PLASMA-CATECHOLAMINES IN PATIENTS WITH ADDISONS-DISEASE

BACKGROUND AND OBJECTIVE Two endocrine tissues are present within the adrenal gland: the steroid producing cortical cells and the catecholam ine producing chromaffin cells. Glucocorticoids occur in high concentr ations in the adrenal medulla. In vitro, glucocorticoids have been sho wn to induce the enzyme phenyl-N-methyl-transferase which is necessary for the production of adrenaline in adrenal medullary cells. The purp ose of this study was to evaluate the possible significance of a local glucocorticoid effect on adrenomedullary function. DESIGN Plasma cate cholamine levels were measured in patients with autoimmune Addison's d isease where local production of corticosteroids is deficient in the p resence of intact chromaffin tissue, MEASUREMENTS Catecholamines were measured by high pressure liquid chromatography and ACTH, renin and ad renal steroids by radioimmunoassay. PATIENTS Nineteen Addisonian patie nts (9 females, 10 males) were treated according to a standard regime with oral cortisone acetate (37.5 mg/day) and fludrocortisone (0.1 mg/ day). All patients were clinically well. RESULTS Mean plasma adrenalin e in patients with Addison's disease was significantly reduced compare d to a sex and age matched control group (males (n = 10) 143 +/- 36 pm ol/l, controls (n = 27) 303 +/- 30 pmol/l, P < 0.01; females (n = 9) 7 7 +/- 25 pmol/l, controls (n = 27) 293 +/- 21 pmol, P < 0.001). The no radrenaline: adrenaline ratio was clearly higher in patients with Addi son's disease (males 24 +/- 4, controls 9 +/- 1, P < 0.01; females 45 +/- 6, controls 9 +/- 1, P < 0.01). CONCLUSION We conclude that the ph ysiologically high local glucocorticoid concentration may be responsib le for normal adrenaline production under basal conditions.