Primary hyperepinephrinemia in patients without pheochromocytoma

Article Abstract:

Increased levels of catecholamine hormones, norepinephrine and epinephrine, may result from pheochromocytoma, a tumor of chromaffin cells which are found in abundance in the inner or medullary portion of the adrenal gland. Increased catecholamine levels may also result as a response to the stress of severe illness. Hyperepinephrinemia, or a specific increase in epinephrine levels, is a common response to hypoglycemia or decreased blood glucose, caffeine intake, cigarette smoking, emotional factors, and in some cases, pheochromocytoma. Clinical symptoms associated with epinephrine release helped to detect elevated blood levels of epinephrine in five patients, four of whom had normal blood levels of norepinephrine. Adrenal medullary hyperplasia, the excessive overgrowth of medullary cells, was diagnosed in three of these patients. One patient with adrenal medullary hyperplasia had a family history of endocrine neoplasia type IIa, a disease characterized by the abnormal overgrowth of endocrine (glandular) tissue. Symptoms of adrenal medullary hyperplasia were relieved by treatment with beta blocking agents, propranolol or atenolol, which prevent the activation of beta receptors by catecholamine hormones. Beta receptors are cell membrane proteins involved in specific cell processes such as heart rate and contraction. The remaining two patients had adrenal cysts, or sac-like structures containing fluid and/or solid material. The symptoms of patients with adrenal cysts were relieved after removal of the cysts. In one patient with adrenal cysts, other disorders such as diabetes, hypertension (high blood pressure), and fingertip ulcers disappeared after removal of the cysts. These findings show that symptoms of hyperepinephrinemia can be relieved by treatment with beta blockers or surgical removal of the adrenal cyst if present. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Measurement, Physiological aspects, Surgery, Cysts, Adrenal glands, Pheochromocytoma, Catecholamines, Adrenal medulla

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Primary care patients who refuse specialized mental health services

Article Abstract:

Most referrals to psychiatrists in fee-for-service practice come from primary care physicians; however, studies have found that one-third to three-fourths of these patients fail to follow through with obtaining mental health care. The characteristics of patients who refuse mental health care have not been defined in terms of their use of health care services and whether they receive help for psychiatric problems from their primary care physicians. To answer some of these questions, the records of 65 patients who completed mental health referrals and 65 who did not were reviewed. All of these patients were enrolled in a prepaid health plan. In the group from which the sample was taken, 25 percent of the patients failed to follow through with the referral, an unusually low rate. Those patients who did not complete the referral saw their physicians more frequently than those who did seek mental health services. Physical complaints of patients who rejected the referral were less likely to have a medically verifiable basis. Physical symptoms caused by psychological distress are common in primary care, but many primary care physicians have little interest in mental health care and are unable to diagnose psychiatric problems accurately. Some physicians were unusually successful, and others unusually unsuccessful, in having patients complete mental health referrals, and the physician's skill in ensuring follow-through was the most important determinant of success. Patients who resisted mental health referrals often resisted other types of medical referrals as well, perhaps because of a preference for the primary care physician. Unfortunately, these patients often receive low levels of psychiatric care from their physicians. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Usage, Practice, Physician and patient, Physician-patient relations, Mental illness, Mental disorders, Physicians (General practice), General practitioners, Mental health counseling, Psychiatric counseling

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