Differences between sporadic pheochromocytoma and pheochromocytoma in multiple endocrime neoplasia, type 2.

We studied the gross and microscopic pathology of the adrenal gland in 69 cases of sporadic phenochromocytoma in order to develop a profile of the neoplasm to compare with that of pheochromocytoma observed in the syndrome of multiple endocrine neoplasia, type 2 (MEN 2). The results showed that sporadic pheochromocytoma was a unicentric (93%), unilateral (100%) neoplasm, which was associated with normal extratumoral adrenal medulla (100%). The findings contrast with those encountered in the adrenal gland in MEN 2, in which the tumor involvement is frequently multicentric, usually bilateral, and associated with extratumoral medullary hyperplasia in cases of early involvement.

Familial pheochromocytoma and islet cell tumor of the pancreas.

The occurrence of pheochromocytoma(s) or pancreatic islet cell tumor(s), or both, in two or more members of three unrelated families in a manner consistent with autosomal dominant inheritance suggests that this tumor association is a genetically determined syndrome. Among 11 affected patients (aged five to 53 years), 10 had pheochromocytoma (bilateral in six), four had islet cell tumor (multicentric in one), and three had both tumors. Clinical presentation was due to pheochromocytoma in 10 cases (symptoms or signs commencing before age 10 years in three patients) and islet cell carcinoma in one case.

Saralasin infusion in renovascular hypertension: increased response rate in seated patients.

Most series report a significant percentage of nondepressor (negative) responses to saralasin infusions in patients with surgically curable renovascular hypertension. Usually the infusions have been performed with the supine position. In the present study saralasin infusions were done in 33 acutely sodium-depleted hypertensive patients--17 with renovascular and 16 with the essential variety.

Utilization of the preemployment health examination in a university staff health service.

This study assessed the utilization of a mandatory preemployment health examination (PEHE) for 507 new full-time university staff in 1976. A random sample of 126 new employees was interviewed by telephone. Of the 108(86%) who completed the interview, 80 (74%) had been examined by the staff health service.

The Mayo Three-Community Hypertension Control Program. III. Outcome in a community-based hypertension clinic.

As part of a broader community program to evaluate approaches to hypertension control, a Community Hypertension Clinic, staffed by two nurse practitioners, was set up in a rural community. Hypertensive persons were identified either by an initial central blood pressure screening or by a subsequent home screening. Slightly more than half of the hypertensive patients at initial screening, or 256 persons, elected to go to the Community Hypertension Clinic for second-stage screening, whereas the remainder elected to see their physicians or to do neither.

Analysis for urinary catecholamines by liquid chromatography with amperometric detection: methodology and clinical interpretation of results.

A method is presented for the quantitative analysis of urinary unconjugated norepinephrine, epinephrine, and dopamine as discrete entities. The procedure requires initial purification of the specimen on aluminum oxide and a boric acid-gel. We used "high-performance" reversed-phase paired-ion chromatography, with a flow-through amperometric cell as the detector.

Renovascular hypertension. Relationship of surgical curability to renin-angiotensin activity.

Fifteen patients whose renovascular hypertension was cured or improved by renal artery reconstructive surgery or nephrectomy (or both) underwent studies of their renin-angiotensin systems preoperatively. These studies included measurements of peripheral venous renin activity in the erect position without diuretic preparation, blood pressure response to blockade of endogenous angiotensin II with a saralasin infusion in the acutely sodium-depleted state, and levels of renal venous renin activity, also after sodium depletion. In 13 of these 15 patients who had benefitted from surgical intervention for relief of renovascular hypertension, at least one index of renin dependency was positive.

Management of the patient with renovascular hypertension.

Renal artery stenosis, either fibromuscular or atheromatous, is probably the most common cause of secondary hypertension in man. Both of these diseases are active, ongoing processes that may be ameliorated but not cured by medical or surgical treatment. The clinical history and examination of the patient with hypertension may help differentiate renovascular hypertension from essential hypertension.

Prazosin-new hypertensive agent. A double-blind crossover study in the treatment of hypertension.

Prazosin hydrochloride, a new antihypertensive agent, is said to be of mild-to-moderate potency when used as a sole agent in mild-to-moderate hypertension and when used in conjunction with other agents in severe hypertension. In our study of 14 patients comparing hydrochlorothiazide with prazosin, the antigypertensive effect of prazosin was less than that of hydrochlorothiazide. The greatest application of prazosin may be in conjunction with thiazide diuretics and beta-adrenergic blocking agents as the second or third drug.

Single-voided urine metanephrine assays in screening for pheochromocytoma.

To facilitate the screening for pheochromocytoma, we have validated the use of single-voided, spot urine specimens for the determination of total metanephrines. Metanephrine excretion was found to be quite constant throughout the day and night in ten patients with essential hypertension and seven patients with pheochromocytoma. The levels in single-voided specimens were closely correlated to those in 24-hour specimens in 100 hypertensive subjects.

Adrenal medullary disease in multiple endocrine neoplasia, type 2: pheochromocytoma and its precursors.

Multiple endocrine neoplasia, type 2 (MEN-type 2), designates the syndrome of medullary thyroid carcinoma, pheochromocytoma, and occasional parathyroid hyperplasia. The thyroid carcinoma, which is usually bilateral and multicentric, is preceded by multifocal C-cell hyperplasia. The adrenal gland manifests pheochromocytoma, which is frequently bilateral and multicentric, and may be malignant.

Use of an elastic garment in the treatment of orthostatic hypotension.

The most common cause of orthostatic hypotension is poor postural adjustment. The most severe form of orthostatic hypotension is of unknown etiology; the primary disorder is a degeneration of the peripheral autonomic nervous system, resulting in a decrease in production of catecholamine. Physiologically, there is a failure of arteriolar and venous vasoconstriction and a lack of cardiac response, both in rate and in contractility to sympathetic stimulation.

Large artery involvement in giant cell (temporal) arteritis.

Of 248 patients with giant cell arteritis, 34 had evidence that the disease affected the aorta or its major branches. Symptoms suggestive of large artery involvement were intermittent claudication of an extremity, paresthesias, and Raynaud's phenomenon. Physical findings included absent or decreased large artery pulses and bruits over large arteries.

Hypertension.

Hypertension, a health problem of epidemic proportions, has not been controlled successfully. Screening efforts are increasing the detection of cases, and current emphasis on treatment rather than detailed evaluation is increasing the incidence of control of hypertension. Patient compliance is crucial, however, because all of the currently available treatments require daily taking of pills by patients who commonly do not understand their disease or the need for treatment.

[Vestibular disorders in contusions of the temporal lobe of the brain].

An analysis of the caloric test results in 30 victims of a severe contusion-crush of the temporal lobe of the brain showed that to this type of pathology the common significant changes in the vestibular-oculomotor reflex which, more often than not, found their expression in the prevalence of an experimental nystagmus in the direction toward the affected hemisphere. The victims, in whom contusions of the temporal lobe were attended by lesions of the brain stem of the primary or dislocation genesis, demonstrated the presence of vestibular areflexia or dissociaton of the quick nystagmus phase. Against the background of a continual tonic component there would become evident gross functional disruptions of the oculomotor elements which in a number of cases proved unrecognizable with an ordinary clinical observation.

Glucagon-blood catecholamine test: use in isolated and familial pheochromocytoma.

In 149 cases, blood pressure response to glucagon test did not exceed 20/10 mm Hg more than the response in the cold pressor test control and was considered negative. Plasma catecholamine level increases may be seen in 95% of patients without pheochromocytomas. Among six patients with pheochromocytomas, urinary metanephrine levels were of diagnostic importance in two with isolated pheochromocytoma and in one with the multiple endocrine neoplasia of type 2 (MEN-type 2).

Daily and alternate-day corticosteroid regimens in treatment of giant cell arteritis: comparison in a prospective study.

Alternate-day corticosteroid therapy was compared with two daily corticosteroid regimens for the treatment of giant cell arteritis. In a prospective study 60 patients with this disease were randomly assigned to three treatment groups: group A, 15 mg of prednisone every 8 hours; group B, 45 mg of prednisone every morning; and group C, 90 mgof prednisone every other morning. After 1 month of treatment, the arteritis seemed to be completely suppressed in 18 patients in group A and 16 in group B but in only 6 in group C.

Cardiovascular complications of pheochromocytoma crisis.

Two patients with hypertensive crises due to pheochromocytoma presented with unusual features suggestive of cardiovascular disorders other than pheochromocytoma. These features included transient cortical blindness and other neurologic deficits, electrocardiographic changes indicative of transmural infarction and peripheral arterial spasm. In both patients the diagnosis of pheochromocytoma was made later; removal of the tumor was followed by ready reversal of the clinical and biochemical abnormalities.