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The association between systolic blood pressure reduction during clonidine suppression testing and the decrease in

Tiran Golani1,2, Boris Fishman1,2, Yehonatan Sharabi1,2

  • 1Department of Internal Medicine D and Hypertension unit, The Chaim Sheba Medical Center, Tel-Hashomer, Israel.

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PubMed
Summary
This summary is machine-generated.

Blood pressure reduction during the clonidine suppression test (CST) correlates with decreased norepinephrine (NE) and normetanephrine (NMT) levels. This finding may offer a rapid indicator for diagnosing pheochromocytoma and paraganglioma (PPGL).

Keywords:
catecholamines and metanephrinesclonidine suppression testpheochromocytoma and paragangliomasystolic blood pressure reduction

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Area of Science:

  • Endocrinology
  • Clinical Biochemistry
  • Diagnostic Medicine

Background:

  • Borderline elevations in norepinephrine (NE) and normetanephrine (NMT) are common in patients suspected of having pheochromocytoma and paraganglioma (PPGL).
  • The clonidine suppression test (CST) is utilized to differentiate PPGL, but its interpretation can be limited by laboratory processing times and assay availability.

Purpose of the Study:

  • To investigate the association between blood pressure (BP) reduction during CST and changes in plasma NMT and NE levels.
  • To determine if BP response during CST can serve as an early indicator of biochemical results for PPGL diagnosis.

Main Methods:

  • A cross-sectional study included 36 patients with suspected PPGL undergoing CST between January 2014 and December 2019.
  • Linear regression models analyzed the relationship between BP reduction (specifically systolic BP - SBP) 90 minutes post-clonidine and the decrease in plasma NMT and NE.
  • Subgroup analyses were performed for patients with hypertension and diabetes mellitus.

Main Results:

  • A decrease in SBP 90 minutes after clonidine administration was significantly associated with a reduction in plasma NMT (R=0.668, P=0.025) and NE (R=0.562, P=0.005).
  • A 40% decrease in NMT and NE levels corresponded to approximately 9.74% and 7.16% decreases in SBP, respectively.
  • The association between SBP reduction and decreased NMT/NE was stronger in patients with hypertension and diabetes mellitus.

Conclusions:

  • Systolic blood pressure reduction during the clonidine suppression test is linked to a decrease in plasma normetanephrine and norepinephrine.
  • The observed decrease in SBP 90 minutes post-clonidine may function as a valuable, immediate complementary tool for the clinical diagnosis of PPGL.