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Disimpaction of swallowed bolus.

Comment Plasma catecholamine concentrations are characteristically considerably raised in patients with phaeochromocytomas, and biochemical detection ofa tumour by measuring the 24 hour urinary excretion of vanillylmandelic acid relies on the high excretion of the breakdown products of catecholamine metabolism. Our patient had consistently normal plasma concentrations of catecholamines at rest and after stimulation, and increased concentrations were found only during episodes. The production of immunoreactive somatostatin within phaeochromocytomas has been described,3 but the production of somatostatin messenger RNA and the probable secretion of functional somatostatin have not been reported. Somatostatin inhibits the release ofmany hormones and neurotransmitters and suppression of the growth hormone response to growth hormone releasing hormone typically occurs. Our patient showed a blunted response, which returned to normal after his tumour had been removed; his gastrointestinal symptoms also improved after operation. The tumour was probably secreting somatostatin, but whether this was responsible for our patient's normal resting catecholamine concentrations is not known.