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Yan D, Zou X, Li X, Zeng Q, He H, Guo J, Wang Y, Zheng H, Fu J, Wang M, Peng D, Zhou X, Luo X, Luo J, Li S, Liu J, Hu P, Shen Y. Screening parameters for diagnosing primary aldosteronism in patients with moderate to severe obstructive sleep apnea hypopnea syndrome and resistant hypertension. Front Cardiovasc Med 2024; 11:1383567. [PMID: 38720919 PMCID: PMC11076699 DOI: 10.3389/fcvm.2024.1383567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/11/2024] [Indexed: 05/12/2024] Open
Abstract
Background Patients with obstructive sleep apnea hypopnea syndrome (OSAHS) combined with resistant hypertension (RH) have a high risk of developing primary aldosteronism (PA). This study investigated the aldosterone-renin ratio (ARR), plasma aldosterone concentration (PAC), and plasma renin activity (PRA) to determine the optimal cutoff values for PA diagnosis in patients with OSAHS combined with RH. Methods Patients diagnosed with moderate and severe OSAHS combined with RH were recruited from the inpatient clinic of the Department of Endocrinology at Ji'an Central Hospital between October 2020 and April 2023. The included patients were divided into PA and no-PA groups. Diagnostic accuracy measures were calculated for each group, and receiver operating characteristic (ROC) curves were generated. Results A total of 241 patients were included, of which 103 had positive ARR screening results in the diagnostic accuracy analysis and 66 were diagnosed with PA. PAC and ARR showed moderate predictive capacity for PA, with area under the curve (AUC) values of 0.66 [95% confidence interval (CI): 0.55-0.77] and 0.72 (95% CI: 0.63-0.82), respectively, while PRA exhibited a limited predictive capacity (AUC = 0.51, 95% CI: 0.40-0.63). Using 45 as the optimal cutoff value for ARR, the sensitivity was 86% and the specificity was 52%. The optimal cutoff value for PAC was 17, with a sensitivity of 78% and a specificity of 55%. Notably, in patients with severe OSAHS, ARR at screening demonstrated significant predictive value for PA, with an AUC of 0.84 (95% CI: 0.72-0.96), a sensitivity of 85%, and a specificity of 76%. Conversely, in patients with moderate OSAHS, only ARR demonstrated significant predictive value for PA diagnosis, while PAC did not demonstrate notable diagnostic value. Conclusion ARR and PAC are initial screening tools for PA, facilitating early detection, particularly in low-resource settings. In patients with OSAHS and RH, the ARR and PAC thresholds for PA diagnosis may require more stringent adjustment.
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Affiliation(s)
- Dien Yan
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Department of Endocrinology, Ji'an Central Hospital, Ji'an, Jiangxi, China
| | - Xiaofan Zou
- Department of Respiratory and Critical Care Medicine, Ji'an Central Hospital, Ji'an, Jiangxi, China
| | - Xiao Li
- Department of Obstetrics and Gynecology, Ji'an First People’s Hospital, Ji'an, Jiangxi, China
| | - Qiao Zeng
- School of Nursing, Ji'an College, Ji’an, Jiangxi, China
| | - Hongbing He
- Department of Endocrinology, Ji'an Central Hospital, Ji'an, Jiangxi, China
| | - Jianping Guo
- Department of Endocrinology, Ji'an Central Hospital, Ji'an, Jiangxi, China
| | - Yulan Wang
- Department of Endocrinology, Ji'an Central Hospital, Ji'an, Jiangxi, China
| | - Huanhuan Zheng
- Department of Endocrinology, Ji'an Central Hospital, Ji'an, Jiangxi, China
| | - Jinxiang Fu
- Department of Endocrinology, Ji'an Central Hospital, Ji'an, Jiangxi, China
| | - Meili Wang
- Department of Endocrinology, Ji'an Central Hospital, Ji'an, Jiangxi, China
| | - Danping Peng
- Department of Endocrinology, Ji'an Central Hospital, Ji'an, Jiangxi, China
| | - Xiaozi Zhou
- Department of Endocrinology, Ji'an Central Hospital, Ji'an, Jiangxi, China
| | - Xian Luo
- Department of Endocrinology, Ji'an Central Hospital, Ji'an, Jiangxi, China
| | - Jiahua Luo
- Department of Neurology, Ji'an Central Hospital, Ji'an, Jiangxi, China
| | - Shaofen Li
- Department of Laboratory, Ji'an Central Hospital, Ji'an, Jiangxi, China
| | - Jinping Liu
- Department of Endocrinology, Ji'an Central Hospital, Ji'an, Jiangxi, China
| | - Pingsheng Hu
- Department of Respiratory and Critical Care Medicine, Ji'an Central Hospital, Ji'an, Jiangxi, China
| | - Yunfeng Shen
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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A liquid chromatography-tandem mass spectrometry (LC-MS/MS)-based assay for simultaneous quantification of aldosterone, renin activity, and angiotensin II in human plasma. J Chromatogr B Analyt Technol Biomed Life Sci 2021; 1179:122740. [PMID: 34247101 DOI: 10.1016/j.jchromb.2021.122740] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/18/2021] [Accepted: 04/24/2021] [Indexed: 01/14/2023]
Abstract
Accurate quantification of plasma aldosterone (ALD) and renin activity (PRA)is critical for the diagnosis of primary aldosteronism (PA). Liquid chromatography-tandem mass spectrometry (LC-MS/MS) is considered the "gold standard" method for the determination of ALDand PRA. The aim of this study is to develop a new LC-MRM/MS assay for quantifying plasma ALD, PRA, and angiotensin II (Ang II) simultaneously and validate its effectiveness. To be more specific, plasmasamples were prepared by solid-phase extraction and separated in an ultra-performance reversed-phase column. MS detection was performed via a triple quadrupole mass spectrometer containing both positive and negative ion monitoring modes. The developed assay was then validated according to the standard guidelines and the influence of sample incubation on ALD and Ang II concentration was evaluated. In addition, the variation of endogenous Ang I was explored. The proposed LC-MRM/MS method was compared another LC-MS/MS method, which detects ALD, Ang I, and Ang II separately. Analyteswere separated and quantified within 5 min. The assay wasvalidated to be linear up to 5000 pg/ml for ALD and Ang II and 33.3 ng/ml/h for PRA.The lower limit of quantification (LLOQ) was 15 pg/ml, 15 pg/ml, and 0.1 ng/ml/hfor ALD, Ang II, and PRArespectively. Specificity, precision, accuracy, and stability were tested to meet the requirements of the guidelines. Significant changes were not found in ALD and Ang II concentrations over the 3 h-incubation. In addition, it was demonstratedthat the resultof PRA was not stronglyinfluenced by the endogenous Ang I. Comparison with another LC-MS/MS method was performed using the same apparatusand the proposed method was proved to be in good coincidence with the correlation coefficients rangingfrom 0.955to0.996. A sensitive and reliable method for simultaneousquantification of ALD, PRA, and Ang II has been developed and this study will significantly promote laboratory workflow efficiency and throughput.
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Wu S, Yang J, Hu J, Song Y, He W, Yang S, Luo R, Li Q. Confirmatory tests for the diagnosis of primary aldosteronism: A systematic review and meta-analysis. Clin Endocrinol (Oxf) 2019; 90:641-648. [PMID: 30721529 DOI: 10.1111/cen.13943] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 01/22/2019] [Accepted: 01/29/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Saline infusion test (SIT), captopril challenge test (CCT), fludrocortisone suppression test (FST) and oral sodium loading test (SLT) are recommended by the Endocrine Society's Clinical Practice Guidelines to diagnose primary aldosteronism, but which one is the best remains controversial. We aimed to summarize the available comparative data and evaluate the diagnostic accuracy of these four tests. DESIGN We searched PubMed, Embase and the Cochrane Library for relevant studies published between January 1980 and January 2018. PATIENTS Eligible studies reported on the accuracy of one or more of the four confirmatory tests in patients suspected of PA. MEASUREMENTS Two reviewers independently conducted the data extraction of all selected studies, which consisted of study characteristics and data to estimate the summary receiver operating characteristic (SROC) curve and the corresponding summary area under the curve (SAUC), pooled sensitivity and specificity, diagnostic odds ratios (DOR) with 95% confidence interval (CI). RESULTS We identified 26 articles including 3686 patients. Fifteen articles evaluated the diagnostic accuracy of CCT, 10 of SIT, 1 of FST and none of SLT. For CCT, the SAUC was 0.9207, and the pooled sensitivity and specificity were 0.87 (95% CI: 0.84-0.89) and 0.84 (95% CI: 0.81-0.86), respectively. For SIT, the SAUC was 0.9232, and the pooled sensitivity and specificity were 0.85 (95% CI: 0.82-0.87) and 0.87 (95% CI: 0.85-0.89), respectively. For FST, the pooled sensitivity and specificity were 0.87 (95% CI: 0.66-0.97) and 0.95 (95% CI: 0.82-0.99), respectively. Overall, we found no significant differences in the diagnostic accuracy of CCT and SIT. CONCLUSIONS CCT and SIT exhibit high and comparable accuracy for diagnosing PA. CCT may be a more feasible alternative as it is safe and much easier to perform.
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Affiliation(s)
- Sicen Wu
- Medical Examination Centre, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jun Yang
- Cardiovascular Endocrinology Laboratory, Hudson Institute of Medical Research, Clayton, Vic, Australia
| | - Jinbo Hu
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ying Song
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenwen He
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shumin Yang
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rong Luo
- Medical Examination Centre, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qifu Li
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Bongarzone S, Basagni F, Sementa T, Singh N, Gakpetor C, Faugeras V, Bordoloi J, Gee AD. Development of [ 18F]FAMTO: A novel fluorine-18 labelled positron emission tomography (PET) radiotracer for imaging CYP11B1 and CYP11B2 enzymes in adrenal glands. Nucl Med Biol 2019; 68-69:14-21. [PMID: 30578137 PMCID: PMC6859501 DOI: 10.1016/j.nucmedbio.2018.11.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 11/02/2018] [Accepted: 11/04/2018] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Primary aldosteronism accounts for 6-15% of hypertension cases, the single biggest contributor to global morbidity and mortality. Whilst ~50% of these patients have unilateral aldosterone-producing adenomas, only a minority of these have curative surgery as the current diagnosis of unilateral disease is poor. Carbon-11 radiolabelled metomidate ([11C]MTO) is a positron emission tomography (PET) radiotracer able to selectively identify CYP11B1/2 expressing adrenocortical lesions of the adrenal gland. However, the use of [11C]MTO is limited to PET centres equipped with on-site cyclotrons due to its short half-life of 20.4 min. Radiolabelling a fluorometomidate derivative with fluorine-18 (radioactive half life 109.8 min) in the para-aromatic position ([18F]FAMTO) has the potential to overcome this disadvantage and allow it to be transported to non-cyclotron-based imaging centres. METHODS Two strategies for the one-step radio-synthesis of [18F]FAMTO were developed. [18F]FAMTO was obtained via radiofluorination via use of sulfonium salt (1) and boronic ester (2) precursors. [18F]FAMTO was evaluated in vitro by autoradiography of pig adrenal tissues and in vivo by determining its biodistribution in rodents. Rat plasma and urine were analysed to determine [18F]FAMTO metabolites. RESULTS [18F]FAMTO is obtained from sulfonium salt (1) and boronic ester (2) precursors in 7% and 32% non-isolated radiochemical yield (RCY), respectively. Formulated [18F]FAMTO was obtained with >99% radiochemical and enantiomeric purity with a synthesis time of 140 min from the trapping of [18F]fluoride ion on an anion-exchange resin (QMA cartridge). In vitro autoradiography of [18F]FAMTO demonstrated exquisite specific binding in CYP11B-rich pig adrenal glands. In vivo [18F]FAMTO rapidly accumulates in adrenal glands. Liver uptake was about 34% of that in the adrenals and all other organs were <12% of the adrenal uptake at 60 min post-injection. Metabolite analysis showed 13% unchanged [18F]FAMTO in blood at 10 min post-administration and rapid urinary excretion. In vitro assays in human blood showed a free fraction of 37.5%. CONCLUSIONS [18F]FAMTO, a new 18F-labelled analogue of metomidate, was successfully synthesised. In vitro and in vivo characterization demonstrated high selectivity towards aldosterone-producing enzymes (CYP11B1 and CYP11B2), supporting the potential of this radiotracer for human investigation.
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Affiliation(s)
- Salvatore Bongarzone
- School of Imaging Sciences & Biomedical Engineering, 4th floor Lambeth Wing, St Thomas' Hospital, King's College London, London SE1 7EH, United Kingdom
| | - Filippo Basagni
- School of Imaging Sciences & Biomedical Engineering, 4th floor Lambeth Wing, St Thomas' Hospital, King's College London, London SE1 7EH, United Kingdom
| | - Teresa Sementa
- School of Imaging Sciences & Biomedical Engineering, 4th floor Lambeth Wing, St Thomas' Hospital, King's College London, London SE1 7EH, United Kingdom
| | - Nisha Singh
- School of Imaging Sciences & Biomedical Engineering, 4th floor Lambeth Wing, St Thomas' Hospital, King's College London, London SE1 7EH, United Kingdom; Department of Neuroimaging, Institute of Psychiatry, King's College London, London SE5 8AF, United Kingdom
| | - Caleb Gakpetor
- School of Imaging Sciences & Biomedical Engineering, 4th floor Lambeth Wing, St Thomas' Hospital, King's College London, London SE1 7EH, United Kingdom
| | - Vincent Faugeras
- School of Imaging Sciences & Biomedical Engineering, 4th floor Lambeth Wing, St Thomas' Hospital, King's College London, London SE1 7EH, United Kingdom
| | - Jayanta Bordoloi
- School of Imaging Sciences & Biomedical Engineering, 4th floor Lambeth Wing, St Thomas' Hospital, King's College London, London SE1 7EH, United Kingdom
| | - Antony D Gee
- School of Imaging Sciences & Biomedical Engineering, 4th floor Lambeth Wing, St Thomas' Hospital, King's College London, London SE1 7EH, United Kingdom.
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Guo Z, Poglitsch M, McWhinney BC, Ungerer JPJ, Ahmed AH, Gordon RD, Wolley M, Stowasser M. Aldosterone LC-MS/MS Assay-Specific Threshold Values in Screening and Confirmatory Testing for Primary Aldosteronism. J Clin Endocrinol Metab 2018; 103:3965-3973. [PMID: 30137438 DOI: 10.1210/jc.2018-01041] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/15/2018] [Indexed: 02/13/2023]
Abstract
CONTEXT Current threshold values for primary aldosteronism (PA) diagnostic testing are based on measuring aldosterone (PAC) using immunoassays. Quantification of PAC by liquid chromatography-tandem mass spectrometry (LC-MS/MS) yields lower values. OBJECTIVE To compare aldosterone measurement by radioimmunoassay (RIA) with LC-MS/MS and evaluate performances of proposed LC-MS/MS-specific cutoffs for PA screening and confirmatory testing. PATIENTS AND INTERVENTION Forty-one patients underwent aldosterone/renin ratio (ARR) testing to screen for, and fludrocortisone suppression testing (FST) to confirm or exclude, PA. Renin (DRC) was measured by chemiluminescent immunoassay. RESULTS Median serum PACLC-MS/MS was 27.8% lower (P < 0.05) than plasma PACRIA in 164 pairs of FST samples. A positive correlation (Spearman coefficient, 0.894, P < 0.01; Pearson r coefficient, 0.861, P < 0.01) was observed between the two assays. Thirty-seven patients showed consistent FST diagnoses (29 positive, 8 negative), whereas four showed inconsistent FSTs by the two assays. Good agreement (κ coefficient, 0.736; P < 0.01) was observed between the current FST diagnostic PACRIA cutoff of 165 pmol/L and the proposed PACLC-MS/MS cutoff of 133 pmol/L. Among 37 patients with consistent FST results, no differences were observed in sensitivity (89.7% vs 93.1%) or specificity (87.5% vs 87.5%) for PA screening between the current ARR cutoff of 70 pmol/mU (PACRIA/DRC) and the proposed cutoff of 55 pmol/mU (PACLC-MS/MS/DRC). CONCLUSIONS Adjustment of the current cutoffs for PA diagnostic testing is necessary if PAC is measured by LC-MS/MS. Our preliminary results suggest that the proposed LC-MS/MS cutoffs for ARR and FST perform as well as current RIA cutoffs.
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Affiliation(s)
- Zeng Guo
- Endocrine Hypertension Research Centre, University of Queensland Diamantina Institute, Greenslopes and Princess Alexandra Hospitals, Brisbane, Queensland, Australia
| | | | - Brett C McWhinney
- Department of Chemical Pathology, Pathology Queensland, Queensland Health, Brisbane, Queensland, Australia
| | - Jacobus P J Ungerer
- Department of Chemical Pathology, Pathology Queensland, Queensland Health, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Ashraf H Ahmed
- Endocrine Hypertension Research Centre, University of Queensland Diamantina Institute, Greenslopes and Princess Alexandra Hospitals, Brisbane, Queensland, Australia
| | - Richard D Gordon
- Endocrine Hypertension Research Centre, University of Queensland Diamantina Institute, Greenslopes and Princess Alexandra Hospitals, Brisbane, Queensland, Australia
| | - Martin Wolley
- Endocrine Hypertension Research Centre, University of Queensland Diamantina Institute, Greenslopes and Princess Alexandra Hospitals, Brisbane, Queensland, Australia
| | - Michael Stowasser
- Endocrine Hypertension Research Centre, University of Queensland Diamantina Institute, Greenslopes and Princess Alexandra Hospitals, Brisbane, Queensland, Australia
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Song Y, Yang S, He W, Hu J, Cheng Q, Wang Y, Luo T, Ma L, Zhen Q, Zhang S, Mei M, Wang Z, Qing H, Bruemmer D, Peng B, Li Q. Confirmatory Tests for the Diagnosis of Primary Aldosteronism: A Prospective Diagnostic Accuracy Study. Hypertension 2017; 71:118-124. [PMID: 29158354 DOI: 10.1161/hypertensionaha.117.10197] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 08/22/2017] [Accepted: 10/12/2017] [Indexed: 11/16/2022]
Abstract
The diagnosis of primary aldosteronism typically requires at least one confirmatory test. The fludrocortisone suppression test is generally accepted as a reliable confirmatory test, but it is cumbersome. Evidence from accuracy studies of the saline infusion test (SIT) and the captopril challenge test (CCT) has provided conflicting results. This prospective study aimed to evaluate the diagnostic accuracy of the SIT and CCT using fludrocortisone suppression test as the reference standard. One hundred thirty-five patients diagnosed with primary aldosteronism and 101 patients diagnosed with essential hypertension who completed the 3 confirmatory tests were included for the diagnostic accuracy analysis. The areas under the receiver-operator characteristics curves of the CCT and SIT were 0.96 (95% confidence interval [CI], 0.92-0.98) and 0.96 (95% CI, 0.92-0.98), respectively, using post-test plasma aldosterone concentration (PAC) for diagnosis. However, the areas under the receiver-operator characteristics curves of the CCT decreased to 0.71 (95% CI, 0.65-0.77) when the PAC suppression percentage was used to diagnose primary aldosteronism. The optimal cutoff of PAC post-CCT was set at 11 ng/dL, resulting in a sensitivity of 0.90 (95% CI, 0.84-0.95) and a specificity of 0.90 (95% CI, 0.83-0.95), which were not significantly different from those of SIT (with PAC post-SIT set at 8 ng/dL, sensitivity: 0.85 [95% CI, 0.78-0.91], P=0.192; specificity: 0.92 [95% CI, 0.85-0.97], P=0.551). In conclusion, both CCT and SIT are accurate alternatives to the more complex fludrocortisone suppression test. Because CCT is safe and much easier to perform, it may serve as a more feasible alternative. When interpreting the results of CCT, PAC post-CCT is highly recommended.
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Affiliation(s)
- Ying Song
- From the Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University (Y.S., S.Y., W.H., J.H., Q.C., Y.W., T.L., L.M., Q.Z., S.Z., M.M., Z.W., H.Q., Q.L.) and School of Public Health and Management, Chongqing Medical University (B.P.), China; and Division of Cardiology, Department of Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, PA (D.B.)
| | - Shumin Yang
- From the Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University (Y.S., S.Y., W.H., J.H., Q.C., Y.W., T.L., L.M., Q.Z., S.Z., M.M., Z.W., H.Q., Q.L.) and School of Public Health and Management, Chongqing Medical University (B.P.), China; and Division of Cardiology, Department of Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, PA (D.B.)
| | - Wenwen He
- From the Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University (Y.S., S.Y., W.H., J.H., Q.C., Y.W., T.L., L.M., Q.Z., S.Z., M.M., Z.W., H.Q., Q.L.) and School of Public Health and Management, Chongqing Medical University (B.P.), China; and Division of Cardiology, Department of Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, PA (D.B.)
| | - Jinbo Hu
- From the Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University (Y.S., S.Y., W.H., J.H., Q.C., Y.W., T.L., L.M., Q.Z., S.Z., M.M., Z.W., H.Q., Q.L.) and School of Public Health and Management, Chongqing Medical University (B.P.), China; and Division of Cardiology, Department of Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, PA (D.B.)
| | - Qingfeng Cheng
- From the Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University (Y.S., S.Y., W.H., J.H., Q.C., Y.W., T.L., L.M., Q.Z., S.Z., M.M., Z.W., H.Q., Q.L.) and School of Public Health and Management, Chongqing Medical University (B.P.), China; and Division of Cardiology, Department of Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, PA (D.B.)
| | - Yue Wang
- From the Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University (Y.S., S.Y., W.H., J.H., Q.C., Y.W., T.L., L.M., Q.Z., S.Z., M.M., Z.W., H.Q., Q.L.) and School of Public Health and Management, Chongqing Medical University (B.P.), China; and Division of Cardiology, Department of Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, PA (D.B.)
| | - Ting Luo
- From the Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University (Y.S., S.Y., W.H., J.H., Q.C., Y.W., T.L., L.M., Q.Z., S.Z., M.M., Z.W., H.Q., Q.L.) and School of Public Health and Management, Chongqing Medical University (B.P.), China; and Division of Cardiology, Department of Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, PA (D.B.)
| | - Linqiang Ma
- From the Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University (Y.S., S.Y., W.H., J.H., Q.C., Y.W., T.L., L.M., Q.Z., S.Z., M.M., Z.W., H.Q., Q.L.) and School of Public Health and Management, Chongqing Medical University (B.P.), China; and Division of Cardiology, Department of Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, PA (D.B.)
| | - Qianna Zhen
- From the Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University (Y.S., S.Y., W.H., J.H., Q.C., Y.W., T.L., L.M., Q.Z., S.Z., M.M., Z.W., H.Q., Q.L.) and School of Public Health and Management, Chongqing Medical University (B.P.), China; and Division of Cardiology, Department of Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, PA (D.B.)
| | - Suhua Zhang
- From the Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University (Y.S., S.Y., W.H., J.H., Q.C., Y.W., T.L., L.M., Q.Z., S.Z., M.M., Z.W., H.Q., Q.L.) and School of Public Health and Management, Chongqing Medical University (B.P.), China; and Division of Cardiology, Department of Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, PA (D.B.)
| | - Mei Mei
- From the Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University (Y.S., S.Y., W.H., J.H., Q.C., Y.W., T.L., L.M., Q.Z., S.Z., M.M., Z.W., H.Q., Q.L.) and School of Public Health and Management, Chongqing Medical University (B.P.), China; and Division of Cardiology, Department of Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, PA (D.B.)
| | - Zhihong Wang
- From the Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University (Y.S., S.Y., W.H., J.H., Q.C., Y.W., T.L., L.M., Q.Z., S.Z., M.M., Z.W., H.Q., Q.L.) and School of Public Health and Management, Chongqing Medical University (B.P.), China; and Division of Cardiology, Department of Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, PA (D.B.)
| | - Hua Qing
- From the Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University (Y.S., S.Y., W.H., J.H., Q.C., Y.W., T.L., L.M., Q.Z., S.Z., M.M., Z.W., H.Q., Q.L.) and School of Public Health and Management, Chongqing Medical University (B.P.), China; and Division of Cardiology, Department of Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, PA (D.B.)
| | - Dennis Bruemmer
- From the Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University (Y.S., S.Y., W.H., J.H., Q.C., Y.W., T.L., L.M., Q.Z., S.Z., M.M., Z.W., H.Q., Q.L.) and School of Public Health and Management, Chongqing Medical University (B.P.), China; and Division of Cardiology, Department of Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, PA (D.B.)
| | - Bin Peng
- From the Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University (Y.S., S.Y., W.H., J.H., Q.C., Y.W., T.L., L.M., Q.Z., S.Z., M.M., Z.W., H.Q., Q.L.) and School of Public Health and Management, Chongqing Medical University (B.P.), China; and Division of Cardiology, Department of Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, PA (D.B.)
| | - Qifu Li
- From the Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University (Y.S., S.Y., W.H., J.H., Q.C., Y.W., T.L., L.M., Q.Z., S.Z., M.M., Z.W., H.Q., Q.L.) and School of Public Health and Management, Chongqing Medical University (B.P.), China; and Division of Cardiology, Department of Medicine, Pittsburgh Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, PA (D.B.).
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7
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Yamazaki Y, Nakamura Y, Omata K, Ise K, Tezuka Y, Ono Y, Morimoto R, Nozawa Y, Gomez-Sanchez CE, Tomlins SA, Rainey WE, Ito S, Satoh F, Sasano H. Histopathological Classification of Cross-Sectional Image-Negative Hyperaldosteronism. J Clin Endocrinol Metab 2017; 102:1182-1192. [PMID: 28388725 PMCID: PMC5460723 DOI: 10.1210/jc.2016-2986] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 12/05/2016] [Indexed: 01/28/2023]
Abstract
Context Approximately half of patients with primary aldosteronism (PA) have clinically evident disease according to clinical (hypertension) and/or laboratory (aldosterone and renin levels) findings but do not have nodules detectable in routine cross-sectional imaging. However, the detailed histopathologic, steroidogenic, and pathobiological features of cross-sectional image-negative PA are controversial. Objective To examine histopathology, steroidogenic enzyme expression, and aldosterone-driver gene somatic mutation status in cross-sectional image-negative hyperaldosteronism. Methods Twenty-five cross-sectional image-negative cases were retrospectively reviewed. In situ adrenal aldosterone production capacity was determined using immunohistochemistry (IHC) of steroidogenic enzymes. Aldosterone-driver gene somatic mutation status (ATP1A1, ATP2B3, CACNA1D, and KCNJ5) was determined in the CYP11B2 immunopositive areas [n = 35; micronodule, n = 32; zona glomerulosa (ZG), n = 3] using next-generation sequencing after macrodissection. Results Cases were classified as multiple adrenocortical micronodules (MN; n = 13) or diffuse hyperplasia (DH) of ZG (n = 12) based upon histopathological evaluation and CYP11B2 IHC. Aldosterone-driver gene somatic mutations were detected in 21 of 26 (81%) of CYP11B2-positive cortical micronodules in MN; 17 (65%) mutations were in CACNA1D, 2 (8%) in KCNJ5, and 1 each (4% each) in ATP1A1 and ATP2B. One of 6 (17%) of nodules in DH harbored somatic aldosterone-driver gene mutations (CACNA1D); however, no mutations were detected in CYP11B2-positive nonnodular DH areas. Conclusion Morphologic evaluation and CYP11B2 IHC enabled the classification of cross-sectional image-negative hyperaldosteronism into MN and DH. Somatic mutations driving aldosterone overproduction are common in micronodules of MN, suggesting a histological entity possibly related to aldosterone-producing cell cluster development.
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Affiliation(s)
| | - Yasuhiro Nakamura
- Department of Pathology, and
- Division of Pathology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai 981-8558, Japan
| | - Kei Omata
- Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Hospital, Sendai 980-8577, Japan
- Division of Endocrinology, Department of Medicine, The University of Mississippi Medical Center, Jackson, Mississippi 39216
- Research and Medicine Services, G.V. (Sonny) Montgomery Veterans Affairs Medical Center, Jackson, Mississippi 39216
- Pathology
- Michigan Center for Translational Pathology, and
| | - Kazue Ise
- Department of Pathology, and
- Division of Pathology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai 981-8558, Japan
| | - Yuta Tezuka
- Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Hospital, Sendai 980-8577, Japan
| | - Yoshikiyo Ono
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Hospital, Sendai 980-8577, Japan
| | - Ryo Morimoto
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Hospital, Sendai 980-8577, Japan
| | - Yukinaga Nozawa
- Division of Cardiology, Asahikawa Red Cross Hospital, Hokkaido 070-0061, Japan
| | - Celso E. Gomez-Sanchez
- Division of Endocrinology, Department of Medicine, The University of Mississippi Medical Center, Jackson, Mississippi 39216
- Research and Medicine Services, G.V. (Sonny) Montgomery Veterans Affairs Medical Center, Jackson, Mississippi 39216
| | - Scott A. Tomlins
- Pathology
- Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan 48109
| | | | - Sadayoshi Ito
- Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Hospital, Sendai 980-8577, Japan
| | - Fumitoshi Satoh
- Division of Pathology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai 981-8558, Japan
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Hospital, Sendai 980-8577, Japan
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8
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Edinga-Melenge BE, Ama Moor VJ, Nansseu JRN, Nguetse Djoumessi R, Mengnjo MK, Katte JC, Noubiap JJN, Sobngwi E. Renin angiotensin aldosterone system altered in resistant hypertension in Sub-Saharan African diabetes patients without evidence of primary hyperaldosteronism. JRSM Cardiovasc Dis 2017; 6:2048004017695006. [PMID: 28321294 PMCID: PMC5347415 DOI: 10.1177/2048004017695006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 01/05/2017] [Accepted: 01/22/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The renin-angiotensin-aldosterone system may be altered in patients with resistant hypertension. This study aimed to evaluate the relation between renin-angiotensin-aldosterone system activity and resistant hypertension in Cameroonian diabetes patients with resistant hypertension. METHODS We carried out a case-control study including 19 diabetes patients with resistant hypertension and 19 diabetes patients with controlled hypertension matched to cases according to age, sex and duration of hypertension since diagnosis. After collection of data, fasting blood was collected for measurement of sodium, potassium, chloride, active renin and plasma aldosterone of which the aldosterone-renin ratio was derived to assess the activity of renin-angiotensin-aldosterone system. Then, each participant received 2000 ml infusion of saline solution after which plasma aldosterone was re-assayed. RESULTS Potassium levels were lower among cases compared to controls (mean: (4.10 ± 0.63 mmol/l vs. 4.47 ± 0.58 mmol/l), though nonsignificant (p = 0.065). Active renin, plasma aldosterone both before and after the dynamic test and aldosterone-renin ratio were comparable between cases and controls (all p values > 0.05). Plasma aldosterone significantly decreased after the dynamic test in both groups (p < 0.001), but no participant exhibited a post-test value>280 pmol/l. We found a significant negative correlation between potassium ion and plasma aldosterone (ρ = -0.324; p = 0.047), the other correlations being weak and unsignificant. CONCLUSION Although this study failed to show an association between RH and primary hyperaldosteronism in our context, there was a hyperactivity of renin-angiotensin-aldosterone system. Moreover, this study confirms the importance of potassium dosage when screening the renin-angiotensin-aldosterone system.
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Affiliation(s)
- Bertille Elodie Edinga-Melenge
- Centre Pasteur of Cameroon, Yaoundé, Cameroon; Department of Biochemistry and Physiological Sciences, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Vicky J Ama Moor
- Department of Biochemistry and Physiological Sciences, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Jobert Richie N Nansseu
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Romance Nguetse Djoumessi
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Michel K Mengnjo
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | | | - Jean Jacques N Noubiap
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Eugene Sobngwi
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon; National Obesity Centre, Diabetes and Metabolic Diseases Unit, Yaoundé Central Hospital, Yaoundé, Cameroon
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9
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Gomez-Sanchez CE, Qi X, Gomez-Sanchez EP, Sasano H, Bohlen MO, Wisgerhof M. Disordered zonal and cellular CYP11B2 enzyme expression in familial hyperaldosteronism type 3. Mol Cell Endocrinol 2017; 439:74-80. [PMID: 27793677 PMCID: PMC5123946 DOI: 10.1016/j.mce.2016.10.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 10/23/2016] [Accepted: 10/24/2016] [Indexed: 11/27/2022]
Abstract
Three forms of familial primary aldosteronism have been recognized. Familial Hyperaldosteronism type 1 (FH1) or dexamethasone suppressible hyperaldosteronism, FH2, the most common form of as yet unknown cause(s), and FH3. FH3 is due to activating mutations of the potassium channel gene KCNJ5 that increase constitutive and angiotensin II-induced aldosterone synthesis. In this study we examined the cellular distribution of CYP11B2, CYP11B1, CYP17A1 and KCNJ5 in adrenals from two FH3 siblings using immunohistochemistry and immunofluorescence and obtained unexpected results. The adrenals were markedly enlarged with loss of zonation. CYP11B2 was expressed sporadically throughout the adrenal cortex. CYP11B2 was most often expressed by itself, relatively frequently with CYP17A1, and less frequently with CYP11B1. KCNJ5 was co-expressed with CYP11B2 and in some cells with CYP11B1. This aberrant co-expression of enzymes likely explains the abnormally high secretion rate of the hybrid steroid, 18-oxocortisol.
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Affiliation(s)
- Celso E Gomez-Sanchez
- Endocrinology Division, G.V. (Sonny) Montgomery VA Medical Center, Jackson, MS, United States; University of Mississippi Medical Center, Jackson, MS, United States.
| | - Xin Qi
- University of Mississippi Medical Center, Jackson, MS, United States
| | - Elise P Gomez-Sanchez
- Department of Pharmacology and Toxicology and Medicine, University of Mississippi Medical Center, Jackson, MS, United States
| | | | - Martin O Bohlen
- Department of Anatomical Sciences, University of Mississippi Medical Center, Jackson, MS, United States
| | - Max Wisgerhof
- Division of Endocrinology, Henry Ford Health System, Detroit, MI, United States
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10
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Significance of adrenal computed tomography in predicting laterality and indicating adrenal vein sampling in primary aldosteronism. J Hum Hypertens 2016; 31:195-199. [PMID: 27582025 DOI: 10.1038/jhh.2016.61] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 07/20/2016] [Indexed: 11/08/2022]
Abstract
Although laterality assessed by computed tomography (CT) in primary aldosteronism (PA) is not always concordant with that assessed by adrenal vein sampling (AVS), it is unclear whether all patients diagnosed with PA should undergo AVS for subtype classification. The aim of the current study was to investigate the accuracy of CT in subtype classification and to develop a prediction score for bilateral subtype in patients without adrenal tumour. As part of the WAVES-J study, 393 patients with PA were analysed. Subtyping using CT was concordant with that using AVS in 68% (269/393) of patients in the total sample, and in 38% (68/156) of patients with unilateral tumours, 56% (5/9) of patients with bilateral tumours and 89% (204/228) of patients without tumour. In patients without tumour, female gender, plasma aldosterone concentration (pg ml-1) to plasma renin activity ratio ⩽550 and serum potassium ⩾3.8 mEq l-1 were shown to be independent predictors for bilateral subtype. A prediction score based on these three variables was constructed with one point attributed to each variable. A score of three points had 29% sensitivity and 96% specificity in a receiver operating characteristic curve analysis. The results suggest that although CT is not sufficiently accurate for subtype classification in patients with adrenal tumours, it is sufficient to determine bilateral subtype in patients without tumour. Moreover, using our clinical prediction score in patients without tumour could be useful in determining the necessity of AVS for subtype classification.
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11
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Kim JH, Park KS, Hong AR, Shin CS, Kim SY, Kim SW. Diagnostic Role of Captopril Challenge Test in Korean Subjects with High Aldosterone-to-Renin Ratios. Endocrinol Metab (Seoul) 2016; 31:277-83. [PMID: 27184013 PMCID: PMC4923412 DOI: 10.3803/enm.2016.31.2.277] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 12/15/2015] [Accepted: 01/05/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Diagnosis of primary aldosteronism (PA) begins with aldosterone-to-renin ratio (ARR) measurement followed by confirmative tests. However, the ARR has high false positive rates which led to unnecessary confirmatory tests. Captopril challenge test (CCT) has been used as one of confirmatory tests, but the accuracy of it in the diagnosis of PA is still controversial. We aimed to examine the clinical efficacy of CCT as a post-screening test in PA. METHODS In a prospective study, we enrolled subjects with suspected PA who had hypertension and ARR >20 (ng/dL)/(ng/mL/hr). Sixty-four patients who underwent both the saline infusion test and the CCT were included. RESULTS The diagnostic performance of plasma aldosterone concentration (PAC) post-CCT was greater than that of ARR post-CCT and ARR pre-CCT in PA (area under the curve=0.956, 0.797, and 0.748, respectively; P=0.001). A cut-off value of 13 ng/dL showed the highest diagnostic odds ratio considering PAC post-CCT at 60 and 90 minutes. A PAC post-CCT of 19 ng/dL had a specificity of 100%, which can be used as a cut-off value for the confirmative test. Determining the diagnostic performance of PAC post-CCT at 90 minutes was sufficient for PA diagnosis. Subjects with PAC post-CCT at 90 minutes <13 ng/dL are less likely to have PA, and those with PAC post-CCT at 90 minutes ≥13 but <19 ng/dL should undergo secondary confirmatory tests. CONCLUSION The CCT test may be a reliable post-screening test to avoid the hospitalization in the setting of falsely elevated ARR screening tests.
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Affiliation(s)
- Jung Hee Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kyeong Seon Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - A Ram Hong
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Chan Soo Shin
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Seong Yeon Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Wan Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
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12
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Seidel E, Scholl UI. Intracellular Molecular Differences in Aldosterone- Compared to Cortisol-Secreting Adrenal Cortical Adenomas. Front Endocrinol (Lausanne) 2016; 7:75. [PMID: 27445978 PMCID: PMC4921773 DOI: 10.3389/fendo.2016.00075] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 06/14/2016] [Indexed: 12/18/2022] Open
Abstract
The adrenal cortex is a major site of steroid hormone production. Two hormones are of particular importance: aldosterone, which is produced in the zona glomerulosa in response to volume depletion and hyperkalemia, and cortisol, which is produced in the zona fasciculata in response to stress. In both cases, acute stimulation leads to increased hormone production, and chronic stimulation causes hyperplasia of the respective zone. Aldosterone- and cortisol-producing adenomas (APAs and CPAs) are benign tumors of the adrenal cortex that cause excess hormone production, leading to primary aldosteronism and Cushing's syndrome, respectively. About 40% of the APAs carry somatic heterozygous gain-of-function mutations in the K(+) channel KCNJ5. These mutations lead to sodium permeability, depolarization, activation of voltage-gated Ca(2+) channels, and Ca(2+) influx. Mutations in the Na(+)/K(+)-ATPase subunit ATP1A1 and the plasma membrane Ca(2+)-ATPase ATP2B3 similarly cause Na(+) or H(+) permeability and depolarization, whereas mutations in the Ca(2+) channel CACNA1D directly lead to increased calcium influx. One in three CPAs carries a recurrent gain-of-function mutation (L206R) in the PRKACA gene, encoding the catalytic subunit of PKA. This mutation causes constitutive PKA activity by abolishing the binding of the inhibitory regulatory subunit to the catalytic subunit. These mutations activate pathways that are relatively specific to the respective cell type (glomerulosa versus fasciculata), and there is little overlap in mutation spectrum between APAs and CPAs, but co-secretion of both hormones can occur. Mutations in CTNNB1 (beta-catenin) and GNAS (Gsα) are exceptions, as they can cause both APAs and CPAs through pathways that are incompletely understood.
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Affiliation(s)
- Eric Seidel
- Department of Nephrology, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Ute I. Scholl
- Department of Nephrology, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
- *Correspondence: Ute I. Scholl,
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13
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Hanslik G, Wallaschofski H, Dietz A, Riester A, Reincke M, Allolio B, Lang K, Quack I, Rump LC, Willenberg HS, Beuschlein F, Quinkler M, Hannemann A. Increased prevalence of diabetes mellitus and the metabolic syndrome in patients with primary aldosteronism of the German Conn's Registry. Eur J Endocrinol 2015; 173:665-75. [PMID: 26311088 DOI: 10.1530/eje-15-0450] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 08/26/2015] [Indexed: 12/30/2022]
Abstract
DESIGN Abnormalities in glucose homeostasis have been described in patients with primary aldosteronism (PA) but most studies show inconsistent results. Therefore, we aimed to compare the prevalence of type 2 diabetes mellitus and metabolic syndrome (MetS) in newly diagnosed PA patients to a matched control cohort of the background population. METHODS In total, 305 PA patients of the prospective German Conn's Registry were compared to the population-based Study of Health In Pomerania (SHIP1; n=2454). A 1:1 match regarding sex, age, and BMI resulted in 269 matched pairs regarding type 2 diabetes and 183 matched pairs regarding MetS. Of the total, 153 PA patients underwent oral glucose tolerance testing (OGTT) at diagnosis and 38 PA patients were reevaluated at follow-up. RESULTS Type 2 diabetes and MetS were significantly more frequent in PA patients than in the control population (17.2% vs 10.4%, P=0.03; 56.8% vs 44.8%, P=0.02 respectively). Also, HbA1c levels were higher in PA patients than in controls (P<0.01). Of the total, 35.3% of non-diabetic PA patients showed an abnormal OGTT (¼ newly diagnosed type 2 diabetes and ¾ impaired glucose tolerance). PA patients with an abnormal OGTT at baseline presented with significantly improved 2 h OGTT glucose (P=0.01) at follow-up. We detected a negative correlation between 2 h OGTT glucose levels and serum potassium (P<0.01). CONCLUSIONS Type 2 diabetes and MetS are more prevalent in patients with PA than in controls matched for sex, age, BMI, and blood pressure. This may explain in part the increased cardiovascular disease morbidity and mortality in PA patients.
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Affiliation(s)
- Gregor Hanslik
- Clinical EndocrinologyCharité Campus Mitte, Charité University Medicine Berlin, Berlin, GermanyInstitute of Clinical Chemistry and Laboratory MedicineUniversity Medicine Greifswald, Greifswald, GermanyMedizinische Klinik und Poliklinik IVEndocrinology and Metabolism, University Hospital Munich, Munich, GermanyEndocrinology and Diabetes UnitDepartment of Internal Medicine I, University Hospital of Wuerzburg, Wuerzburg, GermanyDepartment of NephrologyMedical Faculty, Heinrich-Heine University Duesseldorf, Duesseldorf, GermanyDivision of Endocrinology and MetabolismRostock University Medical Center, Rostock, GermanyEndocrinology in CharlottenburgStuttgarter Platz 1, 10627 Berlin, Germany
| | - Henri Wallaschofski
- Clinical EndocrinologyCharité Campus Mitte, Charité University Medicine Berlin, Berlin, GermanyInstitute of Clinical Chemistry and Laboratory MedicineUniversity Medicine Greifswald, Greifswald, GermanyMedizinische Klinik und Poliklinik IVEndocrinology and Metabolism, University Hospital Munich, Munich, GermanyEndocrinology and Diabetes UnitDepartment of Internal Medicine I, University Hospital of Wuerzburg, Wuerzburg, GermanyDepartment of NephrologyMedical Faculty, Heinrich-Heine University Duesseldorf, Duesseldorf, GermanyDivision of Endocrinology and MetabolismRostock University Medical Center, Rostock, GermanyEndocrinology in CharlottenburgStuttgarter Platz 1, 10627 Berlin, Germany
| | - Anna Dietz
- Clinical EndocrinologyCharité Campus Mitte, Charité University Medicine Berlin, Berlin, GermanyInstitute of Clinical Chemistry and Laboratory MedicineUniversity Medicine Greifswald, Greifswald, GermanyMedizinische Klinik und Poliklinik IVEndocrinology and Metabolism, University Hospital Munich, Munich, GermanyEndocrinology and Diabetes UnitDepartment of Internal Medicine I, University Hospital of Wuerzburg, Wuerzburg, GermanyDepartment of NephrologyMedical Faculty, Heinrich-Heine University Duesseldorf, Duesseldorf, GermanyDivision of Endocrinology and MetabolismRostock University Medical Center, Rostock, GermanyEndocrinology in CharlottenburgStuttgarter Platz 1, 10627 Berlin, Germany
| | - Anna Riester
- Clinical EndocrinologyCharité Campus Mitte, Charité University Medicine Berlin, Berlin, GermanyInstitute of Clinical Chemistry and Laboratory MedicineUniversity Medicine Greifswald, Greifswald, GermanyMedizinische Klinik und Poliklinik IVEndocrinology and Metabolism, University Hospital Munich, Munich, GermanyEndocrinology and Diabetes UnitDepartment of Internal Medicine I, University Hospital of Wuerzburg, Wuerzburg, GermanyDepartment of NephrologyMedical Faculty, Heinrich-Heine University Duesseldorf, Duesseldorf, GermanyDivision of Endocrinology and MetabolismRostock University Medical Center, Rostock, GermanyEndocrinology in CharlottenburgStuttgarter Platz 1, 10627 Berlin, Germany
| | - Martin Reincke
- Clinical EndocrinologyCharité Campus Mitte, Charité University Medicine Berlin, Berlin, GermanyInstitute of Clinical Chemistry and Laboratory MedicineUniversity Medicine Greifswald, Greifswald, GermanyMedizinische Klinik und Poliklinik IVEndocrinology and Metabolism, University Hospital Munich, Munich, GermanyEndocrinology and Diabetes UnitDepartment of Internal Medicine I, University Hospital of Wuerzburg, Wuerzburg, GermanyDepartment of NephrologyMedical Faculty, Heinrich-Heine University Duesseldorf, Duesseldorf, GermanyDivision of Endocrinology and MetabolismRostock University Medical Center, Rostock, GermanyEndocrinology in CharlottenburgStuttgarter Platz 1, 10627 Berlin, Germany
| | - Bruno Allolio
- Clinical EndocrinologyCharité Campus Mitte, Charité University Medicine Berlin, Berlin, GermanyInstitute of Clinical Chemistry and Laboratory MedicineUniversity Medicine Greifswald, Greifswald, GermanyMedizinische Klinik und Poliklinik IVEndocrinology and Metabolism, University Hospital Munich, Munich, GermanyEndocrinology and Diabetes UnitDepartment of Internal Medicine I, University Hospital of Wuerzburg, Wuerzburg, GermanyDepartment of NephrologyMedical Faculty, Heinrich-Heine University Duesseldorf, Duesseldorf, GermanyDivision of Endocrinology and MetabolismRostock University Medical Center, Rostock, GermanyEndocrinology in CharlottenburgStuttgarter Platz 1, 10627 Berlin, Germany
| | - Katharina Lang
- Clinical EndocrinologyCharité Campus Mitte, Charité University Medicine Berlin, Berlin, GermanyInstitute of Clinical Chemistry and Laboratory MedicineUniversity Medicine Greifswald, Greifswald, GermanyMedizinische Klinik und Poliklinik IVEndocrinology and Metabolism, University Hospital Munich, Munich, GermanyEndocrinology and Diabetes UnitDepartment of Internal Medicine I, University Hospital of Wuerzburg, Wuerzburg, GermanyDepartment of NephrologyMedical Faculty, Heinrich-Heine University Duesseldorf, Duesseldorf, GermanyDivision of Endocrinology and MetabolismRostock University Medical Center, Rostock, GermanyEndocrinology in CharlottenburgStuttgarter Platz 1, 10627 Berlin, Germany
| | - Ivo Quack
- Clinical EndocrinologyCharité Campus Mitte, Charité University Medicine Berlin, Berlin, GermanyInstitute of Clinical Chemistry and Laboratory MedicineUniversity Medicine Greifswald, Greifswald, GermanyMedizinische Klinik und Poliklinik IVEndocrinology and Metabolism, University Hospital Munich, Munich, GermanyEndocrinology and Diabetes UnitDepartment of Internal Medicine I, University Hospital of Wuerzburg, Wuerzburg, GermanyDepartment of NephrologyMedical Faculty, Heinrich-Heine University Duesseldorf, Duesseldorf, GermanyDivision of Endocrinology and MetabolismRostock University Medical Center, Rostock, GermanyEndocrinology in CharlottenburgStuttgarter Platz 1, 10627 Berlin, Germany
| | - Lars C Rump
- Clinical EndocrinologyCharité Campus Mitte, Charité University Medicine Berlin, Berlin, GermanyInstitute of Clinical Chemistry and Laboratory MedicineUniversity Medicine Greifswald, Greifswald, GermanyMedizinische Klinik und Poliklinik IVEndocrinology and Metabolism, University Hospital Munich, Munich, GermanyEndocrinology and Diabetes UnitDepartment of Internal Medicine I, University Hospital of Wuerzburg, Wuerzburg, GermanyDepartment of NephrologyMedical Faculty, Heinrich-Heine University Duesseldorf, Duesseldorf, GermanyDivision of Endocrinology and MetabolismRostock University Medical Center, Rostock, GermanyEndocrinology in CharlottenburgStuttgarter Platz 1, 10627 Berlin, Germany
| | - Holger S Willenberg
- Clinical EndocrinologyCharité Campus Mitte, Charité University Medicine Berlin, Berlin, GermanyInstitute of Clinical Chemistry and Laboratory MedicineUniversity Medicine Greifswald, Greifswald, GermanyMedizinische Klinik und Poliklinik IVEndocrinology and Metabolism, University Hospital Munich, Munich, GermanyEndocrinology and Diabetes UnitDepartment of Internal Medicine I, University Hospital of Wuerzburg, Wuerzburg, GermanyDepartment of NephrologyMedical Faculty, Heinrich-Heine University Duesseldorf, Duesseldorf, GermanyDivision of Endocrinology and MetabolismRostock University Medical Center, Rostock, GermanyEndocrinology in CharlottenburgStuttgarter Platz 1, 10627 Berlin, Germany
| | - Felix Beuschlein
- Clinical EndocrinologyCharité Campus Mitte, Charité University Medicine Berlin, Berlin, GermanyInstitute of Clinical Chemistry and Laboratory MedicineUniversity Medicine Greifswald, Greifswald, GermanyMedizinische Klinik und Poliklinik IVEndocrinology and Metabolism, University Hospital Munich, Munich, GermanyEndocrinology and Diabetes UnitDepartment of Internal Medicine I, University Hospital of Wuerzburg, Wuerzburg, GermanyDepartment of NephrologyMedical Faculty, Heinrich-Heine University Duesseldorf, Duesseldorf, GermanyDivision of Endocrinology and MetabolismRostock University Medical Center, Rostock, GermanyEndocrinology in CharlottenburgStuttgarter Platz 1, 10627 Berlin, Germany
| | - Marcus Quinkler
- Clinical EndocrinologyCharité Campus Mitte, Charité University Medicine Berlin, Berlin, GermanyInstitute of Clinical Chemistry and Laboratory MedicineUniversity Medicine Greifswald, Greifswald, GermanyMedizinische Klinik und Poliklinik IVEndocrinology and Metabolism, University Hospital Munich, Munich, GermanyEndocrinology and Diabetes UnitDepartment of Internal Medicine I, University Hospital of Wuerzburg, Wuerzburg, GermanyDepartment of NephrologyMedical Faculty, Heinrich-Heine University Duesseldorf, Duesseldorf, GermanyDivision of Endocrinology and MetabolismRostock University Medical Center, Rostock, GermanyEndocrinology in CharlottenburgStuttgarter Platz 1, 10627 Berlin, Germany Clinical EndocrinologyCharité Campus Mitte, Charité University Medicine Berlin, Berlin, GermanyInstitute of Clinical Chemistry and Laboratory MedicineUniversity Medicine Greifswald, Greifswald, GermanyMedizinische Klinik und Poliklinik IVEndocrinology and Metabolism, University Hospital Munich, Munich, GermanyEndocrinology and Diabetes UnitDepartment of Internal Medicine I, University Hospital of Wuerzburg, Wuerzburg, GermanyDepartment of NephrologyMedical Faculty, Heinrich-Heine University Duesseldorf, Duesseldorf, GermanyDivision of Endocrinology and MetabolismRostock University Medical Center, Rostock, GermanyEndocrinology in CharlottenburgStuttgarter Platz 1, 10627 Berlin, Germany
| | - Anke Hannemann
- Clinical EndocrinologyCharité Campus Mitte, Charité University Medicine Berlin, Berlin, GermanyInstitute of Clinical Chemistry and Laboratory MedicineUniversity Medicine Greifswald, Greifswald, GermanyMedizinische Klinik und Poliklinik IVEndocrinology and Metabolism, University Hospital Munich, Munich, GermanyEndocrinology and Diabetes UnitDepartment of Internal Medicine I, University Hospital of Wuerzburg, Wuerzburg, GermanyDepartment of NephrologyMedical Faculty, Heinrich-Heine University Duesseldorf, Duesseldorf, GermanyDivision of Endocrinology and MetabolismRostock University Medical Center, Rostock, GermanyEndocrinology in CharlottenburgStuttgarter Platz 1, 10627 Berlin, Germany
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Leal Reyna M, Gómez RM, Lupi SN, Belli SH, Fenili CA, Martínez MS, Ruibal GF, Rossi MA, Chervin RA, Cornaló D, Contreras LN, Costa L, Nofal MT, Damilano SA, Pardes EM. Screening for primary aldosteronism in an argentinian population: a multicenter prospective study. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2015. [PMID: 26222233 DOI: 10.1590/2359-3997000000075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Primary aldosteronism (PA) is characterized by the autonomous overproduction of aldosterone. Its prevalence has increased since the use of the aldosterone (ALD)/plasma renin activity (PRA) ratio (ARR). The objective of this study is to determine ARR and ARC (ALD/plasma renin concentration ratio) cut-off values (COV) and their diagnostic concordance (DC%) in the screening for PA in an Argentinian population.Design multicenter prospective study. SUBJECTS AND METHODS We studied 353 subjects (104 controls and 249 hypertensive patients). Serum aldosterone, PRA and ARR were determined. In 220 randomly selected subjects, 160 hypertensive patients and 60 controls, plasma renin concentration (PRC) was simultaneously measured and ARC was determined. RESULTS According to the 95th percentile of controls, we determined a COV of 36 for ARR and 2.39 for ARC, with ALD ≥ 15 ng/dL. In 31/249 hypertensive patients, ARR was ≥ 36. PA diagnosis was established in 8/31 patients (23/31 patients did not complete confirmatory tests). DC% between ARR and ARC was calculated. A significant correlation between ARR and ARC (r = 0.742; p < 0.0001) was found only with PRA > 0.3 ng/mL/h and PRC > 5 pg/mL. DC% for ARR and ARC above or below 36 and 2.39 was 79.1%, respectively. CONCLUSION This first Argentinian multicenter study determined a COV of 36 for ARR and 2.39 for ARC. Applying an ARR ≥ 36 in the hypertensive group, we confirmed PA in a higher percentage of patients than the previously reported one in our population. As for ARC, further studies are needed for its clinical application, since DC% is acceptable only for medium range renin values.
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Affiliation(s)
| | - Reynaldo M Gómez
- Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | | | | | | | | | | | - María A Rossi
- Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Raúl A Chervin
- Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
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15
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Lacerda L, Faria APD, Fontana V, Moreno H, Sandrim V. Role of MMP-2 and MMP-9 in resistance to drug therapy in patients with resistant hypertension. Arq Bras Cardiol 2015; 105:168-75. [PMID: 26039662 PMCID: PMC4559126 DOI: 10.5935/abc.20150060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background Despite the increased evidence of the important role of matrix metalloproteinases
(MMP-9 and MMP‑2) in the pathophysiology of hypertension, the profile of these
molecules in resistant hypertension (RHTN) remains unknown. Objectives To compare the plasma levels of MMP-9 and MMP-2 and of their tissue inhibitors
(TIMP-1 and TIMP-2, respectively), as well as their MMP-9/TIMP-1 and MMP-2/TIMP-2
ratios, between patients with controlled RHTN (CRHTN, n=41) and uncontrolled RHTN
(UCRHTN, n=35). In addition, the association of those parameters with clinical
characteristics, office blood pressure (BP) and arterial stiffness (determined by
pulse wave velocity) was evaluate in those subgroups. Methods This study included 76 individuals diagnosed with RHTN and submitted to physical
examination, electrocardiogram, and laboratory tests to assess biochemical
parameters. Results Similar values of MMP-9, MMP-2, TIMP-1, TIMP-2, and MMP-9/TIMP-1 and MMP-2/TIMP-2
ratios were found in the UCRHTN and CRHTN subgroups (P>0.05). A significant
correlation was found between diastolic BP (DBP) and MMP-9/TIMP-1 ratio (r=0.37;
P=0.02) and DPB and MMP-2 (r=-0.40; P=0.02) in the UCRHTN subgroup. On the other
hand, no correlation was observed in the CRHTN subgroup. Logistic regression
models demonstrated that MMP-9, MMP-2, TIMP-1, TIMP-2 and their ratios were not
associated with the lack of BP control. Conclusion These findings suggest that neither MMP-2 nor MMP-9 affect BP control in RHTN
subjects.
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Affiliation(s)
- Leandro Lacerda
- Núcleo de Pós-Graduação e Pesquisa, Santa Casa de Belo Horizonte, Belo Horizonte, MG, BR
| | | | | | - Heitor Moreno
- Faculdade de Ciências Médicas, UNICAMP, Campinas, SP, BR
| | - Valéria Sandrim
- Núcleo de Pós-Graduação e Pesquisa, Santa Casa de Belo Horizonte, Belo Horizonte, MG, BR
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Ardhanari S, Kannuswamy R, Chaudhary K, Lockette W, Whaley-Connell A. Mineralocorticoid and apparent mineralocorticoid syndromes of secondary hypertension. Adv Chronic Kidney Dis 2015; 22:185-95. [PMID: 25908467 DOI: 10.1053/j.ackd.2015.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 03/02/2015] [Accepted: 03/04/2015] [Indexed: 11/11/2022]
Abstract
The mineralocorticoid aldosterone is a key hormone in the regulation of plasma volume and blood pressure in man. Excessive levels of this mineralocorticoid have been shown to mediate metabolic disorders and end-organ damage more than what can be attributed to its effects on blood pressure alone. Inappropriate excess levels of aldosterone contribute significantly to the cardiorenal metabolic syndrome and target organ injury that include atherosclerosis, myocardial hypertrophy, fibrosis, heart failure, and kidney disease. The importance of understanding the role of excess mineralocorticoid hormones such as aldosterone in resistant hypertension and in those with secondary hypertension should be visited. Primary aldosteronism is one of the commonly identified causes of hypertension and is treatable and/or potentially curable. We intend to review the management of mineralocorticoid-induced hypertension in the adult population along with other disease entities that mimic primary aldosteronism.
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Piaditis G, Markou A, Papanastasiou L, Androulakis II, Kaltsas G. Progress in aldosteronism: a review of the prevalence of primary aldosteronism in pre-hypertension and hypertension. Eur J Endocrinol 2015; 172:R191-203. [PMID: 25538205 DOI: 10.1530/eje-14-0537] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Primary aldosteronism (PA) secondary to excessive and/or autonomous aldosterone secretion from the renin-angiotensin system accounts for ∼10% of cases of hypertension and is primarily caused by bilateral adrenal hyperplasia (BAH) or aldosterone-producing adenomas (APAs). Although the diagnosis has traditionally been supported by low serum potassium levels, normokalaemic and even normotensive forms of PA have been identified expanding further the clinical phenotype. Moreover, recent evidence has shown that serum aldosterone correlates with increased blood pressure (BP) in the general population and even moderately raised aldosterone levels are linked to increased cardiovascular morbidity and mortality. In addition, aldosterone antagonists are effective in BP control even in patients without evidence of dysregulated aldosterone secretion. These findings indicate a higher prevalence of aldosterone excess among hypertensive patients than previously considered that could be attributed to disease heterogeneity, aldosterone level fluctuations related to an ACTH effect or inadequate sensitivity of current diagnostic means to identify apparent aldosterone excess. In addition, functioning aberrant receptors expressed in the adrenal tissue have been found in a subset of PA cases that could also be related to its pathogenesis. Recently a number of specific genetic alterations, mainly involving ion homeostasis across the membrane of zona glomerulosa, have been detected in ∼50% of patients with APAs. Although specific genotype/phenotype correlations have not been clearly identified, differential expression of these genetic alterations could also account for the wide clinical phenotype, variations in disease prevalence and performance of diagnostic tests. In the present review, we critically analyse the current means used to diagnose PA along with the role that ACTH, aberrant receptor expression and genetic alterations may exert, and provide evidence for an increased prevalence of aldosterone dysregulation in patients with essential hypertension and pre-hypertension.
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Affiliation(s)
- George Piaditis
- Department of Endocrinology and Diabetes CenterG. Gennimatas Hospital, 154 Mesogion Avenue, 11527 Holargos, Athens, Greece andDepartment of PathophysiologyNational University of Athens, Mikras Asias 75, 11527 Athens, Greece
| | - Athina Markou
- Department of Endocrinology and Diabetes CenterG. Gennimatas Hospital, 154 Mesogion Avenue, 11527 Holargos, Athens, Greece andDepartment of PathophysiologyNational University of Athens, Mikras Asias 75, 11527 Athens, Greece
| | - Labrini Papanastasiou
- Department of Endocrinology and Diabetes CenterG. Gennimatas Hospital, 154 Mesogion Avenue, 11527 Holargos, Athens, Greece andDepartment of PathophysiologyNational University of Athens, Mikras Asias 75, 11527 Athens, Greece
| | - Ioannis I Androulakis
- Department of Endocrinology and Diabetes CenterG. Gennimatas Hospital, 154 Mesogion Avenue, 11527 Holargos, Athens, Greece andDepartment of PathophysiologyNational University of Athens, Mikras Asias 75, 11527 Athens, Greece Department of Endocrinology and Diabetes CenterG. Gennimatas Hospital, 154 Mesogion Avenue, 11527 Holargos, Athens, Greece andDepartment of PathophysiologyNational University of Athens, Mikras Asias 75, 11527 Athens, Greece
| | - Gregory Kaltsas
- Department of Endocrinology and Diabetes CenterG. Gennimatas Hospital, 154 Mesogion Avenue, 11527 Holargos, Athens, Greece andDepartment of PathophysiologyNational University of Athens, Mikras Asias 75, 11527 Athens, Greece
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18
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Laboratory challenges in primary aldosteronism screening and diagnosis. Clin Biochem 2015; 48:377-87. [DOI: 10.1016/j.clinbiochem.2015.01.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 01/08/2015] [Accepted: 01/12/2015] [Indexed: 01/07/2023]
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Abstract
Primary hyperaldosteronism is an important and commonly unrecognized secondary cause of hypertension. This article provides an overview of the current literature with respect to screening, diagnosis, and lateralization. Selection and outcomes of medical and surgical treatment are discussed.
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Affiliation(s)
- Adrian M Harvey
- Section of General Surgery and Surgical Oncology, Department of Surgery, Faculty of Medicine, Foothills Medical Center, University of Calgary, 1403 29th Street Northwest, FMC, North Tower, Calgary, Alberta T2N 2T9, Canada.
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Satoh M, Hosaka M, Asayama K, Kikuya M, Inoue R, Metoki H, Utsugi MT, Hara A, Hirose T, Obara T, Mori T, Totsune K, Hoshi H, Mano N, Imai Y, Ohkubo T. Aldosterone-to-renin ratio and nocturnal blood pressure decline assessed by self-measurement of blood pressure at home: the Ohasama Study. Clin Exp Hypertens 2014; 36:108-14. [DOI: 10.3109/10641963.2014.892121] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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21
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Prevalence of and risk factors for primary aldosteronism among patients with resistant hypertension in China. J Hypertens 2014; 31:1465-71; discussion 1471-2. [PMID: 24006040 DOI: 10.1097/hjh.0b013e328360ddf6] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES It is estimated that there are more than 16 million adults with drug-resistant hypertension in China. Nevertheless, the prevalence of and risk factors for primary aldosteronism, a highly curable condition among adults with drug-resistant hypertension, has not been fully investigated. METHODS Between January 2010 and October 2011, a multicenter epidemiologic study was conducted among 1656 patients with resistant hypertension in 11 provinces of China. Serum aldosterone and plasma renin activity were measured in every participant and aldosterone-to-renin ratio (ARR) was calculated. Patients with ARR more than 20 underwent an intravenous (i.v.) sodium infusion test, and diagnosis of primary aldosteronism was established by the presence of unsuppressed postinfusion aldosterone (>8 ng/dl). Patients with biochemically proved primary aldosteronism then underwent adrenal computed tomography (CT) scanning and adrenal vein sampling (AVS) for subtype classification. RESULTS Among the 1656 patients, 494 (29.8%) had ARR greater than 20 and underwent i.v. sodium infusion. Of these 494, 118 were diagnosed as primary aldosteronism, yielding a prevalence of 7.1% (95% confidential interval 5.9-8.3%). Seventy of the 118 patients were categorized into unilateral (39) and bilateral (31) by AVS. Generalized additive regression analysis revealed that among all the factors investigated (age of hypertension onset, BMI, family history of hypertension, cigarette smoking, alcohol consumption, diabetes, serum potassium, hyperlipidemia, and creatinine), only age of hypertension onset and serum potassium were independently associated with the presence of primary aldosteronism. CONCLUSION The prevalence of primary aldosteronism among Chinese patients with resistant hypertension is relatively lower than that reported previously for other ethnic populations. The screening for primary aldosteronism should be focused on those with early onset hypertension and/or hypokalemia.
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Olivieri O, Cecconi D, Castagna A, Chiecchi L, Guarini P, Gunasekaran M, Morandini F, Brazzarola P, Zolla L, D'Alessandro A, Veglio F, Mulatero P, Pizzolo F. Urinary protease inhibitor Serpin B3 is higher in women and is further increased in female patients affected by aldosterone producing adenoma. MOLECULAR BIOSYSTEMS 2014; 10:1281-9. [DOI: 10.1039/c3mb70538b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
Background Urinary 18-hydroxycortisol has been investigated as a marker of aldosterone-producing adenoma (APA). The aim of this study was to develop and validate a method for the measurement of 18-hydroxycortisol using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Methods Urine was collected over a 24-hour period in patients with APA ( n = 11), idiopathic hyperaldosteronism (IHA, n = 9), and essential hypertension (EH, n = 6). 18-Hydroxycortisol was extracted in solid-phase, and measured by LC-MS/MS based on selected reaction monitoring. Results The method allowed quantification of 18-hydroxycortisol with a lower quantification limit of 0.26 nmol/L, intra- and inter-assay coefficients of variation of <3.4% and a range of analytical recovery of 98.0–103.7%. Urinary 18-hydroxycortisol excretion for APA, IHA and EH were determined as 725 (SD 451), 102 (SD 68) and 88 (SD 76) nmol/day, respectively. Conclusions The proposed method met the basic analytical requirements and was considered to be useful in the screening and differential diagnosis of APA.
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Wu CH, Yang YW, Hu YH, Tsai YC, Kuo KL, Lin YH, Hung SC, Wu VC, Wu KD. Comparison of 24-h urinary aldosterone level and random urinary aldosterone-to-creatinine ratio in the diagnosis of primary aldosteronism. PLoS One 2013; 8:e67417. [PMID: 23840695 PMCID: PMC3696056 DOI: 10.1371/journal.pone.0067417] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 05/18/2013] [Indexed: 12/22/2022] Open
Abstract
Background Historically, urinary aldosterone level measurement was a commonly employed confirmatory test to detect primary aldosteronism (PA). However, 24-h urine collection is inconvenient and cumbersome. We hypothesized that random urinary aldosterone measurements with correction for creatinine concentration might be comparable to 24-h urinary aldosterone levels (Uald-24 h) in the diagnosis of PA. Methods The non-concurrent prospective study was conducted between June 2006 and March 2008 in patients admitted for confirmation of aldosteronism by salt loading test. A 24-h urine sample, which was collected during hospitalization on the day before saline infusion testing after restoration of serum hypokalemia, was collected from all subjects. Moreover, participants were asked to collect a first bladder voiding random urine sample during clinic visits. Uald-24 h and the random urinary aldosterone-to-creatinine ratio (UACR) were calculated accordingly. Results A total of 102 PA patients (71 patients diagnosed of aldosterone-producing adenoma, 31 with idiopathic hyperaldosteronism) and 65 patients with EH were enrolled. The receiver operating characteristic curve showed comparable areas under the curves of UACR and Uald-24 h. The Bland-Altman plot showed mean bias but no obvious heteroscedasticity between the two tests. When using random UACR >3.0 ng/mg creatinine as the cutoff value, we obtained a specificity of 90.6% to confirm PA from essential hypertension. Conclusions Our study reinforce that the diagnostic accuracy of random UACR was comparable to that of Uald-24 h in PA patients. With the quickness and simplicity of the UACR method and its equivalence to Uald-24 h, this assay could be a good alternative diagnostic tool for PA confirmation.
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Affiliation(s)
- Che-Hsiung Wu
- Division of Nephrology, Buddhist Tzu Chi General Hospital, Taipei Branch, Taiwan
| | - Ya-Wen Yang
- Division of General Surgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Ya-Hui Hu
- Division of Endocrine and Metabolism, Buddhist Tzu Chi General Hospital, Taipei Branch, Taiwan
| | - Yao-Chou Tsai
- Division of Urology, Buddhist Tzu Chi General Hospital, Taipei Branch, Taipei, Taiwan
| | - Ko-Lin Kuo
- Division of Nephrology, Buddhist Tzu Chi General Hospital, Taipei Branch, Taiwan
| | - Yen-Hung Lin
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Szu-Chun Hung
- Division of Nephrology, Buddhist Tzu Chi General Hospital, Taipei Branch, Taiwan
- * E-mail: (SCH); (VCW)
| | - Vin-Cent Wu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- * E-mail: (SCH); (VCW)
| | - Kwan-Dun Wu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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The PI3K/AKT/mTOR signaling pathway is overactivated in primary aldosteronism. PLoS One 2013; 8:e62399. [PMID: 23626817 PMCID: PMC3633845 DOI: 10.1371/journal.pone.0062399] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 03/20/2013] [Indexed: 12/21/2022] Open
Abstract
Background To date, the available non-invasive remedies for primary aldosteronism are not satisfactory in clinical practice. The phosphoinositide 3-kinase (PI3Ks)/protein kinase B (PKB or AKT)/mammalian target of rapamycin (mTOR) signaling pathway is essential for tumorigenesis and metastasis in many types of human tumors, including renal cancer, adrenal carcinoma and pheochromocytoma. The possibility that this pathway is also necessary for the pathogenesis of primary aldosteronism has not yet been explored. To answer this question, we investigated the activity of the PI3K/AKT/mTOR signaling pathway in normal adrenal glands (NAGs), primary aldosteronism (PA) patients and NCI-H295R cells. Methodology/Principal Findings Between January 2005 and December 2011, we retrospectively reviewed the records of 45 patients with PA. We compared clinical characteristics (age, gender and biochemical data) and the expression of phospho-AKT (p-AKT), phospho-mTOR (p-mTOR), phospho-S6 (p-S6) and vascular endothelial growth factor (VEGF) by immunohistochemical staining and western blotting, analyzing 30 aldosterone-producing adenomas (APAs), 15 idiopathic hyperaldosteronism (IHA) tissues and 12 NAGs following nephrectomy for renal tumors (control group). Compared with the control group, most of the PA patients presented with polydipsia, polyuria, resistant hypertension, profound hypokalemia, hyperaldosteronemia and decreased plasma renin activity. Compared with normal zona glomerulosa, the levels of p-AKT, p-mTOR, p-S6 and VEGF were significantly upregulated in APA and IHA. No significant differences were found between APA and IHA in the expression of these proteins. Additionally, positive correlations existed between the plasma aldosterone levels and the expression of p-AKT and p-mTOR. In vitro studies showed that mTOR inhibitor rapamycin could inhibit cell proliferation in NCI-H295R cells in a dose- and time-dependent manner. Furthermore, this inhibitor also decreased aldosterone secretion. Conclusions Our data suggest that the PI3K/AKT/mTOR signaling pathway, which was overactivated in APA and IHA compared with normal zona glomerulosa, may mediate aldosterone hypersecretion and participate in the development of PA.
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Horváth D, Lőcsei Z, Csizmadia Z, Toldy E, Szabolcs I, Rácz K. [Clinical evaluation of the renin-aldosterone system: comparison of two methods in different clinical conditions]. Orv Hetil 2012; 153:1701-10. [PMID: 23089169 DOI: 10.1556/oh.2012.29476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Measurement of plasma aldosterone/renin ratio is the key step in the diagnosis of primary aldosteronism. AIM The aim of the authors was to analyze and compare the diagnostic utility of plasma aldosterone/renin activity and plasma aldosterone/renin concentration ratios. METHODS Plasma aldosterone and plasma renin activity were determined by radioimmunoassays and plasma renin concentration was measured by immunoradiometric assay in 134 subjects (80 women and 54 men, aged 46±15.5 years) including 49 healthy blood donors (control group), 59 patients with hypertension (25 treated and 34 untreated) and 26 patients with incidentally discovered adrenal adenomas. RESULTS There was a weak correlation (r = 0.59) between plasma renin activity and plasma renin concentration in the lower range (plasma renin activity, 0.63±0.41 ng/ml/h; plasma renin concentration, 8.1±4.9 ng/l). Considering the cut-off value of plasma aldosterone/renin ratios determined in controls (plasma aldosterone/renin activity ratio, 30 ng/dl/ng/ml/h; plasma aldosterone/renin concentration ratio, 3.0 ng/dl/ng/l), high proportion of falsely positive results were found among patients on beta-receptor blocker therapy (plasma aldosterone/renin activity ratio, 22.2%; plasma aldosterone/renin concentration ratio, 44.4%) CONCLUSION The widely used plasma aldosterone/renin activity ratio can only be replaced with plasma aldosterone/renin concentration ratio with precaution on different clinical conditions.
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Affiliation(s)
- Dóra Horváth
- Vas Megyei Markusovszky Kórház, Egyetemi Oktatókórház Nonprofit Zrt. Általános Belgyógyászati Osztály, Szombathely
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Satoh M, Kikuya M, Ohkubo T, Mori T, Metoki H, Hara A, Utsugi MT, Hashimoto T, Hirose T, Obara T, Inoue R, Asayama K, Kanno A, Totsune K, Hoshi H, Satoh H, Imai Y. Aldosterone-to-renin ratio as a predictor of stroke under conditions of high sodium intake: the Ohasama study. Am J Hypertens 2012; 25:777-83. [PMID: 22476023 DOI: 10.1038/ajh.2012.33] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Aldosterone is thought to have deleterious effects on the cardiovascular system. The aldosterone-to-renin ratio (ARR) is more reproducible than aldosterone levels alone and could be an index for inappropriate aldosterone secretion or activity. We previously reported the apparent relation between ARR and hypertension in subjects with high sodium intake. This prospective study investigated the risk of ARR for a first stroke in a general population stratified by sodium intake. METHODS We obtained plasma renin activity (PRA) and plasma aldosterone concentrations (PAC) for 883 participants aged ≥ 35 years not receiving antihypertensive treatment in the general population of Ohasama (mean age: 59.0 ± 11.3 years; 65.6% women). RESULTS Over a mean of 10.9 follow-up years, 45 strokes occurred. The median PRA, PAC, and ARR were 1.2 ng/ml/h, 6.4 ng/dl, and 5.3 ng/dl per ng/ml/h, respectively. Using Cox regression, we computed hazard ratios adjusted for sex, age, body mass index (BMI), and systolic blood pressure. No association between logARR and stroke was observed in subjects overall. However, in subjects with high sodium intake (≥ median of 4,058 mg/day (salt equivalent, 10.5 g/day)), each 1 s.d. increase in logARR was associated with an increased hazard ratio for stroke (hazard ratio: 1.49, P = 0.04). No significant association was observed in subjects with low sodium intake (P = 0.7). When we repeated all the analyses using logPRA or logPAC, no significant associations were found. CONCLUSION These results suggest that high ARR, that is, relative aldosterone excess, is a predictor for stroke under conditions of high sodium intake.
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Aldosterone-to-renin ratio and nocturnal blood pressure decline in a general population. J Hypertens 2011; 29:1940-7. [DOI: 10.1097/hjh.0b013e32834ab46a] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
A few simple rules can allow physicians to successfully identify many patients with arterial hypertension caused by PA among the so-called essential hypertensive patients. The hyperaldosteronism and the hypokalemia can be cured with adrenalectomy in practically all of these patients. Moreover, in a substantial proportion of them, the blood pressure can be normalized or markedly lowered if a unilateral cause of PA is discovered. Hence, the screening for PA can be rewarding both for the patient and for the clinician, particularly in those cases where hypertension is severe and/or resistant to treatment, in which the removal of an APA can allow blood pressure to be brought under control despite withdrawal of, or a prominent reduction in, the number and doses of antihypertensive medications.
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Affiliation(s)
- Gian Paolo Rossi
- Molecular Hypertension Laboratory, Dipartimento di Medicina Clinica e Sperimentale G. Patrassi - Internal Medicine 4, University of Padua, University Hospital Padua, Via Giustiniani, 2, 35126 Padua, Italy.
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Diagnostic value of I-131 NP-59 SPECT/CT scintigraphy in patients with subclinical or atypical features of primary aldosteronism. J Biomed Biotechnol 2011; 2011:209787. [PMID: 21541242 PMCID: PMC3085291 DOI: 10.1155/2011/209787] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Accepted: 02/15/2011] [Indexed: 11/17/2022] Open
Abstract
Accumulating evidence has shown the adverse effect of long-term hyperaldosteronism on cardiovascular morbidity that is independent of blood pressure. However, the diagnosis of primary aldosteronism (PA) remains a challenge for patients who present with subtle or atypical features or have chronic kidney disease (CKD). SPECT/CT has proven valuable in the diagnosis of a number of conditions. The aim of this study was to determine the usefulness of I-131 NP-59 SPECT/CT in patients with atypical presentations of PA and in those with CKD. The records of 15 patients with PA were retrospectively analyzed. NP-59 SPECT/CT was able to identify adrenal lesion(s) in CKD patients with suspected PA. Patients using NP-59 SPECT/CT imaging, compared with those not performing this procedure, significantly featured nearly normal serum potassium levels, normal aldosterone-renin ratio, and smaller adrenal size on CT and pathological examination and tended to feature stage 1 hypertension and non-suppressed plasma renin activity. These findings show that noninvasive NP-59 SPECT/CT is a useful tool for diagnosis in patients with subclinical or atypical features of PA and those with CKD.
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Faselis C, Doumas M, Papademetriou V. Common secondary causes of resistant hypertension and rational for treatment. Int J Hypertens 2011; 2011:236239. [PMID: 21423678 PMCID: PMC3057025 DOI: 10.4061/2011/236239] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Accepted: 01/11/2011] [Indexed: 12/20/2022] Open
Abstract
Resistant hypertension is defined as uncontrolled blood pressure despite the use of three antihypertensive drugs, including a diuretic, in optimal doses. Treatment resistance can be attributed to poor adherence to antihypertensive drugs, excessive salt intake, physician inertia, inappropriate or inadequate medication, and secondary hypertension. Drug-induced hypertension, obstructive sleep apnoea, primary aldosteronism, and chronic kidney disease represent the most common secondary causes of resistant hypertension. Several drugs can induce or exacerbate pre-existing hypertension, with non-steroidal anti-inflammatory drugs being the most common due to their wide use. Obstructive sleep apnoea and primary aldosteronism are frequently encountered in patients with resistant hypertension and require expert management. Hypertension is commonly found in patients with chronic kidney disease and is frequently resistant to treatment, while the management of renovascular hypertension remains controversial. A step-by-step approach of patients with resistant hypertension is proposed at the end of this review paper.
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Affiliation(s)
- Charles Faselis
- Veterans Affairs Medical Center, George Washington University, VAMC 50 Irving Street NW, Washington, DC 20422, USA
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Fischer E, Beuschlein F, Bidlingmaier M, Reincke M. Commentary on the Endocrine Society Practice Guidelines: Consequences of adjustment of antihypertensive medication in screening of primary aldosteronism. Rev Endocr Metab Disord 2011; 12:43-8. [PMID: 21331645 DOI: 10.1007/s11154-011-9163-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The Endocrine Society guidelines suggest to screen patients with primary aldosteronism (PA) free of hypertensive medications or alternatively to switch to drugs known to have minimal influence on the aldosterone to renin ratio (ARR). We retrospectively investigated the impact of such strategy on clinical outcome. 25 patients with PA and 25 with essential hypertension (EH) were studied. Initially all subjects were evaluated biochemically and received if possible an adjustment of their medication following the guidlines. Mineralocorticoid antagonists were discontinued in all subjects. Only 26 of 50 patients could be studied under optimal conditions (drug free or on medication with minimal influence on ARR) whereas the remaining 24 subjects had to receive additional drugs (such as ACE inhibitor, angiotensin-2 receptor blocker, or betablockers) because of initial blood pressure or comorbidities. Every fifth patient with a switch of the medication experienced a significant increase in blood pressure. 13 of 25 of PA patients needed potassium supplementation (105+/-25 mEq per day; range 8-320 mEq). Nine of these patients remained hypokalemic despite substitution (serum K 2.82+/-0.07 mmol/l), with 7 classified severely hypokalemic (<.3.0). We observed 6 serious adverse events requiring hospitalization including hypertensive crisis (n = 3), atrial fibrillation (n = 1), heart failure (n = 1) and ICD triggered electric shock (n = 1). In conclusion, in our experience the adjustment of the antihypertensive treatment during screening for PA is only possible in approximately half of patients and can cause severe side effect. Such recommendation, therefore, must include a note of caution because of possibly deleterious side effects.
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Affiliation(s)
- Evelyn Fischer
- Medizinische Klinik, Ludwig-Maximilians-Universität München, München, Germany
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Abstract
Primary aldosteronism involves more than 11% of hypertensive patients who are referred to specialized centers for the diagnosis and treatment of hypertension. If not diagnosed early it causes an excess damage to the heart, vessels and kidney, which translates into an cardiovascular events. Since these ominous consequences can be corrected with a timely diagnosis and an appropriate therapy, physicians should exercise a high degree of alert concerning the possibility that primary aldosteronism is present in hypertensive patients. The purpose of this review is to provide up-dated information on the strategy for case detection, the subtype differentiation and the management of primary aldosteronism.
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Westerdahl C, Bergenfelz A, Isaksson A, Nerbrand C, Valdemarsson S. Primary aldosteronism among newly diagnosed and untreated hypertensive patients in a Swedish primary care area. Scand J Prim Health Care 2011; 29:57-62. [PMID: 21323498 PMCID: PMC3347934 DOI: 10.3109/02813432.2011.554015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the prevalence of primary aldosteronism (PA) in newly diagnosed and untreated hypertensive patients in primary care using the aldosterone/renin ratio (ARR), and to assess clinical and biochemical characteristics in patients with high and normal ARR. DESIGN Patient survey study. SETTING AND SUBJECTS A total of 200 consecutive patients with newly diagnosed and untreated hypertension from six primary health care centres in Sweden were included. MAIN OUTCOME MEASURES ARR was calculated from serum aldosterone and plasma renin concentrations. The cut-off level for ARR was 65. Patients with an increased ARR were considered for confirmatory testing with the fludrocortisone suppression test (FST), followed by adrenal computed tomographic radiology (CT) and adrenal venous sampling (AVS). RESULTS Of 200 patients, 36 patients had an ARR > 65. Of these 36 patients, 11 patients had an incomplete aldosterone inhibition during FST. Three patients were diagnosed with an aldosterone producing adenoma (APA) and eight with bilateral adrenal hyperplasia (BHA). Except for moderately lower level of P-K in patients with an ARR > 65 and in patients with PA, there were no biochemical or clinical differences found among hypertensive patients with PA compared with patients without PA. CONCLUSION Eleven of 200 evaluated patients (5.5%) were considered to have PA. The diagnosis of PA should therefore be considered in newly diagnosed hypertensive subjects and screening for the diagnosis is warranted.
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Aldosterone-to-renin ratio and home blood pressure in subjects with higher and lower sodium intake: the Ohasama Study. Hypertens Res 2010; 34:361-6. [DOI: 10.1038/hr.2010.236] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Martinez-Aguayo A, Aglony M, Campino C, Garcia H, Bancalari R, Bolte L, Avalos C, Loureiro C, Carvajal CA, Avila A, Perez V, Inostroza A, Fardella CE. Aldosterone, Plasma Renin Activity, and Aldosterone/Renin Ratio in a Normotensive Healthy Pediatric Population. Hypertension 2010; 56:391-6. [DOI: 10.1161/hypertensionaha.110.155135] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Primary aldosteronism is an important cause of secondary hypertension and is suspected in adults with an aldosterone/renin ratio ≥25. The normal aldosterone/renin ratio is unknown in children. The aim was to establish serum aldosterone, plasma renin activity, and aldosterone/renin ratio values in a healthy pediatric population. A cross-sectional study was performed in 211 healthy normotensive children (4 to 16 years old). Two subgroups of normotensive children were obtained: with hypertensive parents (NH) (n=113) and normotensive parents (n=98). Blood samples for measuring serum aldosterone, plasma renin activity, aldosterone/renin ratio, and DNA were collected. In subjects with aldosterone/renin ratio ≥25, the chimeric CYP11B1/CYP11B2 gene was investigated by long-extension PCR. Results are expressed as median [Q
1
–Q
3
]. NH and normotensive parents groups were similar in serum aldosterone (6.5 [3.6 to 9.0] ng/dL versus 6.5 [2.9 to 9.7] ng/dL;
P
=0.968) and plasma renin activity (2.3 [1.6 to 3.1] versus 2.4 [1.7 to 3.7] ng/mL per hour;
P
=0.129). The aldosterone/renin ratio was higher in the NH group, but this difference did not reach statistical significance (2.8 [1.9 to 4.1] versus 2.5 [1.4 to 4.0],
P
=0.104). In one subject of the NH group, the chimeric CYP11B1/CYP11B2 gene was detected. We demonstrated that normal aldosterone/renin ratio values in a healthy pediatric population without NH were lower than those reported for an adult normotensive population.
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Affiliation(s)
- Alejandro Martinez-Aguayo
- From the Departments of Pediatrics (A.M.-A., M.A., H.G., R.B., L.B., C.L., V.P.), Endocrinology (C.C., C.A.C., C.E.F.), Nephrology (A.I.), Pontificia Universidad Católica de Chile, Santiago, Chile; Department of Pediatrics (C.A.), Universidad de Antofagasta, Antofagasta, Chile; Institute of Maternal and Child Research (A.A.), Faculty of Medicine, University of Chile, Santiago, Chile
| | - Marlene Aglony
- From the Departments of Pediatrics (A.M.-A., M.A., H.G., R.B., L.B., C.L., V.P.), Endocrinology (C.C., C.A.C., C.E.F.), Nephrology (A.I.), Pontificia Universidad Católica de Chile, Santiago, Chile; Department of Pediatrics (C.A.), Universidad de Antofagasta, Antofagasta, Chile; Institute of Maternal and Child Research (A.A.), Faculty of Medicine, University of Chile, Santiago, Chile
| | - Carmen Campino
- From the Departments of Pediatrics (A.M.-A., M.A., H.G., R.B., L.B., C.L., V.P.), Endocrinology (C.C., C.A.C., C.E.F.), Nephrology (A.I.), Pontificia Universidad Católica de Chile, Santiago, Chile; Department of Pediatrics (C.A.), Universidad de Antofagasta, Antofagasta, Chile; Institute of Maternal and Child Research (A.A.), Faculty of Medicine, University of Chile, Santiago, Chile
| | - Hernan Garcia
- From the Departments of Pediatrics (A.M.-A., M.A., H.G., R.B., L.B., C.L., V.P.), Endocrinology (C.C., C.A.C., C.E.F.), Nephrology (A.I.), Pontificia Universidad Católica de Chile, Santiago, Chile; Department of Pediatrics (C.A.), Universidad de Antofagasta, Antofagasta, Chile; Institute of Maternal and Child Research (A.A.), Faculty of Medicine, University of Chile, Santiago, Chile
| | - Rodrigo Bancalari
- From the Departments of Pediatrics (A.M.-A., M.A., H.G., R.B., L.B., C.L., V.P.), Endocrinology (C.C., C.A.C., C.E.F.), Nephrology (A.I.), Pontificia Universidad Católica de Chile, Santiago, Chile; Department of Pediatrics (C.A.), Universidad de Antofagasta, Antofagasta, Chile; Institute of Maternal and Child Research (A.A.), Faculty of Medicine, University of Chile, Santiago, Chile
| | - Lillian Bolte
- From the Departments of Pediatrics (A.M.-A., M.A., H.G., R.B., L.B., C.L., V.P.), Endocrinology (C.C., C.A.C., C.E.F.), Nephrology (A.I.), Pontificia Universidad Católica de Chile, Santiago, Chile; Department of Pediatrics (C.A.), Universidad de Antofagasta, Antofagasta, Chile; Institute of Maternal and Child Research (A.A.), Faculty of Medicine, University of Chile, Santiago, Chile
| | - Carolina Avalos
- From the Departments of Pediatrics (A.M.-A., M.A., H.G., R.B., L.B., C.L., V.P.), Endocrinology (C.C., C.A.C., C.E.F.), Nephrology (A.I.), Pontificia Universidad Católica de Chile, Santiago, Chile; Department of Pediatrics (C.A.), Universidad de Antofagasta, Antofagasta, Chile; Institute of Maternal and Child Research (A.A.), Faculty of Medicine, University of Chile, Santiago, Chile
| | - Carolina Loureiro
- From the Departments of Pediatrics (A.M.-A., M.A., H.G., R.B., L.B., C.L., V.P.), Endocrinology (C.C., C.A.C., C.E.F.), Nephrology (A.I.), Pontificia Universidad Católica de Chile, Santiago, Chile; Department of Pediatrics (C.A.), Universidad de Antofagasta, Antofagasta, Chile; Institute of Maternal and Child Research (A.A.), Faculty of Medicine, University of Chile, Santiago, Chile
| | - Cristian A. Carvajal
- From the Departments of Pediatrics (A.M.-A., M.A., H.G., R.B., L.B., C.L., V.P.), Endocrinology (C.C., C.A.C., C.E.F.), Nephrology (A.I.), Pontificia Universidad Católica de Chile, Santiago, Chile; Department of Pediatrics (C.A.), Universidad de Antofagasta, Antofagasta, Chile; Institute of Maternal and Child Research (A.A.), Faculty of Medicine, University of Chile, Santiago, Chile
| | - Alejandra Avila
- From the Departments of Pediatrics (A.M.-A., M.A., H.G., R.B., L.B., C.L., V.P.), Endocrinology (C.C., C.A.C., C.E.F.), Nephrology (A.I.), Pontificia Universidad Católica de Chile, Santiago, Chile; Department of Pediatrics (C.A.), Universidad de Antofagasta, Antofagasta, Chile; Institute of Maternal and Child Research (A.A.), Faculty of Medicine, University of Chile, Santiago, Chile
| | - Viviana Perez
- From the Departments of Pediatrics (A.M.-A., M.A., H.G., R.B., L.B., C.L., V.P.), Endocrinology (C.C., C.A.C., C.E.F.), Nephrology (A.I.), Pontificia Universidad Católica de Chile, Santiago, Chile; Department of Pediatrics (C.A.), Universidad de Antofagasta, Antofagasta, Chile; Institute of Maternal and Child Research (A.A.), Faculty of Medicine, University of Chile, Santiago, Chile
| | - Andrea Inostroza
- From the Departments of Pediatrics (A.M.-A., M.A., H.G., R.B., L.B., C.L., V.P.), Endocrinology (C.C., C.A.C., C.E.F.), Nephrology (A.I.), Pontificia Universidad Católica de Chile, Santiago, Chile; Department of Pediatrics (C.A.), Universidad de Antofagasta, Antofagasta, Chile; Institute of Maternal and Child Research (A.A.), Faculty of Medicine, University of Chile, Santiago, Chile
| | - Carlos E. Fardella
- From the Departments of Pediatrics (A.M.-A., M.A., H.G., R.B., L.B., C.L., V.P.), Endocrinology (C.C., C.A.C., C.E.F.), Nephrology (A.I.), Pontificia Universidad Católica de Chile, Santiago, Chile; Department of Pediatrics (C.A.), Universidad de Antofagasta, Antofagasta, Chile; Institute of Maternal and Child Research (A.A.), Faculty of Medicine, University of Chile, Santiago, Chile
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Williams TA, Monticone S, Morello F, Liew CC, Mengozzi G, Pilon C, Asioli S, Sapino A, Veglio F, Mulatero P. Teratocarcinoma-Derived Growth Factor-1 Is Upregulated in Aldosterone-Producing Adenomas and Increases Aldosterone Secretion and Inhibits Apoptosis In Vitro. Hypertension 2010; 55:1468-75. [DOI: 10.1161/hypertensionaha.110.150318] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Tracy A. Williams
- From the Division of Internal Medicine and Hypertension Unit, Department of Medicine and Experimental Oncology (T.A.W., S.M., F.M., F.V., P.M.) and Department of Biomedical Sciences and Human Oncology (S.A., A.S.), University of Torino, Torino, Italy; GeneNews Ltd (C.-C.L.), Richmond Hill, Ontario, Canada; Clinical Chemistry Laboratory (G.M.), AOU San Giovanni Battista, Torino, Italy; Department of Medical and Surgical Sciences (C.P.), University of Padova, Padova, Italy
| | - Silvia Monticone
- From the Division of Internal Medicine and Hypertension Unit, Department of Medicine and Experimental Oncology (T.A.W., S.M., F.M., F.V., P.M.) and Department of Biomedical Sciences and Human Oncology (S.A., A.S.), University of Torino, Torino, Italy; GeneNews Ltd (C.-C.L.), Richmond Hill, Ontario, Canada; Clinical Chemistry Laboratory (G.M.), AOU San Giovanni Battista, Torino, Italy; Department of Medical and Surgical Sciences (C.P.), University of Padova, Padova, Italy
| | - Fulvio Morello
- From the Division of Internal Medicine and Hypertension Unit, Department of Medicine and Experimental Oncology (T.A.W., S.M., F.M., F.V., P.M.) and Department of Biomedical Sciences and Human Oncology (S.A., A.S.), University of Torino, Torino, Italy; GeneNews Ltd (C.-C.L.), Richmond Hill, Ontario, Canada; Clinical Chemistry Laboratory (G.M.), AOU San Giovanni Battista, Torino, Italy; Department of Medical and Surgical Sciences (C.P.), University of Padova, Padova, Italy
| | - Choong-Chin Liew
- From the Division of Internal Medicine and Hypertension Unit, Department of Medicine and Experimental Oncology (T.A.W., S.M., F.M., F.V., P.M.) and Department of Biomedical Sciences and Human Oncology (S.A., A.S.), University of Torino, Torino, Italy; GeneNews Ltd (C.-C.L.), Richmond Hill, Ontario, Canada; Clinical Chemistry Laboratory (G.M.), AOU San Giovanni Battista, Torino, Italy; Department of Medical and Surgical Sciences (C.P.), University of Padova, Padova, Italy
| | - Giulio Mengozzi
- From the Division of Internal Medicine and Hypertension Unit, Department of Medicine and Experimental Oncology (T.A.W., S.M., F.M., F.V., P.M.) and Department of Biomedical Sciences and Human Oncology (S.A., A.S.), University of Torino, Torino, Italy; GeneNews Ltd (C.-C.L.), Richmond Hill, Ontario, Canada; Clinical Chemistry Laboratory (G.M.), AOU San Giovanni Battista, Torino, Italy; Department of Medical and Surgical Sciences (C.P.), University of Padova, Padova, Italy
| | - Catia Pilon
- From the Division of Internal Medicine and Hypertension Unit, Department of Medicine and Experimental Oncology (T.A.W., S.M., F.M., F.V., P.M.) and Department of Biomedical Sciences and Human Oncology (S.A., A.S.), University of Torino, Torino, Italy; GeneNews Ltd (C.-C.L.), Richmond Hill, Ontario, Canada; Clinical Chemistry Laboratory (G.M.), AOU San Giovanni Battista, Torino, Italy; Department of Medical and Surgical Sciences (C.P.), University of Padova, Padova, Italy
| | - Sofia Asioli
- From the Division of Internal Medicine and Hypertension Unit, Department of Medicine and Experimental Oncology (T.A.W., S.M., F.M., F.V., P.M.) and Department of Biomedical Sciences and Human Oncology (S.A., A.S.), University of Torino, Torino, Italy; GeneNews Ltd (C.-C.L.), Richmond Hill, Ontario, Canada; Clinical Chemistry Laboratory (G.M.), AOU San Giovanni Battista, Torino, Italy; Department of Medical and Surgical Sciences (C.P.), University of Padova, Padova, Italy
| | - Anna Sapino
- From the Division of Internal Medicine and Hypertension Unit, Department of Medicine and Experimental Oncology (T.A.W., S.M., F.M., F.V., P.M.) and Department of Biomedical Sciences and Human Oncology (S.A., A.S.), University of Torino, Torino, Italy; GeneNews Ltd (C.-C.L.), Richmond Hill, Ontario, Canada; Clinical Chemistry Laboratory (G.M.), AOU San Giovanni Battista, Torino, Italy; Department of Medical and Surgical Sciences (C.P.), University of Padova, Padova, Italy
| | - Franco Veglio
- From the Division of Internal Medicine and Hypertension Unit, Department of Medicine and Experimental Oncology (T.A.W., S.M., F.M., F.V., P.M.) and Department of Biomedical Sciences and Human Oncology (S.A., A.S.), University of Torino, Torino, Italy; GeneNews Ltd (C.-C.L.), Richmond Hill, Ontario, Canada; Clinical Chemistry Laboratory (G.M.), AOU San Giovanni Battista, Torino, Italy; Department of Medical and Surgical Sciences (C.P.), University of Padova, Padova, Italy
| | - Paolo Mulatero
- From the Division of Internal Medicine and Hypertension Unit, Department of Medicine and Experimental Oncology (T.A.W., S.M., F.M., F.V., P.M.) and Department of Biomedical Sciences and Human Oncology (S.A., A.S.), University of Torino, Torino, Italy; GeneNews Ltd (C.-C.L.), Richmond Hill, Ontario, Canada; Clinical Chemistry Laboratory (G.M.), AOU San Giovanni Battista, Torino, Italy; Department of Medical and Surgical Sciences (C.P.), University of Padova, Padova, Italy
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Impact of Different Diagnostic Criteria During Adrenal Vein Sampling on Reproducibility of Subtype Diagnosis in Patients With Primary Aldosteronism. Hypertension 2010; 55:667-73. [DOI: 10.1161/hypertensionaha.109.146613] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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39
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Affiliation(s)
- Paul M Stewart
- Centre for Endocrinology, Diabetes & Metabolism, University of Birmingham and Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.
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40
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Dudczak R, Traub-Weidinger T. PET and PET/CT in endocrine tumours. Eur J Radiol 2010; 73:481-93. [PMID: 20089377 DOI: 10.1016/j.ejrad.2009.12.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Accepted: 12/15/2009] [Indexed: 10/19/2022]
Abstract
Functional information provided by PET tracers together with the superior image quality and the better data quantification by PET technology had a changing effect on the significance of nuclear medicine in medical issues. Recently introduced hybrid PET/CT systems together with the introduction of novel PET radiopharmaceuticals have contributed to the fact that nuclear medicine has become a growing diagnostic impact on endocrinology. In this review imaging strategies, different radiopharmaceuticals including the basic mechanism of their cell uptake, and the diagnostic value of PET and PET/CT in endocrine tumours except differentiated thyroid carcinomas will be discussed.
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Affiliation(s)
- Robert Dudczak
- Department of Nuclear Medicine, Medical University of Vienna, Austria.
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41
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Effects of female sex hormones and contraceptive pill on the diagnostic work-up for primary aldosteronism. J Hypertens 2010; 28:135-42. [DOI: 10.1097/hjh.0b013e32833266e3] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sukor N, Gordon RD, Ku YK, Jones M, Stowasser M. Role of unilateral adrenalectomy in bilateral primary aldosteronism: a 22-year single center experience. J Clin Endocrinol Metab 2009; 94:2437-45. [PMID: 19401369 DOI: 10.1210/jc.2008-2803] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The aim of the study was to examine blood pressure and biochemical responses to unilateral adrenalectomy in patients with bilateral primary aldosteronism (PA) and identify predictive parameters. CONTEXT PA considered due to bilateral autonomous production of aldosterone is usually treated medically. Unilateral adrenalectomy has been considered ineffective. Because quality outcome data are lacking and medical treatment may cause adverse effects or fail to control hypertension, defining the role for unilateral adrenalectomy in bilateral PA is an important clinical issue. DESIGN AND SETTING Between 1984 and 2004, 51 of 684 patients diagnosed with bilateral PA underwent unilateral adrenalectomy. This report is based on the records of the 40 considered suitable for inclusion, who were followed for at least 12 (median, 56.4) months. RESULTS Hypertension was cured in 15% of patients and improved in 20%, usually within 1 yr of unilateral adrenalectomy. The proportion with controlled hypertension was significantly (P < 0.001) higher after adrenalectomy (65%) than before (25%). Mean systolic (P < 0.001) and diastolic (P < 0.001) blood pressure, left ventricular mass index (P < 0.05), plasma upright aldosterone (P < 0.05), and aldosterone/renin ratio (P < 0.001) fell. Serum creatinine independently predicted hypertension cure. CONCLUSION Although this retrospective analysis of patients from a single center does not permit prediction of response rates among patients diagnosed elsewhere, it suggests that unilateral adrenalectomy can be beneficial in some patients with apparent bilateral PA and should not be dismissed as a treatment option.
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Affiliation(s)
- Norlela Sukor
- Endocrine Hypertension Research Center, University of Queensland School of Medicine, Greenslopes and Princess Alexandra Hospitals, Australia
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43
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Mulatero P, Bertello C, Verhovez A, Rossato D, Giraudo G, Mengozzi G, Limerutti G, Avenatti E, Tizzani D, Veglio F. Differential diagnosis of primary aldosteronism subtypes. Curr Hypertens Rep 2009; 11:217-23. [DOI: 10.1007/s11906-009-0038-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Schirpenbach C, Segmiller F, Diederich S, Hahner S, Lorenz R, Rump LC, Seufert J, Quinkler M, Bidlingmaier M, Beuschlein F, Endres S, Reincke M. The diagnosis and treatment of primary hyperaldosteronism in Germany: results on 555 patients from the German Conn Registry. DEUTSCHES ARZTEBLATT INTERNATIONAL 2009; 106:305-11. [PMID: 19547646 DOI: 10.3238/arztebl.2009.0305] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2008] [Accepted: 12/17/2008] [Indexed: 11/27/2022]
Abstract
BACKGROUND Primary hyperaldosteronism (Conn's syndrome) is being diagnosed increasingly often. As many as 12% of patients with hypertension have the characteristic laboratory constellation of Conn's syndrome. Its diagnosis and treatment have not been standardized. METHODS The authors retrospectively analyzed data of 555 patients (327 men and 228 women, aged 55 +/- 13 years) who were treated for primary hyperaldosteronism in 5 different centers from 1990 to 2006. The objective was to determine center-specific features of diagnosis and treatment. RESULTS 353 (63%) of the patients had the hypokalemic variant of primary hyperaldosteronism; 202 never had documented hypokalemia. The centers differed markedly with respect to the patients' clinical presentation, diagnostic testing of endocrine function, and diagnostic imaging techniques, including adrenal venous sampling. The adrenalectomy rate ranged from 15% to 46%. CONCLUSIONS The registry data reveal an unexpected heterogeneity in the diagnostic evaluation and treatment of primary hyperaldosteronism. National or international guidelines are needed so that these can be standardized.
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Affiliation(s)
- Caroline Schirpenbach
- Medizinische Klinik Innenstadt, Klinikum der Ludwig-Maximilians-Universität München, Germany
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Locsei Z, Racz K, Patocs A, Kovacs GL, Toldy E. Influence of sampling and storage conditions on plasma renin activity and plasma renin concentration. Clin Chim Acta 2009; 402:203-5. [DOI: 10.1016/j.cca.2009.01.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Morello F, Schiavone D, Mengozzi G, Bertello C, Liew CC, Bisbocci D, Mulatero P, Veglio F. Adrenal endothelin-1 levels are not associated with aldosterone secretion in primary aldosteronism. Eur J Endocrinol 2009; 160:453-8. [PMID: 19073831 DOI: 10.1530/eje-08-0828] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Endothelin-1 (ET-1) may function as an aldosterone secretagogue and, in turn, aldosterone can upregulate ET-1 expression. Hence, the existence of a feedforward loop involving ETs and aldosterone has been speculated in primary aldosteronism (PA). In the present study, we sought to examine ET-1 secretion from the adrenal glands in patients with PA. DESIGN We determined ET-1 levels in blood samples obtained during adrenal venous sampling of patients affected by PA (n=17). Furthermore, we examined the mRNA expression of the ET system in tissue samples from aldosterone-producing adenomas (APAs, n=9) and control normal adrenals (n=3). METHODS Blood ET-1 levels were determined by RIA. Tissue mRNA expression of the ET system was assayed with Affymetrix microarrays. RESULTS ET-1 levels did not differ between inferior vena cava and adrenal vein blood in both bilateral adrenal hyperplasia and APA patients. Moreover, cortisol-normalized ET-1 levels did not show lateralized adrenal ET-1 secretion in APAs. Through gene expression profiling with microarray performed in a distinct set of APA individuals (n=9), we confirmed the adrenal expression of a complete ET system, but we did not detect a significant upregulation of ET components within the APA tissue compared with normal adrenals. CONCLUSIONS The present data argue against the hypothesis of increased ET-1 secretion from APAs and do not support a general role for adrenal ET-1 in the vascular pathophysiology of PA.
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Affiliation(s)
- F Morello
- Fourth Division of Internal Medicine and Hypertension Unit, San Giovanni Battista Hospital of Torino, University of Torino, Torino, Italy.
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Lampron A, Bourdeau I, Oble S, Godbout A, Schürch W, Arjane P, Hamet P, Lacroix A. Regulation of aldosterone secretion by several aberrant receptors including for glucose-dependent insulinotropic peptide in a patient with an aldosteronoma. J Clin Endocrinol Metab 2009; 94:750-6. [PMID: 19066304 DOI: 10.1210/jc.2008-1340] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Primary adrenal Cushing's syndrome can result from the aberrant adrenal expression of several hormone receptors; this mechanism has not been explored in detail in aldosterone-producing tumors. OBJECTIVE The objective of the study was to evaluate a 56-yr-old male patient with an aldosteronoma for the regulation of aldosterone secretion by aberrant hormone receptors. RESULTS Renin-independent stimulation of aldosterone secretion was observed in vivo after a mixed meal, oral glucose, or administration of glucose-dependent insulinotropic peptide (GIP), vasopressin, and tegaserod. The mixed meal-mediated stimulation of aldosterone was not present in five other cases of aldosteronoma. A smaller response of aldosterone after GIP infusion was observed in a normal subject. Aldosterone secretion was stimulated by GIP in primary cultures of this patient's aldosteronoma. Increased expression of GIP receptor was found in this aldosteronoma by real-time RT-PCR and immunohistochemistry. The GIP receptor protein was also found at lower levels in zona glomerulosa cells of the normal adjacent adrenal gland. Increased expression of serotonin 4 and ACTH receptors was also present in this aldosteronoma. CONCLUSIONS This case report provides new evidence of the implication of aberrant hormone receptors in the regulation of this aldosteronoma and suggests that further detailed studies of the role of aberrant hormone receptors in this frequent pathology should be undertaken.
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Affiliation(s)
- Antoine Lampron
- Division of Endocrinology, Centre Hospitalier de l'Université de Montré al, Montré al, Qué bec, Canada H2W 1T8
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Goto A, Takahashi Y, Kishimoto M, Minowada S, Aibe H, Hasuo K, Kajio H, Noda M. Primary aldosteronism associated with severe rhabdomyolysis due to profound hypokalemia. Intern Med 2009; 48:219-23. [PMID: 19218772 DOI: 10.2169/internalmedicine.48.1444] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 55-year-old Japanese man was admitted to our hospital with severe weakness. Without measurement of serum electrolyte concentrations, diuretic therapy for hypertension was started 2 weeks prior to admission. Laboratory findings showed profound hypokalemia (1.4 mEq/L), and extreme elevation of the serum creatinine phosphokinase levels (15,760 IU/L), suggesting that the patient had hypokalemic paralysis and hypokalemia-induced rhabdomyolysis. Further evaluations, including adrenal venous sampling strongly suggested that he had primary aldosteronism. He was treated successfully by laparoscopic adrenalectomy. This case provides an important lesson that serum electrolyte concentrations should be measured in hypertensive patients before the administration of antihypertensive agents.
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Affiliation(s)
- Atsushi Goto
- Department of Diabetes and Metabolic Medicine, International Medical Center of Japan, Tokyo
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Rossi GP, Seccia TM, Pessina AC. Clinical Use of Laboratory Tests for the Identification of Secondary Forms of Arterial Hypertension. Crit Rev Clin Lab Sci 2008; 44:1-85. [PMID: 17175520 DOI: 10.1080/10408360600931831] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The prevalence of secondary hypertension can be underestimated if appropriate tests are not performed. The importance of selecting patients with a high pre-test probability of secondary forms of hypertension is first discussed. The laboratory tests currently used for seeking a cause of hypertension are critically reviewed, with emphasis on their operative features and limitations. Strategies to identify primary aldosteronism, the most frequent form of secondary hypertension, and to determine its unilateral or bilateral causes are described. Treatment entails adrenalectomy in unilateral forms, and mineralocorticoid receptor blockade in bilateral forms. Renovascular hypertension is also a common, curable form of hypertension, that should be identified as early as possible to avoid the onset of cardiovascular target organ damage. The tests for its confirmation or exclusion are discussed. The various tests available for the diagnosis of pheochromocytoma, which is much rarer than the above but extremely important to identify, are also described, with emphasis on recent developments in genetic testing. Finally, the tests for diagnosing some rarer monogenic forms and other renal and endocrine causes of arterial hypertension are explored.
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Affiliation(s)
- Gian Paolo Rossi
- Department of Clinical and Experimental Medicine, University of Padova, Padova, Italy.
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Nogueira AR, Bloch KV. Screening for Primary Aldosteronism in a Cohort of Brazilian Patients With Resistant Hypertension. J Clin Hypertens (Greenwich) 2008; 10:619-23. [DOI: 10.1111/j.1751-7176.2008.08421.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Armando R. Nogueira
- From the Hypertension Program, University Hospital Clementino Fraga Filho,1 and the Medical School and Institute of Community Health,2 Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Katia V. Bloch
- From the Hypertension Program, University Hospital Clementino Fraga Filho,1 and the Medical School and Institute of Community Health,2 Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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