ADRENALINIC TEST - a diagnostic method of functional disturbances nervous, endocrine and other systems of an organism on the nature of reactions of these systems to parenteral administration of adrenaline.
Physiological premises And. the item is high biological activity of adrenaline (see Adrenaline) as the sympathomimetic agent exerting impact on the majority of systems of an organism which functions are connected with excitement of adrenoreaktivny systems (see).
And. the item gained distribution after Eppinger and Hess's works (N. of Eppinger, L. Hess, 1910) which defined the concepts «vagotonias» and «sympathicotonias» as specific neurosises. It was supposed that such clinical symptoms as concern, the alarm, pallor of skin, trembling, acceleration of pulse, rise in arterial pressure, a glycosuria after a subcutaneous injection of 1 mg of adrenaline are considerably expressed at «simpatikotonik» (positive And. items) are also not expressed at «vagotonik». However extent of the general reaction of an organism to adrenaline is defined not so much by a tone of the sympathetic or vagal centers, how many sensitivity of adrenoreaktivny systems, edges the wasp benno raises in the conditions of oppression of sympathetic influences (e.g., at pharmacological blockade sympathetic gangliyev or the terminations of sympathetic nerves).
Offered for diagnosis of a pheochromocytoma [Koller, Fild, Dyyurant (P. A. Coller, N. of J. Field, T. N. of Durant), 1934] And. it was the item of little use for provocation of sympaticoadrenal crises since at this disease sensitivity of adrenoceptors to exogenous adrenaline often decreases. This feature was suggested to be revealed with the help And. the item at a pheochromocytoma [Mayock and Rose (R. Mayock, P. Rose), 1947]. In a crust, time for this purpose And. the item is applied seldom since yields non-constant results and is inferior on diagnostic value to other pharmacological tests (see the Pheochromocytoma).
In 1913 W. S. Frey offered And. the item for assessment of function of a spleen (on increase of number of lymphocytes in peripheral blood in the first half an hour after an injection, adrenaline). But influence of other factors on dynamics of quantity of lymphocytes reduced the importance of test of W. S. Frey (I. L. Fayerman).
Is of clinical value And. the item on reduction of a spleen after a subcutaneous injection of 0,5 — 1,0 mg of adrenaline. Reduction of the sizes of the palpated spleen allows to judge extent of its morphological changes (fibro the changed spleen is not reduced) and helps to distinguish sometimes correctly palpated education in left hypochondrium in doubtful cases (a left kidney, a tumor). At suspicion of thrombophlebitis of splenic veins And. items consider contraindicated since vigorous reduction of a spleen can lead to a rupture of the struck vessels.
Indications to conducting test and methods of its performance. And. the item is applied preferential to functional diagnosis of endocrinopathies since at morbid conditions of an adenohypophysis, adrenal glands and gonads reaction of these systems on And. the item changes. So, e.g., intravenous drop administration of adrenaline in a dose of 0,8 mg of hectare causes 1 hour considerably big secretion of a cortisone in women with a hirsutism, than in healthy women, and even big, than in healthy men. The following two options A are most widespread. item.
Adrenalinic test with a research of a glycemic curve. Technique: 1 mg of adrenaline (1 ml of solution 1: 1000) enter subcutaneously in the morning on an empty stomach, investigate a sugar content in blood to and every 15 min. after a subcutaneous injection of adrenaline within 2,5 hours.
At healthy people the maximum raising of a sugar curve at 30 — 50% of initial sizes is observed in 40 — 60 min. In 100 — 120 min. the sugar curve is returned to initial level, for - decreases a little and again overtakes initial level in a pra affairs of time of a research. Phases of a curve are connected with property of adrenaline to cause a glycogenolysis in a liver — the first (hyper glycemic) phase and with hyper glycemic stimulation of the vagal and insulin mechanisms lowering the level of sugar of blood — the second (hypoglycemic) phase.
Pathological changes of a glycemic curve at And. item 1. Weak expressiveness or lack of a hyper glycemic phase without changes (or at absence) the second phase is treated as a symptom of depletion of a liver by a glycogen, existence in it of a «steady» glycogen (a glycogenous disease), and at slow increase in a curve — as a symptom of disturbance of glikogenolitichesky function of a liver. 2. Bystry and considerable (more than for 100%) increase of a glycemia in the first phase testifies to an active glycogenolysis in a liver. 3. Lack of decrease sugar curve after achievement of hyper glycemic peak or its long preservation is high over initial level is characteristic of a diabetes mellitus. 4. The reduced first phase with sharply expressed to the second when decrease in level of sugar of blood can be followed by symptoms of a hypoglycemia, testifies to a hyper dysinsulinism.
Forshem and Thorn's eosinophilic test. Test is based on property of adrenaline to stimulate secretion of AKTG with a hypophysis and a pas the assumption of dependence of number of eosinophils in peripheral blood from the level of secretion of glucocorticoids adrenal glands.
Technique: count number of eosinophils in blood to and in 4 hours after a subcutaneous or intramuscular injection of 0,2 — 0,3 ml of 0,1% of solution of adrenaline; at the kept reactivity of cortical substance of adrenal glands and an adenohypophysis quantity of eosinophils the ambassador A. the item decreases not less than by 50%.
Pathological indicators And. the item (decrease in number of eosinophils in blood is less than for 50%) compare to results of the eosinophilic test with AKTG (see Thorn test). If at test with AKTG normal dynamics of eosinophils is observed, draw a conclusion about primary pituitary insufficiency. Such assessment of results And. the item it is admissible only in those stages of a disease when there did not come the secondary atrophy of adrenal glands yet, at a cut (as well as at their primary defeat) pathological results are yielded and And. the item, and test with AKTG. The value of results of the eosinophilic test with adrenaline increases if they are identical at numerous in wasps works And. item. There are data on eozinopenichesky effect of adrenaline without participation of pituitary and adrenal system.
For carrying out And. items are required fresh solutions of adrenaline.
Carrying out And. it is contraindicated to the item at coronary heart disease, in late stages of an idiopathic hypertensia, and also at treatment of a gangliolitikama, sympatholytics or alpha Methyldopa.
Bibliography: Guillaume A. S. Vagotonias, sympathicotonias, nevrotoniya, the lane with fr., page 93, L., 1926; Fayerman I. L. Diseases of a spleen, M. — L., 1928, bibliogr.; Hilko A. S. both Madiyevsky Yu. M. Metodika of conducting adrenalinic test and its indicators at almost healthy people, Laborat. business, JNft 3, page 161, 1972, bibliogr.; Endocrine about - meniaya diagnosis, under the editorship of I. Penchev. the lane from Bulgarians., page 51, Sofia, 1964; S t about of 11 B. and. lake of Biological and clinical significance of the adrenalin test in hematology, Hae-matologia (Budapest), v. l, p. 27, 1968.
V. P. Zhmurkin.