Plasma metanephrine levels are decreased in type 1 diabetic patients with a severely impaired epinephrine response to hypoglycemia, indicating reduced adrenomedullary stores of epinephrine.
Open accessAbstract
A defective epinephrine response to hypoglycemia is a common disorder in type 1 diabetes. We assessed the role of the adrenomedullary capacity to secrete epinephrine in this disorder by measuring plasma metanephrine levels in affected type 1 diabetic patients compared with those in matched nondiabetic controls. Metanephrine is formed from epinephrine that leaks from adrenomedullary storage vesicles by catechol-O-methyl transferase (COMT) and is continuously released into the circulation. Thus, plasma metanephrine levels reflect adrenomedullary epinephrine content and, provided there is normal COMT activity, the adrenomedullary capacity to secrete epinephrine. Diabetic patients had approximately 25% lower plasma metanephrine levels than controls (0.18 +/- 0.09 vs. 0.24 +/- 0.02 nmol/liter; P = 0.012), whereas plasma epinephrine, norepinephrine, and normetanephrine levels were comparable between patients and controls. In response to hypoglycemia, the increments in plasma epinephrine and plasma metanephrine levels were both significantly lower in diabetic patients than in controls (P < 0.001), but the increase in plasma metanephrine as a percentage of the increase in plasma epinephrine was identical, indicating similar COMT activity. We conclude that type 1 diabetic patients with an impaired epinephrine response to hypoglycemia have lower plasma metanephrine levels than matched controls, reflecting decreased adrenomedullary stores of epinephrine and indicating reduced adrenomedullary capacity to secrete epinephrine.
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A reduced plasma metanephrine response to hypoglycemia in patients with HAAF suggests a reduced adrenomedullary epinephrine secretory capacity.
“Finally, a reduced plasma metanephrine response to hypoglycemia in patients with HAAF suggests a reduced adrenomedullary epinephrine secretory capacity (109).”
From Evaluation and Management of Adult Hypoglycemic Disorders: An Endocrine Society Clinical Practice Guideline (2009) · cites this paper as [109]
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- Authors
- de Galan, B. E., Tack, C. J., Willemsen, J. J., Sweep, C. G. J. (., Smits, P., & Lenders, J. W. M.
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2004-05
- Volume
- 89
- Issue
- 5
- Pages
- 2057-2061
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2006547714
- Semantic Scholar
- 5cd9d5918f4d18f9853d270d870b08729959b98b
- Cited by
- 17
- References
- 32
- Citations by year
- 2026: 2 · 2024: 1 · 2023: 1 · 2019: 1 · 2017: 1 · 2016: 1 · 2015: 1 · 2014: 1 · 2013: 1 · 2012: 1
- FWCI
- 1.03
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Surgery › Pancreatic function and diabetes
- Keywords
- type 1 diabetes, hypoglycemia, epinephrine response, plasma metanephrines, catechol-O-methyltransferase, catecholamine release, norepinephrine, normetanephrine, autonomic dysfunction
- MeSH terms
- Adrenal Medulla, Adult, Diabetes Mellitus, Type 1, Epinephrine, Humans, Hypoglycemia, Metanephrine, Glucose Clamp Technique
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