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Liu C, Zheng F, Zhang X, Pan J, Ding W, Tian X. Selective venous sampling for secondary hypertension. Hypertens Res 2024; 47:1766-1778. [PMID: 38750220 DOI: 10.1038/s41440-024-01699-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 03/19/2024] [Accepted: 04/02/2024] [Indexed: 07/06/2024]
Abstract
Selective venous sampling (SVS), an invasive radiographic procedure that depends on contrast media, holds a unique role in diagnosing and guiding the treatment of certain types of secondary hypertension, particularly in patients who may be candidates for curative surgery. The adrenal venous sampling (AVS), in particular, is established as the gold standard for localizing and subtyping primary aldosteronism (PA). Throughout decades of clinical practice, AVS could be applied not only to PA but also to other endocrine diseases, such as adrenal Cushing syndrome (ACS) and Pheochromocytomas (PCCs). Notably, the application of AVS in ACS and PCCs remains less recognized compared to PA, with the low success rate of catheterization, the controversy of results interpretation, and the absence of a standardized protocol. Additionally, the AVS procedure necessitates enhancements to boost its success rate, with several helpful but imperfect methods emerging, yet continued exploration remains essential. We also observed renal venous sampling (RVS), an operation akin to AVS in principle, serves as an effective means of diagnosing renin-dependent hypertension, aiding in the identification of precise sources of renin excess and helping the selection of surgical candidates with renin angiotensin aldosterone system (RAAS) abnormal activation. Nonetheless, further basic and clinical research is needed. Selective venous sampling (SVS) can be used in identifying cases of secondary hypertension that are curable by surgical intervention. Adrenal venous sampling (AVS) and aldosterone measurement for classificatory diagnosis of primary aldosteronism (PA) are established worldwide. While its primary application is for PA, AVS also holds the potential for diagnosing other endocrine disorders, including adrenal Cushing's syndrome (ACS) and pheochromocytomas (PCCs) through the measurements of cortisol and catecholamine respectively. In addition, renal venous sampling and renin measurement can help to diagnose renovascular hypertension and reninoma.
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Affiliation(s)
- Chang Liu
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jingshi Road, 250014, Jinan City, China
| | - Fei Zheng
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jingshi Road, 250014, Jinan City, China
| | - Xinyu Zhang
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jingshi Road, 250014, Jinan City, China
| | - Jinyu Pan
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jingshi Road, 250014, Jinan City, China
| | - Wenyuan Ding
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jingshi Road, 250014, Jinan City, China
| | - Xiuqing Tian
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jingshi Road, 250014, Jinan City, China.
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Yang YH, Chang YL, Lee BC, Lu CC, Wang WT, Hu YH, Liu HW, Lin YH, Chang CC, Wu WC, Tseng FY, Lin YH, Wu VC, Hwu CM. Strategies for subtyping primary aldosteronism. J Formos Med Assoc 2024; 123 Suppl 2:S114-S124. [PMID: 37202237 DOI: 10.1016/j.jfma.2023.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/26/2023] [Accepted: 05/04/2023] [Indexed: 05/20/2023] Open
Abstract
Adrenal venous sampling (AVS) is a crucial method for the lateralization of primary aldosteronism (PA). It is advised to halt the use of the patient's antihypertensive medications and correct hypokalemia prior to undergoing AVS. Hospitals equipped to conduct AVS should establish their own diagnostic criteria based on current guidelines. If the patient's antihypertensive medications cannot be discontinued, AVS can be performed as long as the serum renin level is suppressed. The Task Force of Taiwan PA recommends using a combination of adrenocorticotropic hormone stimulation, quick cortisol assay, and C-arm cone-beam computed tomography to maximize the success of AVS and minimize errors by using the simultaneous sampling technique. If AVS is not successful, an NP-59 (131 I-6-β-iodomethyl-19-norcholesterol) scan can be used as an alternative method to lateralize PA. We depicted the details of the lateralization procedures (mainly AVS, and alternatively NP-59) and their tips and tricks for confirmed PA patients who would consider to undergo surgical treatment (unilateral adrenalectomy) if the subtyping shows unilateral disease.
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Affiliation(s)
- Yun-Hsuan Yang
- Department of Medical Imaging, National Taiwan University Hospital, National Taiwan University College of Medicine, Taiwan
| | - Yu-Ling Chang
- Department of Medical Imaging, National Taiwan University Hospital, National Taiwan University College of Medicine, Taiwan
| | - Bo-Ching Lee
- Department of Medical Imaging, National Taiwan University Hospital, National Taiwan University College of Medicine, Taiwan
| | - Ching-Chu Lu
- Department of Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Ting Wang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan
| | - Ya-Hui Hu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, Taipei, Taiwan
| | - Han-Wen Liu
- Division of Endocrine and Metabolism, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan
| | - Yung-Hsiang Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Puzi, Chia-Yi, Taiwan
| | - Chin-Chen Chang
- Department of Medical Imaging, National Taiwan University Hospital, National Taiwan University College of Medicine, Taiwan; Department and Graduate Institute of Forensic Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Wan-Chen Wu
- Division of Endocrinology & Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Fen-Yu Tseng
- Division of Endocrinology & Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yen-Hung Lin
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan; Primary Aldosteronism Center at National Taiwan University Hospital, Taipei, Taiwan
| | - Vin-Cent Wu
- Primary Aldosteronism Center at National Taiwan University Hospital, Taipei, Taiwan; Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chii-Min Hwu
- Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan; Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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de Freminville JB, Amar L, Azizi M, Mallart-Riancho J. Endocrine causes of hypertension: literature review and practical approach. Hypertens Res 2023; 46:2679-2692. [PMID: 37821565 DOI: 10.1038/s41440-023-01461-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/05/2023] [Accepted: 09/09/2023] [Indexed: 10/13/2023]
Abstract
Hypertension (HTN) affects more than 30% of adults worldwide. It is the most frequent modifiable cardiovascular (CV) risk factor, and is responsible for more than 10 million death every year. Among patients with HTN, we usually distinguish secondary HTN, that is HTN due to an identified cause, and primary HTN, in which no underlying cause has been found. It is estimated that secondary hypertension represents between 5 and 15% of hypertensive patients [1]. Therefore, routine screening of patients for secondary HTN would be too costly and is not recommended. In addition to the presence of signs suggesting a specific secondary cause, screening is based on specific criteria. Identifying secondary HTN can be beneficial for patients in certain situations, because it may lead to specific treatments, and allow better control of blood pressure and sometimes even a cure. Besides, it is now known that secondary HTN are more associated with morbidity and mortality than primary HTN. The main causes of secondary HTN are endocrine and renovascular (mainly due to renal arteries abnormalities). The most frequent endocrine cause is primary aldosteronism, which diagnosis can lead to specific therapies. Pheochromocytoma and Cushing syndrome also are important causes, and can have serious complications. Other causes are less frequent and can be suspected on specific situations. In this article, we will describe the endocrine causes of HTN and discuss their treatments.
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Affiliation(s)
- Jean-Baptiste de Freminville
- Hypertension Unit, AP-HP, Hôpital Européen Georges Pompidou, F-75015, Paris, France.
- Université Paris Cité,, F-75015, Paris, France.
| | - Laurence Amar
- Hypertension Unit, AP-HP, Hôpital Européen Georges Pompidou, F-75015, Paris, France
- Université Paris Cité,, F-75015, Paris, France
| | - Michel Azizi
- Hypertension Unit, AP-HP, Hôpital Européen Georges Pompidou, F-75015, Paris, France
- Université Paris Cité,, F-75015, Paris, France
| | - Julien Mallart-Riancho
- Hypertension Unit, AP-HP, Hôpital Européen Georges Pompidou, F-75015, Paris, France
- Université Paris Cité,, F-75015, Paris, France
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Shi S, Tian Y, Ren Y, Li Q, Li L, Yu M, Wang J, Gao L, Xu S. A new machine learning-based prediction model for subtype diagnosis in primary aldosteronism. Front Endocrinol (Lausanne) 2022; 13:1005934. [PMID: 36506080 PMCID: PMC9728523 DOI: 10.3389/fendo.2022.1005934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/07/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Unilateral primary aldosteronism (UPA) and bilateral primary aldosteronism (BPA) are the two subtypes of PA. Discriminating UPA from BPA is of great significance. Although adrenal venous sampling (AVS) is the gold standard for diagnosis, it has shortcomings. Thus, improved methods are needed. METHODS The original data were extracted from the public database "Dryad". Ten parameters were included to develop prediction models for PA subtype diagnosis using machine learning technology. Moreover, the optimal model was chose and validated in an external dataset. RESULTS In the modeling dataset, 165 patients (71 UPA, 94 BPA) were included, while in the external dataset, 43 consecutive patients (20 UPA, 23 BPA) were included. The ten parameters utilized in the prediction model include age, sex, systolic and diastolic blood pressure, aldosterone to renin ratio (ARR), serum potassium, ARR after 50 mg captopril challenge test (CCT), primary aldosterone concentration (PAC) after saline infusion test (SIT), PAC reduction rate after SIT, and number of types of antihypertensive agents at diagnosis. The accuracy, sensitivity, specificity, F1 score, and AUC for the optimal model using the random forest classifier were 90.0%, 81.8%, 96.4%, 0.878, and 0.938, respectively, in the testing dataset and 81.4%, 90.0%, 73.9%, 0.818 and 0.887, respectively, in the validating external dataset. The most important variables contributing to the prediction model were PAC after SIT, ARR, and ARR after CCT. DISCUSSION We developed a machine learning-based predictive model for PA subtype diagnosis based on ten clinical parameters without CT imaging. In the future, artificial intelligence-based prediction models might become a robust prediction tool for PA subtype diagnosis, thereby, might reducing at least some of the requests for CT or AVS and assisting clinical decision-making.
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Affiliation(s)
- Shaomin Shi
- Department of Endocrinology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Yuan Tian
- Department of Endocrinology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Yong Ren
- Department of Cardiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Qing’an Li
- Department of General Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Luhong Li
- Department of General Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Ming Yu
- Department of General Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Jingzhong Wang
- Department of Interventional Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Ling Gao
- Department of Endocrinology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
- *Correspondence: Shaoyong Xu, ; Ling Gao,
| | - Shaoyong Xu
- Department of Endocrinology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
- Center for Clinical Evidence-Based and Translational Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
- *Correspondence: Shaoyong Xu, ; Ling Gao,
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Araujo-Castro M, Parra-Ramírez P. Diagnosis of primary hyperaldosteronism. Med Clin (Barc) 2021; 158:424-430. [PMID: 34924198 DOI: 10.1016/j.medcli.2021.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/07/2021] [Accepted: 10/12/2021] [Indexed: 11/26/2022]
Abstract
Primary aldosteronism (PA) is the most common cause of secondary arterial hypertension. Moreover, it is associated with a higher cardio-metabolic risk than the observed in patients with essential arterial hypertension (EHT). Therefore, a high index of clinical suspicion for PA is mandatory. If an elevated aldosterone/renin ratio is confirmed, confirmatory tests should be performed, with the exception in those patients with florid PA, with, with spontaneous hypokalaemia, plasma aldosterone > 20 ng/dL and suppressed renin, in whom this step would not be strictly necessary. Intravenous saline infusion test or captopril test are the commonly used confirmatory tests. The last step in the diagnosis of PA is the localization study, being the computerized axial tomography (CT) of the adrenal glands the initial test of choice, and adrenal venous sampling (AVS), the definitive localization test in most cases. This review summarizes the available data about the diagnosis of PA, from screening to confirmatory study and localization.
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Affiliation(s)
- Marta Araujo-Castro
- Unidad de Neuroendocrinología, Servicio de Endocrinología, Hospital Universitario Ramón y Cajal. Madrid & Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS) & Departamento de Medicina, Universidad de Alcalá de Henares, Madrid, España.
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Reincke M, Bancos I, Mulatero P, Scholl UI, Stowasser M, Williams TA. Diagnosis and treatment of primary aldosteronism. Lancet Diabetes Endocrinol 2021; 9:876-892. [PMID: 34798068 DOI: 10.1016/s2213-8587(21)00210-2] [Citation(s) in RCA: 100] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 07/21/2021] [Accepted: 07/26/2021] [Indexed: 02/07/2023]
Abstract
Primary aldosteronism is a common cause of secondary hypertension associated with excess cardiovascular morbidities. Primary aldosteronism is underdiagnosed because it does not have a specific, easily identifiable feature and clinicians can be poorly aware of the disease. The diagnostic investigation is a multistep process of screening, confirmatory testing, and subtype differentiation of unilateral from bilateral forms for therapeutic management. Adrenal venous sampling is key for reliable subtype identification, but can be bypassed in patients with specific characteristics. For unilateral disease, surgery offers the possibility of cure, with total laparoscopic unilateral adrenalectomy being the treatment of choice. Bilateral forms are treated mainly with mineralocorticoid receptor antagonists. The goals of treatment are to normalise both blood pressure and excessive aldosterone production, and the primary aims are to reduce associated comorbidities, improve quality of life, and reduce mortality. Prompt diagnosis of primary aldosteronism and the use of targeted treatment strategies mitigate aldosterone-specific target organ damage and with appropriate patient management outcomes can be excellent. Advances in molecular histopathology challenge the traditional concept of primary aldosteronism as a binary disease, caused by either a unilateral aldosterone-producing adenoma or bilateral adrenal hyperplasia. Somatic mutations drive autonomous aldosterone production in most adenomas. Many of these same mutations have been identified in nodular lesions adjacent to an aldosterone-producing adenoma and in patients with bilateral disease. In addition, germline mutations cause rare familial forms of aldosteronism (familial hyperaldosteronism types 1-4). Genetic testing for inherited forms in suspected cases of familial hyperaldosteronism avoids the burdensome diagnostic investigation in positive patients. In this Review, we discuss advances and future management approaches in the diagnosis of primary aldosteronism.
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Affiliation(s)
- Martin Reincke
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany.
| | - Irina Bancos
- Division of Endocrinology, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Paolo Mulatero
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Ute I Scholl
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Center of Functional Genomics, Berlin, Germany
| | - Michael Stowasser
- Endocrine Hypertension Research Centre, University of Queensland Diamantina Institute, Greenslopes and Princess Alexandra Hospitals, Brisbane, QLD, Australia
| | - Tracy Ann Williams
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany; Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Turin, Italy
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Bouhanick B, Delchier MC, Lagarde S, Boulestreau R, Conil C, Gosse P, Rousseau H, Lepage B, Olivier P, Papadopoulos P, Trillaud H, Cremer A. Radiofrequency ablation for adenoma in patients with primary aldosteronism and hypertension: ADERADHTA, a pilot study. J Hypertens 2021; 39:759-765. [PMID: 33196558 PMCID: PMC7969174 DOI: 10.1097/hjh.0000000000002708] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/16/2020] [Accepted: 10/17/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To evaluate the efficacy and the feasibility of radiofrequency ablation to treat aldosterone-producing adenomas. METHODS In an open prospective bicentric pilot study, patients with hypertension on ambulatory blood pressure measurement, a primary aldosteronism, an adenoma measuring less than 4 cm, and confirmation of lateralization by adrenal venous sampling were recruited. The primary endpoint, based on ABPM performed at 6 months after the radiofrequency ablation, was a daytime SBP/DBP less than 135/85 mmHg without any antihypertensive drugs or a reduction of at least 20 mmHg for SBP or 10 mmHg for DBP. RESULTS Thirty patients have been included (mean age = 51 ± 11 years; 50% women). Mean baseline daytime SBP and DBP were 144 ± 19 / 95 ± 15 mmHg and 80% received at least two antihypertensive drugs. At 6 months: 47% (95% CI 28-66) of patients reached the primary endpoint, mean daytime SBP and DBP were 131 ± 14 (101-154)/87 ± 10 (71-107) mmHg; 43% of them did not take any antihypertensive drug and 70% of them did not take potassium supplements. Few complications were recorded: four cases of back pain at day 1 postablation; three limited pneumothoraxes, which resolved spontaneously; one lesion of a polar renal artery. CONCLUSION Radiofrequency ablation for hypertensive patients with aldosterone-producing adenomas seems to be an emerging promising alternative to surgery. Its efficacy and its feasibility have to be confirmed in a larger sample of patients.
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Affiliation(s)
| | | | | | | | | | - Philippe Gosse
- Service de Cardiologie/HTA, Hôpital Saint André, CHU Bordeaux
| | | | | | - Pascale Olivier
- Service de Pharmacologie Médicale et Clinique, Pharmacovigilance, CHU Toulouse
| | | | - Hervé Trillaud
- Service d’imagerie diagnostique et interventionnelle, CHU Bordeaux, France
| | - Antoine Cremer
- Service de Cardiologie/HTA, Hôpital Saint André, CHU Bordeaux
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Tezuka Y, Yamazaki Y, Nakamura Y, Sasano H, Satoh F. Recent Development toward the Next Clinical Practice of Primary Aldosteronism: A Literature Review. Biomedicines 2021; 9:biomedicines9030310. [PMID: 33802814 PMCID: PMC8002562 DOI: 10.3390/biomedicines9030310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/08/2021] [Accepted: 03/15/2021] [Indexed: 11/24/2022] Open
Abstract
For the last seven decades, primary aldosteronism (PA) has been gradually recognized as a leading cause of secondary hypertension harboring increased risks of cardiovascular incidents compared to essential hypertension. Clinically, PA consists of two major subtypes, surgically curable and uncurable phenotypes, determined as unilateral or bilateral PA by adrenal venous sampling. In order to further optimize the treatment, surgery or medications, diagnostic procedures from screening to subtype differentiation is indispensable, while in the general clinical practice, the work-up rate is extremely low even in the patients with refractory hypertension because of the time-consuming and labor-intensive nature of the procedures. Therefore, a novel tool to simplify the diagnostic flow has been recently in enormous demand. In this review, we focus on recent progress in the following clinically important topics of PA: prevalence of PA and its subtypes, newly revealed histopathological classification of aldosterone-producing lesions, novel diagnostic biomarkers and prediction scores. More effective strategy to diagnose PA based on better understanding of its epidemiology and pathology should lead to early detection of PA and could decrease the cardiovascular and renal complications of the patients.
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Affiliation(s)
- Yuta Tezuka
- Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan;
| | - Yuto Yamazaki
- Department of Pathology, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan; (Y.Y.); (H.S.)
| | - Yasuhiro Nakamura
- Division of Pathology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai 981-8558, Japan;
| | - Hironobu Sasano
- Department of Pathology, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan; (Y.Y.); (H.S.)
| | - Fumitoshi Satoh
- Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan;
- Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan
- Correspondence:
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Kotanidou EP, Giza S, Tsinopoulou VR, Vogiatzi M, Galli-Tsinopoulou A. Diagnosis and Management of Endocrine Hypertension in Children and Adolescents. Curr Pharm Des 2020; 26:5591-5608. [PMID: 33185153 DOI: 10.2174/1381612826666201113103614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 08/18/2020] [Indexed: 12/12/2022]
Abstract
Hypertension in childhood and adolescence has increased in prevalence. Interest in the disease was raised after the 2017 clinical practice guidelines of the American Academy of Paediatrics on the definition and classification of paediatric hypertension. Among the secondary causes of paediatric hypertension, endocrine causes are relatively rare but important due to their unique treatment options. Excess of catecholamine, glucocorticoids and mineralocorticoids, congenital adrenal hyperplasia, hyperaldosteronism, hyperthyroidism and other rare syndromes with specific genetic defects are endocrine disorders leading to paediatric and adolescent hypertension. Adipose tissue is currently considered the major endocrine gland. Obesity-related hypertension constitutes a distinct clinical entity leading to an endocrine disorder. The dramatic increase in the rates of obesity during childhood has resulted in a rise in obesity-related hypertension among children, leading to increased cardiovascular risk and associated increased morbidity and mortality. This review presents an overview of pathophysiology and diagnosis of hypertension resulting from hormonal excess, as well as obesity-related hypertension during childhood and adolescence, with a special focus on management.
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Affiliation(s)
- Eleni P Kotanidou
- Second Department of Paediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Styliani Giza
- Fourth Department of Paediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Vasiliki-Regina Tsinopoulou
- Second Department of Paediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Maria Vogiatzi
- Division of Endocrinology and Diabetes, Children' s Hospital of Philadelphia, PA 19104, United States
| | - Assimina Galli-Tsinopoulou
- Second Department of Paediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
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10
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Meng Z, Zhou L, Dai Z, Xu C, Qian G, Peng M, Zhu Y, Kwong JSW, Wang X. The Quality of Clinical Practice Guidelines and Consensuses on the Management of Primary Aldosteronism: A Critical Appraisal. Front Med (Lausanne) 2020; 7:136. [PMID: 32432118 PMCID: PMC7214671 DOI: 10.3389/fmed.2020.00136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 03/30/2020] [Indexed: 02/05/2023] Open
Abstract
Background: Several guidelines and expert consensuses have been developed for management of primary aldosteronism (PA). It is important to understand the detailed recommendations and quality of these guidelines to help physicians make informed and reliable decision. Methods: PubMed, EMBASE, and three websites were searched for practice guidelines or consensuses of PA from inception to January 24, 2019. We summarized the major recommendations on the management of PA from these guidelines and consensuses. The Appraisal of Guidelines for Research and Evaluation II was used to assess quality of the included guidelines and consensuses. Results: We identified three clinical practice guidelines and three consensus statements. Most of the recommendations on the diagnosis and treatment of PA from these guidelines and consensuses were consistent. Some minor conflicts were recorded for patient's screen and confirmation test. All included guideline documents have a good quality (score, >70%) on the scope and purpose (mean score, 81.02%) and clarity of presentation of the recommendations (mean score, 86.88%). However, the reporting for the stakeholder involvement (mean score, 54.32%) and applicability (mean score, 47.92%) were insufficient. There was an insufficient rigorousness in most of the guideline documents (mean score, 45.56%) on the development process. The Endocrine Society practice guideline 2016 ranked highest in quality (score, 81.13%). Conclusions: Existing guideline documents provided valuable recommendations on the management of PA, but further efforts are needed to improve the methodological quality. The Endocrine Society practice guideline 2016 was recommended for use.
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Affiliation(s)
- Zhe Meng
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China.,Department of Adrenal Hypertension, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Liang Zhou
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhe Dai
- Department of Adrenal Hypertension, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China.,Department of Endocrinology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Chang Xu
- Chinese Evidence Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Guofeng Qian
- Department of Urology, The First Hospital of Zhejiang University, Zhejiang University, Hangzhou, China
| | - Mou Peng
- Department of Urology, The Second Hospital of Xiangya, Zhongnan University, Hangzhou, China
| | - Yuchun Zhu
- Department of Adrenal Hypertension, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Joey S W Kwong
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Xinghuan Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
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Wolley M, Thuzar M, Stowasser M. Controversies and advances in adrenal venous sampling in the diagnostic workup of primary aldosteronism. Best Pract Res Clin Endocrinol Metab 2020; 34:101400. [PMID: 32115358 DOI: 10.1016/j.beem.2020.101400] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Adrenal venous sampling (AVS) is a key part of the diagnostic workup of primary aldosteronism, distinguishing unilateral from bilateral disease and determining treatment options. Although AVS is a well-established procedure, many aspects remain controversial, including optimal patient selection for the procedure and exactly how AVS is performed and interpreted. Despite the controversies, a growing body of evidence supports the use of AVS in most patients with primary aldosteronism, though some specific patient groups may be able to forego AVS and proceed directly to treatment. Although AVS remains a difficult procedure, success rates may be improved with the use of advanced CT imaging techniques and/or rapid cortisol assays. New advances in nuclear imaging and steroid profiling may also offer alternatives or adjuncts to AVS in the future.
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Affiliation(s)
- Martin Wolley
- Endocrine Hypertension Research Centre, University of Queensland Diamantina Institute, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Brisbane, 4102, Australia.
| | - Moe Thuzar
- Endocrine Hypertension Research Centre, University of Queensland Diamantina Institute and Department of Endocrinology Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Brisbane, 4102, Australia.
| | - Michael Stowasser
- Endocrine Hypertension Research Centre, University of Queensland Diamantina Institute, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Brisbane, 4102, Australia.
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12
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Cosyntropin stimulation in adrenal vein sampling improves the judgment of successful adrenal vein catheterization and outcome prediction for primary aldosteronism. Hypertens Res 2020; 43:1105-1112. [PMID: 32355223 DOI: 10.1038/s41440-020-0445-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 03/09/2020] [Accepted: 03/31/2020] [Indexed: 01/16/2023]
Abstract
The importance of cosyntropin stimulation during adrenal vein sampling (AVS) is not fully established, partly due to insufficient AVS data relating the presence and absence of cosyntropin stimulation with postoperative outcome. Therefore, we investigated differences in AVS indices before and after cosyntropin stimulation, and determined whether unstimulated or stimulated AVS indices better correlated with treatment outcome. A retrospective study was conducted in two parts: one with 185 patients who underwent AVS and the other with 81 patients who underwent unilateral adrenalectomy for unilateral aldosterone oversecretion. The selectivity index (SI), lateralized ratio (LR), and contralateral ratio (CR) before and after cosyntropin stimulations were determined, along with blood pressure outcome 1 year after surgery. Primary aldosteronism was diagnosed according to the Japanese Endocrine Society 2009 guidelines. The percentage of AVS patients with successful catheterization, defined as unstimulated SI > 2 before and stimulated SI > 5, increased after cosyntropin stimulation from 52% to 93% and from 74% to 98% for the right and left adrenal veins, respectively. LR decreased after cosyntropin stimulation (P < 0.001). In the postoperative patients, complete and partial clinical success was achieved in 49 and 27%, respectively. Low CR (<1) and high LR (≥2.6) after cosyntropin stimulation better correlated with postoperative blood pressure outcome than those before stimulation (CR < 1 and LR ≥ 2). These data suggest that cosyntropin stimulation facilitated the judgment of catheter insertion and postcosyntropin AVS indices may be more useful for predicting treatment outcome after unilateral adrenalectomy. Further study should examine the usefulness of cosyntropin stimulation in AVS performed in other settings.
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Meyrignac O, Arcis É, Delchier MC, Mokrane FZ, Darcourt J, Rousseau H, Bouhanick B. Impact of cone beam - CT on adrenal vein sampling in primary aldosteronism. Eur J Radiol 2020; 124:108792. [DOI: 10.1016/j.ejrad.2019.108792] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 11/20/2019] [Accepted: 12/11/2019] [Indexed: 10/25/2022]
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Pons Fernández N, Moreno F, Morata J, Moriano A, León S, De Mingo C, Zuñiga Á, Calvo F. Familial hyperaldosteronism type III a novel case and review of literature. Rev Endocr Metab Disord 2019; 20:27-36. [PMID: 30569443 DOI: 10.1007/s11154-018-9481-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Less than 15% of hypertension cases in children are secondary to a primary hyperaldosteronism. This is idiopathic in 60% of the cases, secondary to a unilateral adenoma in 30% and 10% remaining by primary adrenal hyperplasia, familial hyperaldosteronism, ectopic aldosterone production or adrenocortical carcinoma.To date, four types of familial hyperaldosteronism (FH I to FH IV) have been reported. FH III is caused by germline mutations in KCNJ5, encoding the potassium channel Kir3.4. The mutations cause the channel to lose its selectivity for potassium, allowing large quantities of sodium to enter the cell. As a consequence, the membrane depolarizes, voltage-gated calcium channels open, calcium enters the cell, initiating the cascade that leads to aldosterone synthesis. Somatic mutations in KCNJ5 has also been described in aldosterone-producing adenomas. The most frequent presentation of FH III is with severe hyperaldosteronism symptoms and resistance to pharmacological therapy which leads to bilateral adrenalectomy. We will review current literature and describe a child with FH III due to a novel de novo deletion in KCNJ5 with wild phenotype as a sign of clinical variability of this disease.
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Affiliation(s)
- Natividad Pons Fernández
- Department of Pediatrics, Hospital Lluís Alcanyís de Xàtiva, Ctra. Xàtiva a Silla km 2, 46800, Xàtiva, Valencia, Spain.
| | - Francisca Moreno
- Hospital Universitario y Politécnico la Fe de Valencia, Valencia, Spain
| | - Julia Morata
- Department of Pediatrics, Hospital Lluís Alcanyís de Xàtiva, Ctra. Xàtiva a Silla km 2, 46800, Xàtiva, Valencia, Spain
| | - Ana Moriano
- Department of Pediatrics, Hospital Lluís Alcanyís de Xàtiva, Ctra. Xàtiva a Silla km 2, 46800, Xàtiva, Valencia, Spain
| | - Sara León
- Hospital Universitario y Politécnico la Fe de Valencia, Valencia, Spain
| | - Carmen De Mingo
- Hospital Universitario y Politécnico la Fe de Valencia, Valencia, Spain
| | - Ángel Zuñiga
- Hospital Universitario y Politécnico la Fe de Valencia, Valencia, Spain
| | - Fernando Calvo
- Department of Pediatrics, Hospital Lluís Alcanyís de Xàtiva, Ctra. Xàtiva a Silla km 2, 46800, Xàtiva, Valencia, Spain
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La chirurgie d’épargne surrénalienne : du cortex à la médulla. ANNALES D'ENDOCRINOLOGIE 2018; 78 Suppl 1:S11-S20. [PMID: 29157485 DOI: 10.1016/s0003-4266(17)30921-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The 2017 Endocrine Society annual meeting included several communications and debates on the conservative adrenal surgery in bilateral hereditary pheochromocytomas (BHP), bilateral adrenal macronodular hyperplasia (BAMH) and primary hyperaldosteronism (PHA). The general principle is to preserve a part of the adrenal cortex to prevent the occurrence of a definitive adrenal insufficiency. In BHP, cortical sparing surgery allows more than 50% of patients to maintain normal corticotropic function at 10 years with a low recurrence rate (~ 10%). Since the adrenal medulla cannot be removed entirely, recurrence seems inevitable and long-term follow-up is essential. Individual risk of malignancy must be taken into account. In BAMH responsible for Cushing syndrome, unilateral adrenalectomy induces a normalization of urinary free cortisol in 92 to 100% of cases and even corticotropic insufficiency in 40 to 100% of cases. This is most often transient. Late recurrences of Cushing's syndrome may occur in 13 to 60% of cases. Prolonged patient monitoring is therefore essential. In PAH with lateralized aldosterone production, minimally invasive partial adrenal surgery, which consists of removing only the adrenal adenoma visualized at TDM, allows an improvement blood pressure in about 94% of patients. However, failure or recurrence may occur. Its place therefore remains marginal in the treatment of the lateralized PAHs.
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Update in diagnosis and management of primary aldosteronism. ACTA ACUST UNITED AC 2017; 56:360-372. [DOI: 10.1515/cclm-2017-0217] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 07/24/2017] [Indexed: 12/17/2022]
Abstract
Abstract
Primary aldosteronism (PA) is a group of disorders in which aldosterone is excessively produced. These disorders can lead to hypertension, hypokalemia, hypervolemia and metabolic alkalosis. The prevalence of PA ranges from 5% to 12% around the globe, and the most common causes are adrenal adenoma and adrenal hyperplasia. The importance of PA recognition arises from the fact that it can have a remarkably adverse cardiovascular and renal impact, which can even result in death. The aldosterone-to-renin ratio (ARR) is the election test for screening PA, and one of the confirmatory tests, such as oral sodium loading (OSL) or saline infusion test (SIT), is in general necessary to confirm the diagnosis. The distinction between adrenal hyperplasia (AH) or aldosterone-producing adenoma (APA) is essential to select the appropriate treatment. Therefore, in order to identify the subtype of PA, imaging exams such as computed tomography or magnetic ressonance imaging, and/or invasive investigation such as adrenal catheterization must be performed. According to the subtype of PA, optimal treatment – surgical for APA or pharmacological for AH, with drugs like spironolactone and amiloride – must be offered.
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Nasri A, Mansour M, Brahem Z, Kacem A, Hassan AA, Derbali H, Messelmani M, Zaouali J, Mrissa R. Stroke disclosing primary aldosteronism: Report on three cases and review of the literature. ANNALES D'ENDOCRINOLOGIE 2017; 78:9-13. [PMID: 28168953 DOI: 10.1016/j.ando.2016.07.993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 07/06/2016] [Accepted: 07/13/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVES There is a growing evidence of increased risk of cerebrovascular events in primary aldosteronism (PA). Nevertheless, acute neurologic ailment as presenting feature of PA is uncommon. Our aim is to highlight the diagnosis challenges in stroke unmasking PA and to discuss the underlying physiopathology and management dilemmas. MATERIALS AND METHODS We hereby describe three consecutive rare cases of stroke revealing PA. All patients had brain imaging and thorough biological and morphological assessment to rule out other etiologies of stroke. The diagnosis of primary aldosteronism was established according to the Endocrine Society Clinical Practice Guideline, with a review of the literature on the spectrum of neurologic manifestations in PA. RESULTS We report on three cases, two women and a man, presenting with ischemic or hemorrhagic stroke, of early onset in two of them. All of the reported patients had hypertension and hypokaliemia. This association prompted the assessment of renin angiotensin aldosterone system (RAAS) disclosing PA, which was due to bilateral adenomas in the first one or bilateral adrenal hyperplasia in the two others. All patients refused the surgical option and received spironolactone with recurrence of stroke in one of them due to treatment incompliance. CONCLUSION Although cerebrovascular events are quite common in PA, their occurrence as initial feature can be misleading. The association of hypokaliemia and refractory hypertension in ischemic or hemorrhagic strokes should prompt an assessment of the RAAS to rule out PA and initiate adequate management as soon as possible in order to avoid further complications.
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Affiliation(s)
- Amina Nasri
- Department of Neurology, Military Hospital, 1008, Montfleury, 1089 Tunis, Tunisia.
| | - Malek Mansour
- Department of Neurology, Military Hospital, 1008, Montfleury, 1089 Tunis, Tunisia
| | - Zeineb Brahem
- Department of Neurology, Military Hospital, 1008, Montfleury, 1089 Tunis, Tunisia
| | - Amel Kacem
- Department of Medicine, Regional Hospital of Jendouba, Tunisia
| | - Ahmed Abou Hassan
- Department of Neurology, Military Hospital, 1008, Montfleury, 1089 Tunis, Tunisia
| | - Hager Derbali
- Department of Neurology, Military Hospital, 1008, Montfleury, 1089 Tunis, Tunisia
| | - Meriem Messelmani
- Department of Neurology, Military Hospital, 1008, Montfleury, 1089 Tunis, Tunisia
| | - Jamel Zaouali
- Department of Neurology, Military Hospital, 1008, Montfleury, 1089 Tunis, Tunisia
| | - Ridha Mrissa
- Department of Neurology, Military Hospital, 1008, Montfleury, 1089 Tunis, Tunisia
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Amar L, Baguet JP, Bardet S, Chaffanjon P, Chamontin B, Douillard C, Durieux P, Girerd X, Gosse P, Hernigou A, Herpin D, Houillier P, Jeunemaitre X, Joffre F, Kraimps JL, Lefebvre H, Ménégaux F, Mounier-Véhier C, Nussberger J, Pagny JY, Pechère A, Plouin PF, Reznik Y, Steichen O, Tabarin A, Zennaro MC, Zinzindohoue F, Chabre O. SFE/SFHTA/AFCE primary aldosteronism consensus: Introduction and handbook. ANNALES D'ENDOCRINOLOGIE 2016; 77:179-86. [PMID: 27315757 DOI: 10.1016/j.ando.2016.05.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 05/09/2016] [Indexed: 10/21/2022]
Abstract
The French Endocrinology Society (SFE) French Hypertension Society (SFHTA) and Francophone Endocrine Surgery Association (AFCE) have drawn up recommendations for the management of primary aldosteronism (PA), based on an analysis of the literature by 27 experts in 7 work-groups. PA is suspected in case of hypertension associated with one of the following characteristics: severity, resistance, associated hypokalemia, disproportionate target organ lesions, or adrenal incidentaloma with hypertension or hypokalemia. Diagnosis is founded on aldosterone/renin ratio (ARR) measured under standardized conditions. Diagnostic thresholds are expressed according to the measurement units employed. Diagnosis is established for suprathreshold ARR associated with aldosterone concentrations >550pmol/L (200pg/mL) on 2 measurements, and rejected for aldosterone concentration<240pmol/L (90pg/mL) and/or subthreshold ARR. The diagnostic threshold applied is different if certain medication cannot be interrupted. In intermediate situations, dynamic testing is performed. Genetic forms of PA are screened for in young subjects and/or in case of familial history. The patient should be informed of the results expected from medical and surgical treatment of PA before exploration for lateralization is proposed. Lateralization is explored by adrenal vein sampling (AVS), except in patients under 35 years of age with unilateral adenoma on imaging. If PA proves to be lateralized, unilateral adrenalectomy may be performed, with adaptation of medical treatment pre- and postoperatively. If PA is non-lateralized or the patient refuses surgery, spironolactone is administered as first-line treatment, replaced by amiloride, eplerenone or calcium-channel blockers if insufficiently effective or poorly tolerated.
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Affiliation(s)
- Laurence Amar
- Université Paris Descartes, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Unité D'hypertension Artérielle, 75098 Paris Cedex 15, France
| | - Jean Philippe Baguet
- Service de Cardiologie, centre d'excellence en hypertension, Clinique Mutualiste de Grenoble, 38028 Grenoble, France
| | - Stéphane Bardet
- Centre François Baclesse, Service de Médecine Nucléaire, 3, Avenue du Général-Harris, 14076 Caen cedex 05, France
| | - Philippe Chaffanjon
- CHU Grenoble-Alpes, Département de Chirurgie Thoracique, Vasculaire et Endocrinienne, 38700 La Tronche, France; Université Grenoble Alpes, LADAF-Laboratoire d'Anatomie Des Alpes Françaises, UFR de Médecine, 38700 La Tronche, France
| | - Bernard Chamontin
- Centre Hospitalo-Universitaire Rangueil, Service de Médecine Interne et d'Hypertension Artérielle, 31059 Toulouse, France
| | - Claire Douillard
- Service d'endocrinologie et des maladies métaboliques, Centre Hospitalier Régional Universitaire de Lille, 59037 Lille, France
| | - Pierre Durieux
- Santé Publique et Informatique Médicale, Hôpital Européen Georges Pompidou, 20, Rue Leblanc, 75908 Paris cedex 15, France; Centre Cochrane Français, Université Paris Descartes, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, 75098 Paris France
| | - Xaxier Girerd
- Pôle Cœur Métabolisme, Unité de Prévention Cardiovasculaire, Groupe Hospitalier Universitaire Pitié-Salpêtrière, 83, bld de l'Hôpital, 75013 Paris, France
| | - Philippe Gosse
- Service de Cardiologie/Hypertension CHU Bordeaux, 33076 Bordeaux, France
| | - Anne Hernigou
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Unité d'Hypertension, 20, Rue Leblanc, 75908 Paris cedex 15, France
| | - Daniel Herpin
- Service de Cardiologie, Centre Hospitalier Universitaire de Poitiers, 86021 Poitiers, France
| | - Pascal Houillier
- Département des maladies rénales et métaboliques, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France
| | - Xavier Jeunemaitre
- INSERM, UMRS_970, Paris Cardiovascular Research Center, Université Paris Descartes, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Génétique, 75098 Paris, France
| | - Francis Joffre
- Centre Hospitalo-Universitaire Rangueil, Département de Radiologie, 31059 Toulouse, France
| | - Jean-Louis Kraimps
- CHU Poitiers, Hôpital Jean Bernard, Chirurgie Générale et Endocrinienne, Université de Poitiers, Faculté de Médecine, 86000 Poitiers, France
| | - Hervé Lefebvre
- Service d'endocrinologie, Centre Hospitalier Universitaire, 76031 Rouen, France
| | - Fabrice Ménégaux
- Sorbonne Universités, UPMC Univ Paris 06, Faculté de Médecine, 75006 Paris, France; AP-HP, Pitié Salpétrière, Service de Chirurgie Digestive et Viscérale, 75013 Paris, France
| | - Claire Mounier-Véhier
- Service de Médecine Vasculaire et Hypertension Artérielle, Centre Hospitalier Universitaire de Lille, 59037 Lille, France
| | - Juerg Nussberger
- Service de Médecine Interne (unité vasculaire et d'hypertension), Centre Hospitalier Universitaire de Lausanne, 1011 Lausanne, Switzerland
| | - Jean-Yves Pagny
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Département de Radiologie, 20, Rue Leblanc, 75908 Paris cedex 15, France
| | - Antoinette Pechère
- Unité d'Hypertension, Hopital Universitaire de Genève, 1205 Geneve, Switzerland
| | - Pierre-François Plouin
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Unité d'Hypertension, 20, Rue Leblanc, 75908 Paris cedex 15, France
| | - Yves Reznik
- Service d'Endocrinologie et Maladies Métaboliques, CHU Côte de Nacre, 14033 Caen Cedex, France
| | - Olivier Steichen
- AP-HP, hôpital Tenon, Service de Médecine Interne, 75020 Paris, France
| | - Antoine Tabarin
- Service d'Endocrinologie, Hôpital Haut Lévêque, CHU de Bordeaux, Avenue de Magellan, 33600 Pessac, France
| | - Maria-Christina Zennaro
- INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Génétique, 75098 Paris, France
| | - Franck Zinzindohoue
- Sorbonne Paris Cité, Université Paris Descartes, Faculté de Médecine, 75006 Paris, France
| | - Olivier Chabre
- AP-HP, HEGP, Service de Chirurgie Digestive, Générale et Cancérologique, 75015 Paris, France; Endocrinologie, Pavillon des Ecrins, Centre Hospitalier Universitaire de Grenoble, CS 10217, 38043 Grenoble Cedex 9, France.
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