PLASMA NEUROTRANSMITTERS, BLOOD-PRESSURE AND HEART-RATE DURING SUPINERESTING, ORTHOSTASIS AND MODERATE EXERCISE IN SEVERELY ILL PATIENTS -A MODEL OF FAILING TO COPE WITH STRESS

Background: Previous clinical research has shown that severely ill (so matic) as well as many psychosomatic patients show raised noradrenalin e (NA), adrenaline (AD), cortisol, free serotonin (f5HT) and platelet aggregability. Conversely, they show reduced NA/AD plasma ratio and pl atelet serotonin (p5HT). They also show adrenal hyperresponsiveness to an oral glucose load. These findings are opposed to those observed in depressed patients who show adrenal gland sympathetic hyporesponsiven ess and neural sympathetic hyperactivity. Objective: To investigate ad renal gland and neural sympathetic systems as well as the other parame ters in nondrepressed severely ill patients through the orthostasis ex ercise stress test which in normals triggers NA but no AD rise. Method s: We investigated 35 severely ill patients and their age- and sex-pai red controls. Systolic, diastolic pulse pressure (PP), heart rate and neuroendocrine parameters were measured supine (0 min), at orthostasis (1 min) and exercise (5 min). A second test was performed 2 weeks lat er, after atropine injection. Multivariate analysis of variance, paire d t test and Pearson product-moment test were employed. Results: The n ormal PP orthostasis fall was not observed in patients. At this period , an abnormal AD peak substituted the normal NA peak. The normal p5HT- f5HT orthostasis-exercise peaks were absent in patients. Cortisol and platelet aggregability were raised in patients. Conclusions: Severely ill (somatic) patients responded to the orthostasis-exercise stress te st with adrenal and corticosuprarenal but not neural sympathetic activ ity. They did not show the normal parasympathetic activity at orthosta sis. This adrenal gland sympathetic hyperactivity registered in somati c patients is similar to that observed in mammals which fail to cope w ith stress and contrary to the profile registered in depressed subject s who show NA but not AD rise.