121105677
METADATA
IF
–
5.654
Publisher:
Oscar Publishing Services
Servi
INTRODUCTION
According to the World Health Organization, the
number of free people with hypertension is steadily
increasing. Among all patients with arterial
hypertension, arterial hypertension of adrenal etiology
accounts for from 1 to 2.5%.
It is known that arterial hypertension of adrenal
etiology is difficult to stop with medication. The only
radical and effective method of treatment is surgical
removal of an adrenal tumor. [2,5]
Along the course of arterial hypertension, paroxysmal,
permanent and mixed forms can be distinguished.
The paroxysmal form of the disease is characterized by
a sudden sharp increase in blood pressure (sometimes
up to 300 mmHg and higher). Outside of an attack of a
hypertensive crisis, blood pressure is usually normal.
According to multicenter studies, hypertensive crises
that occur against the background of initially normal
blood pressure are tolerated by patients much more
severely than hypertensive crises that occur against
the background of initial hypertension. [7,9]
The permanent form of arterial hypertension is
characterized by a persistent increase in blood
pressure without episodes of a hypertensive crisis and
resembles essential hypertension along the course, it is
less common.
The mechanism of development of stable arterial
hypertension in patients with pheochromocytoma is
not fully established.
In patients with a mixed form of arterial hypertension,
crises occur against the background of a constantly
elevated blood pressure of 160-170 / 100-110 mmHg.
The intensity of crises in patients with mixed
hypertension is less pronounced compared to patients
with paroxysmal hypertension. Symptoms of chronic
damage to the cardiovascular system in these patients
are more common.
During a hypertensive crisis, blood pressure rises to
250-270 / 140-160 mmHg. The clinical picture of the
disease in these patients is somewhat weaker than in
patients with paroxysmal hypertension. [1,2,4,5]
Excessive intake of catecholamines into the blood
leads to the development of tachycardia, an increase in
systemic vascular tone, increases the contractility of
the myocardium and venous insufficiency. The causes
of the development of arterial hypertension of various
forms of paroxysmal, permanent and moderate
hypertension remain unclear. Some authors talk about
the possible existence of a certain connection between
the histological structure of pheochromocytoma and
the nature of arterial hypertension, but these
assumptions do not have an evidence base. [3,6,8]
OBJECTIVE
To determine the relationship between the
concentration of adrenal hormones and the type of
hypertension in patients with pheochromocytoma.
MATERIALS AND METHODS
In the Samarkand branch of the Republican Specialized
Center of Oncology and Radiology in the period from
2015 to 2021, 40 patients with pheochromocytoma
were examined and treated.
Distribution of patients by gender: women 28 (70.0%),
men 12 (30.0%). Between the ages of 16 and 69. The
average age is 39.7±6.1 years. The duration of
Volume 02 Issue 06-2022
17
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
02
I
SSUE
06
Pages:
15-21
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
OCLC
–
1121105677
METADATA
IF
–
5.654
Publisher:
Oscar Publishing Services
Servi
hypertension ranged from 6 months to 10 years and
averaged 4.2±1.7 years.
Patients were divided into two groups in group I of 20
(50%) patients with pheochromocytoma, preoperative
preparation was carried out using an alpha-
adrenoblocker (doxazosin 2-16mg). In group II, 20
(50%) patients were prepared with antihypertensive
drugs Amless 4mg/5mg; 8mg/10mg.
In group I patients, the duration of preoperative
preparation ranged from 7 to 15 days, on average 10.2
± 1.5 days, in group II patients, the duration ranged
from 9 to 18 days, on average 13.5 ± 1.8 days.
The patients were comprehensively examined, general
clinical, biochemical, hormonal, radiation research
methods were carried out, according to the
therapeutic and diagnostic algorithm worked out in
the clinic.
As
instrumental
research
methods,
patients
underwent ultrasound (including intraoperative),
computed tomography (CT), magnetic resonance
imaging (MRI)
In preparation for the operation, the state of the
cardiovascular system and central hemodynamics,
daily blood pressure monitoring, echocardiography
were also examined, the cardiovascular and
respiratory systems were monitored intraoperatively.
The above-mentioned methods of pheochromocyte
examination made it possible to adequately assess the
functional reserves of the div of the operated
patients, to carry out their targeted correction and
prevention of complications at all stages of the
perioperative period.
RESULTS AND DISCUSSIONS
We also studied the relationship between the course of
different variants of arterial hypertension depending
on the concentration of metanephrines in the daily
urine.
Distribution of patients along the course of
hypertension
depending
on
the
level
of
metanephrines.
Form of arterial hypertension
Metanephrine (mcg/day)
Normetanephrine (mcg/day)
Paroxysmal form of arterial
hypertension n 11 (27,5%)
1080,7 [from 940,3 to 2100,5]
1000,5 [from 912 to 1500,5]
Permanent form of arterial
hypertension n 14 (35%)
980,5 [from 810,4 to 1400,8]
898,4 [from 830,5 to 1170]
Mixed form of arterial
hypertension n 15 (37,5%)
1810,7 [from 1625 to 2200,5]
1640,6 [from 1490 to 2145]
Volume 02 Issue 06-2022
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International Journal of Medical Sciences And Clinical Research
(ISSN
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VOLUME
02
I
SSUE
06
Pages:
15-21
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
OCLC
–
1121105677
METADATA
IF
–
5.654
Publisher:
Oscar Publishing Services
Servi
Analyzing the above table, we can conclude that there
is a relationship between the concentration of
metanephrines and the type of hypertension.
In patients with paroxysmal hypertension, the daily
urine metanephrine ranged from 940.3 to 2100.5
mcg/day,
on
average
1080.7
mcg/day.
Normetanephrine daily urine ranged from 912 to 1500.5
mcg / day on average 1000.5 mcg / day.
In patients with a constant form of hypertension, the
daily urine metanephrine ranged from 810.4 to 1400.8
mcg
/day,
on
average
980.5
mcg/
day.
Normetanephrine daily urine ranged from 830.5 to 1170
mcg / day on average 898.4 mcg / day.
In patients with mixed hypertension, the daily urine
metanephrine ranged from 1625 to 2200.5 mcg/day, on
average 1810.7 mcg/day. Normetanephrine daily urine
ranged from 1490 to 2145 mcg / day on average 1640.6
mcg / day.
We also studied the content of metanephrine in daily
urine depending on the size of the tumor.
The level of metanephrins depending on the size of
the.
Dimensions
Metanephrine of daily urine
mcg/day
Normetanephrine of daily urine
mcg/day
≤
2,9 centimeters' (n 11)
942 [from 819,4 to 1240,5]
963 [from 859 to 1405]
от 3,0 до 6,9 centimeters' (n 17) 1060,2 [from 874 to 1459,5]
980,4 [from 836,5 to 1470]
≥
7 centimeters' (n 12)
1810 [from 1465 to 2209,5]
1420,1 [from 1280 to 2140,5]
According to the results of the study, we see that with
an increase in the size of pheochromocytes, the
concentration of secreted metanephrines increases.
We also studied the dependence of the concentration
of metanephrines on the duration of the disease.The
level of metanephrines in the daily urine, depending on
the duration of pheochromocytomas.
The duration of the disease
Metanephrine of daily urine
mcg/day
Normetanephrine of daily urine
mcg/day
from 12 to 35 months (n 12)
860 [from 819,4 to 1070]
841,5 [from 830,5 to 971,8]
from 36 to 60 months (n 14)
1420,5 [from 1100 to 1610,1]
1270,4 [from 920,7 to 2040,5]
≥ 60
months (n 14)
1340,3 [from 995 to 2105,5]
1072,4 [from 964,1 to 1442]
Volume 02 Issue 06-2022
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International Journal of Medical Sciences And Clinical Research
(ISSN
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VOLUME
02
I
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06
Pages:
15-21
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
OCLC
–
1121105677
METADATA
IF
–
5.654
Publisher:
Oscar Publishing Services
Servi
Having studied the dependence of the concentration
of metanephrine in daily urine on the duration of the
disease, we did not find a reliable relationship.
We can conclude that the determination of the level of
metanephrins and vanillylmindal acid is the main
differential diagnostic feature. High levels of
metanephrine and normetanephrine in the daily urine
do not reliably determine the different types of
hypertension.
Preoperative
preparation
of
patients
with
pheochromocytoma is one of the main components of
complex treatment, preparation should be carried out
correctly and adequately, since the outcome of the
operation largely depends on it.
Before surgery, target organs suffering from
prolonged
hypercatecholaminemia
should
be
thoroughly investigated. Preoperative preparation of
patients with pheochromocytoma was carried out
depending on the following factors: duration of arterial
hypertension, general condition of the patient,
intensity and frequency of hypertensive crises, tumor
size, condition of target organs, age, gender and
presence of hypovolemia.
In group I, 20 (50%) patients with pheochromocytoma,
preoperative preparation was carried out using an
alpha-adrenoblocker (doxazosin 2-16mg). In group II,
20 (50%) patients were prepared with antihypertensive
drugs Amless 4mg/5mg; 8mg/10mg.
In group I patients, the duration of preoperative
preparation ranged from 7 to 15 days, on average 10.2
± 1.5 days, in group II patients, the duration ranged
from 9 to 18 days, on average 13.5 ± 1.8 days.
Patients of both groups had approximately the same
blood pressure figures upon admission to the hospital.
Blood pressure indicators of patients in the
perioperative period.
Blood pressure indicators
(mmHg)
I group of patients
I group of patients
Average blood pressure at
admission
230,5
±
11,2/129,3
±
9,6
227,1
±
9,4/124,8
±
6,9
Average blood pressure before
surgery
147,8
±
3,5/89,6
±
3,1
170,3
±
4,9/105,5
±
5,4
Increase in blood pressure
during surgery on average
178,7
±
4,7/105,3
±
4,2
208,4
±
7,2/115,5
±5
,2
As we can see from the table, in patients of group I who
received doxazosin 2-16 mg in the preoperative period,
blood pressure significantly decreased compared to
patients of group II.
Our studies have shown that in order to prevent the
development of the syndrome of "uncontrolled
hemodynamics" and life-threatening conditions
associated with it, all patients should undergo
Volume 02 Issue 06-2022
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(ISSN
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2771-2265)
VOLUME
02
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SSUE
06
Pages:
15-21
SJIF
I
MPACT
FACTOR
(2021:
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694
)
(2022:
5.
893
)
OCLC
–
1121105677
METADATA
IF
–
5.654
Publisher:
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preoperative preparation with the use of the a-blocker
doxazosin, regardless of blood pressure and other
indicators.
CONCLUSIONS
Our research demonstrates that for the prevention of
uncontrolled hemodynamics and the prevention of life-
threatening conditions, in the preoperative period, all
patients should be prescribed an adrenoblocker –
doxazosin at a dose of 2 to 16 mg, regardless of the
initial blood pressure level. The favorable therapeutic
effect of the use of adrenoblockers is reported in the
works of most domestic and foreign authors.
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SJIF
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IF
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5.654
Publisher:
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