Diabetes Mellitus, Type 2 Clinical Trial
Official title:
Association Between Enhanced Sympathetic Activity and Cardiometabolic Complications: a Cross-sectional Study on Predictive Power of 24-hour Urinary Metanephrines (SYMPACT)
Recent studies on catecholamine physiology have shown a direct correlation with arterial
hypertension, overcoming the exclusive role in the diagnosis and follow-up of chromaffin
tumors.
Nevertheless, in literature, few studies explore and reveal the utility of testing
metanephrines for the evaluation of sympathetic activity and its associated cardiometabolic
complications in patients with essential hypertension.
Catecholamines (noradrenaline, adrenaline and dopamine) are adaptive and maladaptive stress
hormones.
In the classic "fight or flight" mechanism, they activate behavioral and physiological
processes that facilitate the overcoming of stress; for instance, challenged by a physical
stressor, an organism responds to the threat either fighting and prevailing or accepting
defeat and fleeing in avoidance.
In the pathological context, an excessive catecholamine secretion is typical of the
chromaffin tissue tumors, determining a clinical picture characterized by blood pressure
elevation, tachycardia, anxiety, pallor, sweating and headache.
COMT enzyme catalyzes the O-methylation of the 3-hydroxyl group of catecholamines. The
O-methylated derivatives of noradrenaline, adrenaline and dopamine are normetanephrine,
metanephrine and 3-methoxytyramine, respectively. The term "metanephrines" is generally used
to collectively refer to the first two compounds.
Compared to catecholamines, metanephrines are characterized by longer half-life and more
stable levels over time. Their superior accuracy for the diagnosis and follow-up of
pheochromocytoma and paraganglioma (PPGL) has been widely proved.
Excluding patients with PPGL, however, metanephrines can be more broadly considered as
reliable markers of the whole sympathetic system activity; therefore, their levels may be
hypothesized to be associated to a higher rate of concurrent cardiometabolic complications
and, if so, could be useful for the stratification of cardiovascular risk.
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