What is the function of norepinephrine? What happens when levels are too low? How can you increase norepinephrine levels? Get the answers to these questions and more.

The Crucial Functions of Norepinephrine

Norepinephrine, also known as noradrenaline, is a neurotransmitter that plays a vital role in the body’s stress response and overall functioning. As a member of the catecholamine family, norepinephrine is released in response to both physical and emotional stress. It acts as a neurotransmitter in the central nervous system and sympathetic nervous system, sending signals between nerve cells.

One of the key functions of norepinephrine is its ability to increase blood pressure. By activating alpha 1 receptors, norepinephrine constricts the arteries, helping to increase blood flow back to the heart. This makes it an important agent for treating conditions like septic shock, where dangerously low blood pressure can lead to organ failure.

In addition to its vascular effects, norepinephrine also enhances alertness, arousal, and mood. Research shows that it plays a crucial role in our ability to focus and concentrate on everyday tasks. Medications used to treat ADHD, such as Ritalin and Adderall, often work by increasing norepinephrine levels.

Furthermore, norepinephrine has been linked to the regulation of cognition, motivation, and social functioning – all of which can impact one’s quality of life. As such, imbalances in norepinephrine have been associated with conditions like depression.

The Consequences of Low Norepinephrine Levels

When norepinephrine levels become too low, it can lead to a variety of health issues. Low blood pressure, brain fog, difficulty sleeping, and anxiety are just a few of the potential consequences of norepinephrine deficiency.

How can you tell if your norepinephrine levels are low? Common symptoms include fatigue, lethargy, lack of focus, and low motivation. In severe cases, low norepinephrine can contribute to the development of conditions like depression.

Strategies to Increase Norepinephrine Levels

Fortunately, there are several ways to help boost norepinephrine levels and maintain a healthy balance. Engaging in regular exercise, reducing daily stress, and maintaining a healthy weight are all important lifestyle strategies.

Certain medications, such as antidepressants and ADHD treatments, can also be used to increase norepinephrine levels under the supervision of a healthcare provider. However, it’s crucial to work closely with your doctor to find the right treatment plan for your individual needs.

The Relationship Between Norepinephrine and Other Neurotransmitters

Norepinephrine doesn’t work in isolation – it interacts closely with other neurotransmitters like dopamine and serotonin. Imbalances in these systems can contribute to a variety of health problems, from mood disorders to cognitive impairment.

Understanding the complex interplay between norepinephrine and other neurotransmitters is essential for developing effective treatment strategies. By addressing underlying imbalances, healthcare providers can help patients achieve optimal health and well-being.

The Clinical Applications of Norepinephrine

In addition to its role in the body’s stress response, norepinephrine also has important clinical applications. The FDA has approved its use for blood pressure control and as an adjunct in the treatment of cardiac arrest for people with severely low pressure.

Norepinephrine is commonly used in intensive care units to treat septic shock, a severe infection that can lead to dangerously low blood pressure. By administering norepinephrine through an IV, healthcare professionals can help increase blood pressure levels and prevent organ failure.

Maintaining a Healthy Balance of Norepinephrine

Given the wide-ranging effects of norepinephrine, it’s essential to maintain a healthy balance of this crucial neurotransmitter. By engaging in stress-reducing activities, exercising regularly, and working with a healthcare provider to address any imbalances, individuals can optimize their norepinephrine levels and enjoy the many benefits it provides.

Ultimately, understanding the role of norepinephrine is key to achieving optimal health and well-being. By staying informed and proactive, individuals can take steps to support their body’s natural stress response and ensure that this important neurotransmitter is functioning at its best.

Norepinephrine Function, Deficiency and How to Increase

You’ve probably heard of adrenaline (or epinephrine) before, but what about another similar hormone called norepinephrine? Like adrenaline, it’s produced during the body’s natural “fight or flight” response and works as one of the body’s first responders to stressful situations.

The hormone also works as a vasoconstrictor, and the FDA has approved its use for blood pressure control and as an adjunct in the treatment of cardiac arrest for people with severely low pressure.

Like all hormones, when norepinephrine levels become too low or too high, it can lead to health conditions, including anxiety, blood pressure changes, brain fog and difficulty sleeping. The key is to keep these stress hormone levels in check by reducing daily stress levels, engaging in regular exercise and maintaining a healthy weight.

What Is Norepinephrine?

Norepinephrine, also called noradrenaline, is a neurotransmitter that belongs to a class of compounds known as catecholamines. Catecholamines are released into the blood in response to both physical and emotional stress. Norepinephrine is synthesized from dopamine and released from the adrenal medulla into the brain. It works as a neurotransmitter in the central nervous system and sympathetic nervous system, where it’s released from our noradrenergic neurons.

As a neurotransmitter, norepinephrine sends signals between our nerve cells. It works by activating alpha 1 receptors that constrict the arteries and work to increase blood pressure so that blood flow returns to the heart.

Noradrenaline also acts as a stress hormone and is widely used as a vasoactive agent that narrows blood vessels and increases blood pressure. It’s responsible for making your heart rate and blood pressure increase during the body’s natural fight or flight response.

When the brain is triggered by a stressful situation, either physical or emotional, the hormone is released into the blood to do its work. It increases your heart rate, boosts blood flow to your muscles and promotes the release of glucose into the blood.

Related: What Is Acetylcholine? Function, Benefits + Dosage of This Neurotransmitter

How It’s Used (and Benefits)

1. Increases Blood Pressure

The norepinephrine neurotransmitter is a peripheral vasoconstrictor, which means that it’s able to narrow your blood vessels and increase your blood pressure. For people with very low pressure that can’t be normalized with lifestyle changes, this can be beneficial.

Studies show that medications used to increase norepinephrine levels can be used by patients with symptomatic hypotension that’s unresponsive to remedies like increased water intake, may be important and effective.

The neurotransmitter is commonly used in intensive care units to treat septic shock, which is a severe infection that often leads to very low blood pressure levels and may cause organ failure. In these cases, norepinephrine is given through an IV by a healthcare professional to increase blood pressure levels to a normal range.

2. Increases Alertness and Arousal

Noradrenaline works as a neurotransmitter that increases alertness and arousal, and boosts mood too. When these hormone levels are normal, you’ll have a better ability to concentrate and stay focused. That’s exactly why low noradrenaline levels may lead to conditions such as ADHD.

Research shows that both noradrenaline and dopamine play a role in our ability to focus on everyday tasks. Many medications that are commonly prescribed to improve ADHD symptoms work to raise levels of norepinephrine, including Ritalin, Adderall and Dexedrine.

3. Improves Depression

Preclinical and clinical evidence suggests that disturbances in norepinephrine, dopamine and serotonin neurotransmitters in the central nervous system are involved in the underlying pathophysiology of depression.

Evidence for the involvement of noradrenaline in depression is abundant. Studies have found that the hormone plays a determinant role in regulating cognition, motivation and intellect, which are all important functions in social relationships.

Researchers point out social dysfunction being one of the most important factors affecting our quality of life may be one major reason why low norepinephrine may lead to depression symptoms.

4. Improves Sleep

When it comes to norepinephrine for sleep, many antidepressants that affect the hormone’s signaling are also used to treat insomnia. Studies show that the neurotransmitter is involved in increasing the arousal system, and it impacts the efficacy of many wake- and sleep-promoting medications.

The right amount of the hormone in your body will promote normal sleep, but too much of it will boost arousal and cause sleep issues.

Related: Stress Hormones: How Diet Affects Hormonal Balance

Norepinephrine vs. Epinephrine

What’s the difference between epinephrine and norepinephrine? Both are neurotransmitters and hormones that are produced during the body’s “fight or flight” response and both have important medical or therapeutic uses. Epinephrine, or adrenaline, is well known for its ability to treat anaphylaxis, and it’s also used in cases of cardiac arrest and severe asthma attacks.

An injection of epinephrine can save the life of someone having a severe allergic reaction by opening up the airways so the person can breath. It can also restart your heart during cardiac arrest, when it has stopped pumping.

The biggest difference between epinephrine and norepinephrine is that the latter effects your blood vessels, acting as a vasoconstrictor that works to increase blood pressure, while an adrenaline rush directly effects your heart’s function.

How to Boost Norepinephrine Levels

To increase your norepinephrine levels, some doctors may prescribe serotonin norepinephrine re-uptake inhibitors (SNRIs), which are drugs for depression, or amphetamines, which are often used to treat ADD and ADHD.

Unfortunately, there are some common side effects of antidepressants, like upset stomach, headaches, restlessness, sexual dysfunction and suicidal thoughts.

For people with low norepinephrine levels, there are also ways to raise the hormone levels naturally. Getting enough sleep and exercising regularly can help to boost norepinephrine.

Studies indicate that our catecholamine levels increase markedly during exercise. Taking serious steps to reduce stress in your life can have a major impact on normalizing stress hormone levels.

Another way to increase norepinephrine levels is by increasing dopamine, which is a precursor for the important neurotransmitter. Taking supplements that will help to boost dopamine, like amino acids tyrosine and phenylalanine may be helpful. There are also brain-boosting norepinephrine supplements on the market that are used to promote dopamine production.

For emergency situations, like sepsis and severe hypotension, norepinephrine is typically administered by continuous IV infusion. This is because the vasoconstrictor has a relatively short half-life of 2.5 minutes. The concentrated norepinephrine drip solution is usually diluted in dextrose-containing solutions in order to provide protection against potential oxidation and loss of drug potency.

To increase norepinephrine as a hypotension treatment, the infusion usually starts at 8 micrograms to 12 micrograms per minute and is then titrated to the desired pressure depending on the patient’s condition. The average maintenance norepinephrine dose is 2–4 micrograms per minute.

Deficiency Symptoms

Norepinephrine deficiency occurs when the neurotransmitter levels become too low. People with certain health conditions, like chronic stress and poor nutrition, or those taking certain medications may develop a deficiency because the body begins to produce less norepinephrine than what is needed.

This can contribute to a range of physical and mental conditions, including:

• depression
• anxiety
• lack of interest
• low energy
• daytime fatigue
• general apathy
• ADHD symptoms
• trouble sleeping
• memory problems
• brain fog
• migraines
• fibromyalgia
• restless leg syndrome
• hypoglycemia
• low blood pressure

Research shows that norepinephrine deficiency is caused by the degeneration of neurons from the brain. This can be due to chronic stress, obesity and certain medical conditions, like Parkinson’s disease.

Signs of Too Much

It is possible for your norepinephrine levels to become too high, causing health issues like high blood pressure, heart palpitations, headaches and anxiety.

When these hormone levels increase rapidly, it can even lead to panic attack symptoms. Too much norepinephrine can be caused by a few factors, including chronic stress and obesity.

As of the five major neurotransmitters that are responsible for regulating mood, energy, sleep and memory, a sudden rush of norepinephrine can make your body think it’s in danger, leading to noticeable symptoms.

Risks and Side Effects

Norepinephrine should be used to improve hypotension by trained healthcare professionals. It works as a vasoconstrictor and too much of it can result in decreased blood flow to major organs, potentially leading to irreversible organ injury and failure.

Research shows that when the vasoconstrictor is used to treat low blood pressure in the case of hypovolemia, or a state of decreased blood volume or body fluid, norepinephrine is not the best therapeutic agent.

Norepinephrine hormone should not be used by patients with vascular thrombosis, as its vasoconstriction effects will increase the area of ischemia and infraction.

People using brain-boosting supplements that are used to increase dopamine levels should first consult with a healthcare professional, especially if they are already taking pharmaceutical medications or other dietary supplements.

Final Thoughts

• Norepinephrine, or noradrenaline, is a neurotransmitter and stress hormone that belongs to a class of compounds known as catecholamines.
• This stress hormone is released into the blood in response to both physical and emotional stress. It’s known as one of the first responders to stress.
• What is norepinephrine used for? It works as a vasoconstrictor that narrows blood vessels and increases blood pressure. It has also shown to improve attention and focus, symptoms of depression and sleep.
• Supplements that are used to increase dopamine may help to boost norepinephrine levels. Other ways to boost this hormone naturally include regular exercise and getting enough rest.

Adrenal Hormones | Endocrine Society

The adrenal (suprarenal) glands are located at the top of both kidneys. The produce hormones that regulate the immune system, blood pressure, metabolism, and the stress response. In addition, also helps your body do the following:

• Promoting proper cardiovascular function
• Helps in how we respond to stress
• Properly utilizing carbohydrates and fats
• Helps distribute stored fat
• Gives you body odor and pubic hair
• Promotes healthy gastrointestinal functions

Adrenaline is produced in the medulla in the adrenal glands as well as some of the central nervous system’s neurons. Within a couple of minutes during a stressful situation, adrenaline is quickly released into the blood, sending impulses to organs to create a specific response.

What is the Function of Adrenaline?

Adrenaline triggers the body’s fight-or-flight response. This reaction causes air passages to dilate to provide the muscles with the oxygen they need to either fight danger or flee. Adrenaline also triggers the blood vessels to contract to re-direct blood toward major muscle groups, including the heart and lungs. The body’s ability to feel pain also decreases as a result of adrenaline, which is why you can continue running from or fighting danger even when injured. Adrenaline causes a noticeable increase in strength and performance, as well as heightened awareness, in stressful times. After the stress has subsided, adrenaline’s effect can last for up to an hour.

Adrenaline is an important part of your body’s ability to survive, but sometimes the body will release the hormone when it is under stress but not facing real danger. This can create feelings of dizziness, light-headedness, and vision changes. Also, adrenaline causes a release of glucose, which a fight-or-flight response would use. When no danger is present, that extra energy has no use, and this can leave the person feeling restless and irritable. Excessively high levels of the hormone due to stress without real danger can cause heart damage, insomnia, and a jittery, nervous feeling.

Medical conditions that cause an overproduction of adrenaline are rare, but can happen. If an individual has tumors on the adrenal glands, for example, he/she may produce too much adrenaline; leading to anxiety, weight loss, palpitations, rapid heartbeat, and high blood pressure. Too little adrenaline rarely occurs, but if it did it would limit the body’s ability to respond properly in stressful situations.

Adrenaline rarely causes problems, but ongoing stress can cause complications associated with adrenaline. Addressing these problems starts with finding healthy ways to deal with stress.

Consider asking your doctor:

• How can I tell if I am dealing with excessive adrenaline?
• How can I reduce stress in my life?
• Could adrenaline be causing my symptoms?
• What affect is adrenaline function and stress having on my overall health?

An endocrinologist is the best type of doctor to talk to when dealing with hormonal issues. Use our helpful form to locate one in your area.

Aldosterone is produced in the cortex of the adrenal glands, which are located above the kidneys. It affects the body’s ability to regulate blood pressure. It sends the signal to organs, like the kidney and colon, that can increase the amount of sodium the body sends into the bloodstream or the amount of potassium released in the urine. The hormone also causes the bloodstream to re-absorb water with the sodium to increase blood volume. All of these actions are integral to increasing and lowering blood vessels. Indirectly, the hormone also helps maintain the blood’s pH and electrolyte levels.

Aldosterone is closely linked to two other hormones: renin and angiotensin, which create the renin-angiotensin-aldosterone system. This system is activated when the body experiences a decrease in blood flow to the kidneys, such as after a drop in blood pressure, or a significant drop in blood volume after a hemorrhage or serious injury. Renin is responsible for the production of angiotensin, which then causes the release of aldosterone. Once the body is rehydrated and has proper salt levels in the blood, renin levels fall, and aldosterone levels lower as a result.

What Can Go Wrong With Aldosterone?

In a healthy individual, the renin-angiotensin-aldosterone system functions without interference, helping to regulate and control blood pressure levels naturally. However, individuals can have too-high or too-low amounts of aldosterone, and both of these can impact aldosterone function.

Individuals with high levels of aldosterone have a condition known as hyperaldosteronism, and this is typically caused by small, benign tumors on the adrenal glands. Hyperaldosteronism can cause high blood pressure, low potassium levels and an abnormal increase in blood volume because of the way the hormone affects the body.

It’s also possible to have low levels of aldosterone. Primary adrenal insufficiency, a disease that causes a general loss of adrenal function, can be a cause. Patients with primary adrenal insufficiency causing low levels of aldosterone may experience low blood pressure, increased potassium levels, and lethargy.

Genetic mutations can also affect the production of aldosterone. Patients with this rare genetic disorder will experience symptoms similar to primary adrenal insufficiency but the symptoms are typically less severe.

If you are struggling with maintaining a healthy blood pressure, and also have changes in blood potassium levels, you may want to talk to your doctor about aldosterone. Consider asking your doctor if your hormones could be the cause of your blood pressure and potassium struggles, especially if lifestyle changes are not helping. If aldosterone levels are not where they should be, talk to your doctor about changes or treatments that are possible to help your condition.

Cortisol is often called the “stress hormone” because of its connection to the stress response, however, cortisol is much more than just a hormone released during stress. Understanding cortisol and its affect on the body will help you balance your hormones and achieve good health.

Cortisol is one of the steroid hormones and is made in the adrenal glands. Most cells within the body have cortisol receptors. Secretion of the hormone is controlled by the hypothalamus, the pituitary gland, and the adrenal gland, a combination glands often referred to as the HPA axis.

What Does Cortisol Do?

Most bodily cells have cortisol receptors, it affects many different functions in the body. Cortisol can help control blood sugar levels, regulate metabolism, help reduce inflammation, and assist with memory formulation. It has a controlling effect on salt and water balance and helps control blood pressure. In women, cortisol also supports the developing fetus during pregnancy. All of these functions make cortisol a crucial hormone to protect overall health and well-being.

Problems Associated with High Cortisol Levels

Sometimes tumors on the pituitary or adrenal glands can contribute to a condition known as Cushing syndrome, which is characterized by high levels of cortisol in the blood. Individuals with Cushing syndrome will experience rapid weight gain in the face, abdomen, and chest. Often doctors will notice this because of the individual’s slender arms and legs compared to the heavy weight in the core of the body. Cushing syndrome also causes a flushed face, high blood pressure, and changes in the skin. Osteoporosis and mood swings are also a factor considered with Cushing disease.

High cortisol levels can also contribute to changes in a woman’s libido and menstrual cycle, even without the presence of Cushing disease. Anxiety and depression may also be linked to high cortisol levels.

Low cortisol levels can cause a condition known as primary adrenal insufficiency or Addison disease. While rare, primary adrenal insufficiency is an autoimmune disease that causes damage to the adrenal glands. Symptoms may start slowly, but they can be quite serious. Patients with primary adrenal insufficiency can experience fatigue, muscle loss, weight loss, mood swings, and changes to the skin.

Consider asking your doctor: 

• How do cortisol levels vary throughout the day?
• What underlying conditions could be affecting my cortisol levels?
• How can I manage cortisol levels to regain my health?
• What testing is needed to determine the cause of my symptoms?

The brain controls the production of DHEA. The body uses a unique mechanism known as negative feedback to control the production of DHEA. Negative feedback tells your brain that once DHEA levels drop in your body, the mechanism is switched “on” and begins to produce more of the hormone. Once DHEA levels begin to rise, negative feedback is switched “off”. 

DHEA and Anti-Aging

There are many rumors and claims that taking DHEA can also help slow down the process of aging. Claims include that DHEA can also increase energy and muscle strength, boosts immunity, and decrease body weight. However, these claims have yet to be medically proven. Does DHEA have a role in treating certain health problems? Some researchers have suggested that DHEA might be used to treat:

• Adrenal insufficiency (Addison’s disease)
• Depression
• Lupus
• Obesity
• Alzheimer’s disease
• Osteoporosis
• Crohn’s disease
• Infertility
• Problems linked to menopause DHEA also might help induce labor in childbirth.

What Problems Can Occur with DHEA? 

Research has shown that women with hirsutism and polycystic ovary syndrome may have higher levels of DHEA. Children diagnosed with congenital adrenal hyperplasia also have high levels of DHEA, as well as some cancer patients. Lower levels of DHEA have been linked to a decreased life span in men. In women, low DHEA levels are often associated with a lower libido and osteoporosis.

DHEA has not yet been approved by the fda as a treatment for these health problems. More research is needed to study the potential benefits and the long-term risks of DHEA. 

Norepinephrine also called noradrenaline is both a hormone, produced by the adrenal glands, and a neurotransmitter, a chemical messenger which transmits signals across nerve endings in the body. Norepinephrine is produced in the inner part of the adrenal glands, also called the adrenal medulla. The adrenal medulla also makes adrenaline (also known as epinephrine). Norepinephrine, adrenaline and dopamine belong are part of the catecholamine family.  

Adrenal glands are making primarily adrenaline and most of the norepinephrine in the blood comes from nerve endings. It plays a role in your mood and ability to concentrate. Together with other hormones, norepinephrine helps the body respond to stress and exercise. Other hormones include:

• Adrenaline
• Cortisol
• Corticotropin releasing hormone
• Adrenocortical hormone

What Does Norepinephrine Do?

Together with adrenaline, norepinephrine increases heart rate and blood pumping from the heart. It also increases blood pressure and helps break down fat and increase blood sugar levels to provide more energy to the body.

In the brain, norepinephrine plays a role in the sleep-wake cycle, helping you to wake up, in increasing attention and focusing on performing a task ,and in memory storage. It is also important for emotions. Problems with norepinephrine levels are associated with depression, anxiety, post-traumatic stress disorder and substance abuse. Bursts of norepinephrine can lead to euphoria (very happy) feelings but are also linked to panic attacks, elevated blood pressure, and hyperactivity. Low levels can cause lethargy (lack of energy), lack of concentration, attention deficit hyperactivity disorder (ADHD), and possibly depression. Some anti-depressant medications affect norepinephrine levels in the brain. In stressful situations, norepinephrine increases as part of the fight or flight response to mobilize the brain and body for action.

Norepinephrine can be used to treat low blood pressure (hypotension) that can occur during certain medical procedures or life-threatening situations where cardiopulmonary resuscitation (CPR) is needed.

How Can you Increase Norepinephrine Naturally?

Norepinephrine and serotonin are a great pair. These chemicals help combat antidepressant effects and have therapeutic benefits. Serotonin, also called a “feel-good” hormone, improves mood and norepinephrine improves alertness and energy. You can boost these chemicals naturally through:

• Exercise
• Sleep
• Small accomplishments
• Music
• Meditation
• Eating dopamine rich foods such as chocolate

Consider asking your healthcare provider:

• How does norepinephrine affect my mood?
• How can I improve my norepinephrine and serotonin levels?
• Is my high blood pressure due to too much norepinephrine or adrenaline?

Return to Hormones and Endocrine Function>>>

Editor(s):
Irina Bancos, M.D.

Last Updated:
January 24, 2022

Catecholamines (epinephrine, norepinephrine, dopamine) and serotonin in the blood

Adrenaline, norepinephrine, dopamine, serotonin are biogenic amines that are hormones and neurotransmitters. Their content significantly increases in biological fluids in some neuroendocrine neoplasms. * The study determines the amount of each indicator separately.

Russian synonyms

Free catecholamines in the blood.

Synonyms English

Catecholamines – adrenaline, norepinephrine, dopamine + serotonin.

Test Method

HPLC.

Units

Pg/ml (picograms per milliliter), ng/ml (nanograms per milliliter).

What biomaterial can be used for research?

Venous blood.

How to properly prepare for an examination?

• Children under 1 year of age do not eat for 30-40 minutes before the test.
• Children 1 to 5 years of age should not eat for 2-3 hours prior to testing.
• Eliminate avocados, bananas, eggplants, pineapples, plums, tomatoes, walnuts from the diet within 72 hours prior to the study.
• Do not eat for 12 hours before the study, you can drink pure still water.
• Cancel (in agreement with the doctor) sympathomimetics 14 days before the study.
• Completely exclude (in agreement with the doctor) the use of drugs within 24 hours before the study.
• Avoid physical and emotional overexertion within 24 hours prior to the study.
• Do not smoke for 2 hours prior to the study.

Study Overview

Catecholamines are a group of related hormones produced by the adrenal medulla. The main catecholamines are: dopamine, epinephrine (epinephrine) and norepinephrine. They are released into the blood in response to physical or emotional stress and are involved in the transmission of nerve impulses to the brain, promote the release of glucose and fatty acids as energy sources, dilate bronchioles and pupils. Norepinephrine constricts blood vessels, raising blood pressure, while adrenaline increases heart rate and stimulates metabolism. After completing their action, these hormones are broken down into physiologically inactive substances (homovanilic acid, normetanephrine, etc. ).

Normally, catecholamines and their breakdown products are present in the body in small amounts. Their content increases significantly for a short time only under stress. However, chromaffin and other neuroendocrine tumors can cause the formation of large amounts of catecholamines, which leads to a significant increase in the levels of these hormones and their breakdown products in the blood and urine. This threatens with long-term or short-term increases in blood pressure and, accordingly, severe headaches. Other symptoms of elevated catecholamines include trembling, increased sweating, nausea, restlessness, and tingling in the extremities. In addition to catecholamines, pheochromocytomas can synthesize serotonin, adrenocorticotropic hormone, vasoactive intestinal peptide, somatostatin, and other hormones. Correspondence between the size of the tumor, the level of catecholamines in the blood and the clinical picture does not exist.

Serotonin is not a catecholamine, but also belongs to the group of biogenic amines with hormonal and neurotransmitter activity. It is synthesized from the amino acid tryptophan and stored in enterochromaffin cells of the gastrointestinal tract (80-95% of the total), various brain structures, mast cells of the skin, platelets and some other endocrine organs. Serotonin lowers the threshold of pain sensitivity, regulates the function of the pituitary gland, affects vascular tone, blood clotting, motility and secretory activity of the gastrointestinal tract.

Approximately 90% of chromaffin tumors are located in the adrenal glands. Most are benign and do not spread beyond the adrenal glands, although they may continue to grow. Without further treatment, as the tumor grows, over time, the manifestations of the disease sometimes become more severe. High blood pressure caused by a chromaffin tumor can lead to kidney and heart damage and even hemorrhage or heart attack.

In most cases, these tumors are removed surgically, after which the catecholamine levels are significantly reduced, and the symptoms and complications associated with the tumor are mitigated or disappear altogether.

A blood test detects the amount of the hormone at the moment of taking the test, while a urine test – for the previous 24 hours.

What is research used for?

• For the diagnosis of chromaffin tumors in symptomatic patients.
• To monitor the effectiveness of the treatment of a chromaffin tumor, in particular after its removal, to ensure that there are no recurrences.

When is the examination scheduled?

• If a chromaffin tumor is suspected.
• If the patient has chronic hypertension accompanied by headache, sweating, rapid pulse.
• When hypertension is unresponsive to treatment (because hypertensive patients with chromaffin tumors are often resistant to conventional therapy).
• If an adrenal tumor or neuroendocrine tumor was detected on a scan, or if the patient has a hereditary predisposition to form them.
• When monitoring the condition of patients who have already been treated for a chromaffin tumor.

What do the results mean?

Reference values ​​

• Adrenaline

• Norepinephrine

• Dopamine: 5.6 – 44 pg/ml.
• Serotonin: 50 – 220 ng/ml.

Since many factors can affect the results of this test, and chromaffin tumors are rare, the results are often erroneously positive. For a confident diagnosis, a general examination of the patient is necessary: ​​an assessment of his physical and emotional state, the medications he takes and the food he eats. When factors interfering with the accuracy of the analysis are established and eliminated, the analysis is often repeated to find out if the level of catecholamines will still be high. In addition, a test for metanephrine in the blood and/or urine and magnetic resonance imaging of the tumor may be ordered to confirm the results.

An elevated catecholamine level in a patient who has previously been treated for a chromaffin tumor indicates tumor recurrence or that therapy has not been entirely effective.

If the catecholamine concentration is normal, then the presence of a chromaffin tumor is unlikely. However, these tumors do not always produce catecholamines at a constant rate. If there have been no recent exacerbations of hypertension, then the concentration of catecholamines may be close to normal even with an existing pheochromocytoma.

Possible causes of increased serotonin levels: carcinoid tumors; medullary thyroid cancer; testicular tumors; celiac disease; endocarditis; dumping syndrome; acute intestinal obstruction; cystic fibrosis; acute myocardial infarction; medication (paracetamol, diazepam, naproxen, pindolol). Reasons for lowering the level of serotonin: mastocytosis; phenylketonuria; Down syndrome; carcinoid tumors of the rectum; Hartnup’s disease; medication (ethanol, imipramine, isoniazid, sulfasalazine).

What can influence the result?

• Medications taken (acetaminophen, aminophylline, amphetamines, appetite suppressants, caffeine-containing drugs, chloral hydrate, clonidine, dexamethasone, diuretics, epinephrine, ethanol, insulin, imipramine, lithium, methyldopa, nicotine, nitroglycerin, nasal drops, tricyclic antidepressants and vasodilators).
• Food consumed (tea, coffee, alcohol).
• Stress.

Important Notes

• Although catecholamine tests can help diagnose chromaffin tumors, they do not show where the tumor is located, whether it is benign (although most of them are), or if it is one or more tumors.
• The amount of catecholamines produced does not necessarily correspond to the size of the tumor, although it tends to increase as the tumor grows.

Also recommended

• Catecholamines (epinephrine, norepinephrine, dopamine) in urine
• Catecholamines (adrenaline, norepinephrine, dopamine) and their metabolites (vanillylmandelic acid, homovanillic acid, 5-hydroxyindoleacetic acid) in urine
• Catecholamine metabolites (vanillylmandelic acid, homovanillic acid, 5-hydroxyindoleacetic acid) in urine
• Neuron-specific enolase (NSE)
• Plasma glucose

Who orders the examination?

Endocrinologist, cardiologist, pediatrician, general practitioner, surgeon.

Literature

• Eisenhofer G., Siegert G, Kotzerke J, Bornstein SR, Pacak K. Current progress and future challenges in the biochemical diagnosis and treatment of pheochromocytomas and paragangliomas. Horm Metab Res. 2008 May;40(5):329-37.
• Ganim RB, Norton JA: Recent advances in carcinoid pathogenesis, diagnosis and management. Surg Oncol 2000;9: 173-179.
• Ghevariya V, Malieckal A, Ghevariya N, Mazumder M, Anand S. Carcinoid tumors of the gastrointestinal tract. South Med J. 2009 Oct;102(10):1032-40.
• Vinik AI et al. NANETS consensus guidelines for the diagnosis of neuroendocrine tumor. pancreas. 2010 Aug;39(6):713-34.
• Pacak K et al. Pheochromocytoma: recommendations for clinical practice from the First International Symposium. October 2005. Nat Clin Pract Endocrinol Metab. 2007 Feb;3(2):92-102.

Adrenaline, endorphins and other neurotransmitters: what they are and how they work

Perhaps you have heard of the “hormone of love”, “hormone of happiness” or “hormone of stress”? Scientists hate these definitions for neurotransmitters, because things are not so simple, and often one neurotransmitter can cause opposite effects. We tell in detail what neurotransmitters are, how they affect our feelings and how we can influence their balance.

WHAT ARE NEUROMEDIATORS AND HOW IT WORKS

Neurons communicate with each other using chemicals called neurotransmitters. Thanks to this, neural networks in a certain part of the brain can fire up, slow down, or begin to cooperate better. We, in turn, feel this as joy, excited expectation of the result, the development of plans or anxiety.

When one neuron fires, the same neurotransmitters are released at the junction with other neurons or muscles—the synapse. This is a signal that should be received and decoded. The ability to do this is determined by the presence of the corresponding receptor in the cell. The receptor and the neurotransmitter interact like a key and a lock, or like pieces of a puzzle, and this triggers a signaling cascade – the cell “understood” what was told to it. Narcotic substances, caffeine and alcohol can also bind to neurotransmitter receptors.

The neurotransmitters are then broken down by enzymes or taken up by neurons, which controls signal duration. It is these processes that some pharmacological drugs for the treatment of depression and premenstrual dysphoric syndrome act on.

WHAT ARE THE NEURO-MEDIATORS AND HOW THEY AFFECT

Adrenaline

Also known as epinephrine, it is released when we are scared, angry or very aroused. It enhances attention, dilates the pupils, increases the level of glucose in the blood, causes adipose tissue to break down fats, and also speeds up the heartbeat, constricts the vessels of the internal organs, dilates the vessels of the muscles and face, and the respiratory tract. That is why epinephrine is administered in cardiac arrest or anaphylactic shock, and so-called “explosive training” and wrestling are so effective for losing weight. Adrenaline can act both as a neurotransmitter, that is, from cell to cell, and as a hormone, that is, a substance that spreads through the bloodstream and has a systemic effect.

Norepinephrine

It’s norepinephrine. It is a neurotransmitter that affects attention, the fight-or-flight response, and blood flow. Violation of the formation and destruction of norepinephrine is accompanied by anxiety and insomnia (there is a lot of it) or lethargy and absent-mindedness (it is not enough). People with Attention Deficit Disorder (often referred to as Childhood Hyperactivity Disorder) may lack norepinephrine.

Dopamine

It may be responsible for pleasure, self-rewarding for certain activities (eg sports, smoking, coffee consumption), expectation of happiness, associative learning, novelty seeking, movement, decision making, adequate perception of reality or desire for certain things, eating and sexual behavior. Dopamine is released from listening to your favorite music. Different people can react to dopamine in different ways: for example, one of the variants of the dopamine receptor DRD4-7r encodes the so-called “tramp gene”, because it is associated with active search activity, travel and a tendency to drug addiction and casual relationships. Or some people need to be given a very strong stimulus in order for them to release dopamine and feel pleasure: there are many such people among top managers, gamblers and alcoholics. Violation of the “dopamine firmware” of the brain occurs in Parkinson’s disease, attention deficit disorder, addictions, including gambling, and schizophrenia.

Serotonin

Literally, this word translates as “vigority serum.” It can act as a hormone: it is produced by intestinal cells, it is distributed in the bloodstream, and a number of cells are sensitive to it – for example, serotonin affects the functioning of the immune system, wound healing and blood clotting. Blood serotonin does not enter the brain – this is prevented by the blood-brain barrier. A lack of serotonin is associated with seasonal affective disorder, depression, and premenstrual syndrome. If you are experiencing symptoms such as disturbed sleep and eating behavior, reluctance to leave the house, lack of joy from things you once loved, bad mood, lack of energy that you experience every day for at least two weeks in a row, then you should contact a neurologist.

Gamma-aminobutyric acid (GABA)

It is the main inhibitory neurotransmitter in the brain. It extinguishes the excitation of neurons, and when there is a lot of it, we are not, not inhibited, but on the contrary, we are focused and calm. People with anxiety disorders and PTSD have lower levels of GABA or receptors for this neurotransmitter. The formation of GABA is impaired in epilepsy and Huntington’s disease. In addition, GABA is involved in the control of movements. GABA does not cross the blood-brain barrier well. This means that even if you take it in tablets, as the dietary supplement manufacturers suggest, it will not enter the brain. But there is a workaround – to consume enough vitamin B6 and drinks that increase its formation by neurons: tea (it contains theanine amino acid), decoctions or extracts of lemon balm, chamomile, hops, valerian.

Acetylcholine

Acetylcholine is the main neurotransmitter for learning, thinking and memory. If it acts on the muscles, it causes contraction. The lack of acetylcholine manifests itself as irritability, inability to collect thoughts and muscle weakness, and in Alzheimer’s disease, the death of neurons that secrete acetylcholine manifests itself as memory lapses. Vitamin B1 is needed for the formation of acetylcholine. It is in bran, beef and pork, green beans and green peas, lentils, corn, nuts and seeds. Another component of the formation of acetylcholine is the substance choline. Found in liver, eggs, cauliflower and Brussels sprouts, expensive oysters and affordable beet leaves. There are plenty to choose from.

Glutamate

60-90% of brain neurons communicate using glutamate. This neurotransmitter is responsible for excitation in the nervous system; without glutamate, learning and memory are impossible. In addition, it is involved in the development of new neural connections – the so-called neuroplasticity. From glutamate, the already known GABA is formed. Glutamate is familiar to us as a food additive. Don’t worry, it’s a lot and it’s neurotoxic – glutamate doesn’t get from the blood to the brain.

Endorphins

This is the general name for neurotransmitters that cause feelings of pleasure and pain relief. They are structurally similar to opiates, hence the name “internal morphine”. Accordingly, endorphin receptors are called opiate receptors. Endorphins are released when we do things we love, including drinking coffee, exercising in the gym, during sex, and after eating spicy food, chocolate.

HOW WE TAKE CARE OF THE BALANCE OF NEURO-MEDIATORS

• Do not self-medicate. Also, do not systematically take tranquilizers and so-called nootropics.
• Eat in a balanced way. This is the only “universal pill”. Vitamins C, B1, B6, B12 and E are essential for the formation of neurotransmitters and protection of neurons from damage. There are no vitamins – the formation of serotonin, acetylcholine and norepinephrine is disrupted. The diet is not only vitamins, but also the amino acids tryptophan, tyrosine and phenylalanine – the precursors of neurotransmitters. Finally, a healthy gut microbiota ensures the absorption of vitamins and serotonin precursors. What to eat to be happy? First of all, hummus, falafel, poultry, currants, blueberries, green peas and green beans, all kinds of cabbage, sweet and hot peppers, bran bread and oatmeal, green and white tea, water and do not drink alcohol. If the last tip is not for you yet (!) then choose a small glass of dark beer – this is a source of B vitamins and hop extracts.
• Be physically active. Regular physical activity and balance exercises keep neurons from dying, help them communicate, cause the release of dopamine, serotonin, endorphins and endocannabinoids, stimulate the brain to absorb the right amino acids, and set the body to follow nutrition and alcohol advice. After all, to train, you need to adhere to the right diet.
• Hug. Oxytocin, which is released during hugging or during sex, increases the number of GABA receptors.