The predictors of long-term outcomes after targeted therapy for primary Aldosteronism

The relationship between tissue inhibitor of metalloproteinases-1 and KCNJ5 mutation in aldosterone-producing adenoma patients

KCNJ5 somatic mutations in aldosterone-producing adenoma (APA) are linked to higher left ventricular mass index (LVMI) and worse diastolic function. We previously identified an association between plasma tissue inhibitor of metalloproteinases-1 (TIMP-1) and an aldosterone-induced increase in LVMI and diastolic dysfunction. This study aimed to investigate the association between the presence of KCNJ5 somatic mutation and plasma TIMP-1 in APA patients. We enrolled 60 APA patients undergoing adrenalectomy, including 30 with KCNJ5 mutations (KCNJ5(+)) and 30 without (KCNJ5(-)). Clinical characteristics, echocardiographic data (including LVMI, inappropriately excessive LVMI (ieLVMI), and diastolic function) and plasma TIMP-1 levels were measured before surgery and 1 year postoperatively. The results showed that the KCNJ5(+) group had higher plasma TIMP-1 levels (P = 0.004) compared to the KCNJ5(-) group. The correlation between the KCNJ5 mutations and TIMP-1 levels remained significant after multiple regression analysis. To detect KCNJ5 mutations, receiver operating characteristic curve analysis showed TIMP-1 had the best area under the curve (AUC) value among various clinical parameters (AUC = 0.682, 95% confidence interval = 0.549-0.796, P = 0.008). Post-adrenalectomy, only the KCNJ5(+) group showed significant decrease in LVMI (P = 0.001) and log-transformed TIMP-1 levels (P = 0.035). Changes in ieLVMI before and after surgery were consistently correlated with changes in TIMP-1 levels in multivariable regression analysis. In conclusion, KCNJ5 somatic mutations in APA are associated with higher plasma TIMP-1 levels. In addition, TIMP-1 is an effective biomarker for detecting the presence of KCNJ5 mutations in APA patients.

Aldosterone-producing Multiple Micronodules With Several Different KCNJ5 Pathogenic Variants

Primary aldosteronism (PA) is the most common form of secondary hypertension. Recently, the genetic analysis of aldosterone-producing adenoma, a major cause of PA, has revealed several causative genes. Herein, we present a case of a 27-year-old Japanese female with PA. She was referred to our hospital with hypertension and hypokalemia (serum potassium, 2.8 mEq/L [2.8 mmol/L]). PA was diagnosed using several confirmatory tests. Computed tomography showed no apparent tumor in either adrenal gland. Adrenal vein sampling showed aldosterone overproduction in the right adrenal gland. Laparoscopic right adrenalectomy was performed, her blood pressure normalized, and the hypokalemia improved after surgery. Pathological findings revealed multiple aldosterone-producing micronodules with diameters of <5 mm. DNAs were extracted from 4 different micronodules and analyzed for KCNJ5. Two micronodules had a T158A pathogenic variant, 1 had a G151R pathogenic variant, and 1 had no pathogenic variant in the KCNJ5 gene. In summary, in our case, multiple nodules were present in 1 adrenal gland, and genetic heterogeneity was identified. No recurrence on the left side has been observed over 17 years following the surgery.

Predicting the resolution of hypertension following adrenalectomy in primary aldosteronism: Controversies and unresolved issues a narrative review

BACKGROUND

Hypertension resolution following adrenalectomy in patients with primary aldosteronism (PA) remains a critical clinical challenge. Identifying preoperatively which patients will become normotensive is both a priority and a point of contention. In this narrative review, we explore the controversies and unresolved issues surrounding the prediction of hypertension resolution after adrenalectomy in PA.

METHODS

A comprehensive literature review was conducted, focusing on studies published between 1954 and 2024 that evaluated all studies that discussed predictive models for hypertension resolution post-adrenalectomy in PA patients. Databases searched included MEDLINE®, Ovid Embase, and Web of Science databases.

RESULTS

The review identified several predictors and predictive models of hypertension resolution, including female sex, duration of hypertension, antihypertensive medication, and BMI. However, inconsistencies in study designs and patient populations led to varied conclusions.

CONCLUSIONS

Although certain predictors and predictive models of hypertension resolution post-adrenalectomy in PA patients are supported by evidence, significant controversies and unresolved issues remain. While the current predictive models provide valuable insights, there is a clear need for further research in this area. Future studies should focus on validating and refining these models.