Evidence for α+-Adrenoreceptor Hyperresponsiveness in Hypotensive Cirrhotic Patients with Ascites

Pinzani, Massimo; Marra, Fabio; Fusco, Bruno M.; Alessandri, Massimo; Laffi, Giacomo; Fanciullacci, Marcello; Gentilini, Paolo
June 1991
American Journal of Gastroenterology;Jun1991, Vol. 86 Issue 6, p711
Academic Journal
Cirrhosis with ascites is often characterized by arterial hypotension associated with increased plasma norepinephrine levels. Clinical evidence suggests a decreased sensitivity to norepinephrine in this clinical setting, indicating a potential derangement of α1 adrenoreceptors. The aim of the present study was to evaluate the reactivity of the alpha;1-adrenoreceptor. using phenylephrine, a selective α1 receptor agonist. First, we evaluated tbe pupillar response to the intraconjunctival administration of tbe agonist. Hypotensive cirrhotic patients showed a trend to a more marked and prolonged response, compared with age-matched healthy controls. Second, we studied the response of α1-adrenoreceptors in the peripheral vasculature by administering iv phenylephrine to a similar group of patients. A significantly greater and longer lasting pressor response was observed in hypotensive cirrhotic patients (p < 0.0001 vs. healthy controls). Our results indicate that in this group of patients, there is a rather peculiar situation, characterized by α1-adrenoreceptor hyperresponsiveness in the presence of high levels of circulating norepinepbrine. This finding could be related to biochemical abnormalities within the peripheral sympathetic nervous system endings.


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