Catecholamines Lecture for 2nd year MBBS by Dr Waseem

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catecholamine

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2nd year MBBS.lecture by Dr Mohammad WAseem Kausar

Transcript of Catecholamines Lecture for 2nd year MBBS by Dr Waseem

Page 1: Catecholamines Lecture for 2nd year MBBS by Dr Waseem

catecholamine

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Hormones that regulates fuel metabolism

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Major hormonesAnabolic hormone

insulinCounter regulatory hormone

epinephrinenor epinephrineglucagoncortisolSomatostatinGrowth hormonethyroid hormone

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CATCHOLAMINES

Not necessary for lifeRequired for adaptation to acute & chronic

stressResponse involves integrated adjustmentCatechol can not facilitate stress alone but

aided by others.• are secreted and stored in the adrenal

medulla and released in response to appropriate stimuli

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Responses to Stress

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Synthesis release of Catecholamine

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Ist step = ring hydroxylation

•Tyrosine enter the mitochondria•Rate limiting step and enzyme(TH), cu containing metalloprotein•Function as oxidoreductase•Requires THB as hydrogen donor•Parkinson disease

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Parkinson’s diseaseA chronic progressive disorder

involuntry tremors, dec- motor power and control, muscular regidity,

postural instabilityDeficiency of dopamin in substantia nigraCatcholamine can not cross the B B BDopa is the treatment

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2nd step = decarboxylation

In cytoplasmDopa comes out from mito- to cytoplasmRequires pyridoxal phosphate. α-Methyl dopa resembles L- dopa, a

competitive inhibitor (antihypertensive)

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3rd step = side chain hydroxylation

Dopamine from cytosole enters in to chromaffin- cells

DBH , a mono oxygenaseA cu containing enzyme (cu is oxdized and

reduced back by vit-C)Ascorbic acid as electron donor

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4th step = N- methylation(cytoplasm)

Nor-epi comes out from granules in to cytoplasm

PNMTMethyl group is donated by active

methionineInduced by glucocorticoidThis reaction does not occur in nerves

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Mechanism of Action

• receptor mediated – adrenergic receptors

• peripheral effects are dependent upon the type and ratio of receptors in target tissues

Receptor

Norepinephrine

+++++

++

Epinephrine ++++ ++++Relative effects of epinephrine and norepinephrine on and adrenergic receptors.

Guyton

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Mechanism of Action 1. Catecholamine binds to β1 and β2Activates adenyl cyclaseIncreases cyclic AMPactivates c- AMP dependant protein

kinasePhosphorylates specific proteinsOn binding to α receptors (opposite of

above)2. Binds to α1Formation of IP3 & DAG or increase in ca+

+ as a second messenger.

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Biochemical actionsIncreases blood glucose & lactate1, glycogenolysis in liver & muscles In liver through cyclic AMP dependant protein kinase mediated by

two ways. Through β2 receptors (similar to glucagon). Through α1 receptors In muscles due to absences of g-6-pase does not directly inc-

blood glucose, but inc- blood lactate & pyruvate β effect No Glucagon effect HEART MUSCLE

Increase in cyclic AMP+ve inotropic effect

2, Stimulate ACTH formation glucocor gluconeogenisis

3, Epinephrine onβ cells through α-adrenergic cyclic AMP & insulin release

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Lipolytic actionBoth epi- & nor-epi breakdown of TG in

adipose tissue by increasing c-AMP(β effect), rapid release of FFA and Glycerol

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Gluconeogenic actionEpinephrine(β2effect)

c-AMPSYNTHESIS OF KEY ENZYMES pyruvate- carboxylase PEP carboxykinase fructose 1 6 bi-phos

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Action on glycolysisEpinephrine ----- LA productionNor-epinephrine---- little effect

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Metabolism of the catecholamines by catechol-O-methyltranferase (COMT) and monoamine oxidase (MAO).

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Pheochromocytoma

• a catecholamine-secreting tumor of chromaffin cells of the adrenal medulla

• paraganglioma – a catecholamine secreting tumour of the sympathetic paraganglia

adrenal pheochromocytoma (90%)

extra-adrenal pheochromocytoma

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Signs and Symptoms of Pheochromocytoma

• treatment resistant hypertension (95%)

• headache• sweating• palpitations• chest pain• anxiety• glucose intolerance• increased metabolic rate

classic triad

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Diagnosis and Treatment

• diagnosed by high plasma catecholamines and increased metabolites in urine

• no test for adrenal or extra-adrenal

• treatment is surgical resection