Plasma catecholamines in Buerger's disease: Effects of cigarette smoking and surgical sympathectomy

Objectives: to study the influence of tobacco exposure and sympathectomy on basal sympathoadrenal function of patients with Buerger's disease. Design: plasma catecholamines were measured before and after smoking, in patients with Buerger's disease (n = 13), in patients with Buerger's disease submitted to surgical bilateral lumbar sympathectomy (n = 13), and in healthy volunteers (n = 16). Materials and Methods: venous blood samples were collected before and 2 h after smoking one cigarette (0.9 mg nicotine). Plasma concentrations (pg/ml) of dihydroxiphenylalanine (pL-DOPA), noradrenalin (pNA), adrenalin (pAD) and 3,4-dihydroxiphenylacetic acid (pDOPAC) were determined. Results: Buerger's patients have low basal plasma catecholamines compared to volunteers: pNA (501 (196-927) vs 1858 (968-3663)) and pAD (71 (31-109) vs 193 (116-334)). Sympathectomy increased pL-DOPA, pAD and pDOPAC, but not pNA. After smoking, pNA only decreased in volunteers (1858 (968-3663) vs 1064 (535-2393)). In Buerger + sympathectomy group, smoking lowered pAD (700 (58-3379) vs 278 (54-429)). Conclusions: in Buerger's disease there is an impairment of sympathoadrenal function with an altered peripheral adrenergic response to cigarette smoking. Patients submitted to sympathectomy have high pAD, but this benefit is reversed after smoking. This might be clinically relevant given the association between cigarette smoking and the manifestations of Buerger's disease and the controversy on the effectiveness of sympathectomy in the management of the disease.