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Yang YH, Chang YL, Lee BC, Lu CC, Wang WT, Hu YH, Liu HW, Lin YH, Chang CC, Wu WC, Tseng FY, Lin YH, Wu VC, Hwu CM. Strategies for subtyping primary aldosteronism. J Formos Med Assoc 2024; 123 Suppl 2:S114-S124. [PMID: 37202237 DOI: 10.1016/j.jfma.2023.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/26/2023] [Accepted: 05/04/2023] [Indexed: 05/20/2023] Open
Abstract
Adrenal venous sampling (AVS) is a crucial method for the lateralization of primary aldosteronism (PA). It is advised to halt the use of the patient's antihypertensive medications and correct hypokalemia prior to undergoing AVS. Hospitals equipped to conduct AVS should establish their own diagnostic criteria based on current guidelines. If the patient's antihypertensive medications cannot be discontinued, AVS can be performed as long as the serum renin level is suppressed. The Task Force of Taiwan PA recommends using a combination of adrenocorticotropic hormone stimulation, quick cortisol assay, and C-arm cone-beam computed tomography to maximize the success of AVS and minimize errors by using the simultaneous sampling technique. If AVS is not successful, an NP-59 (131 I-6-β-iodomethyl-19-norcholesterol) scan can be used as an alternative method to lateralize PA. We depicted the details of the lateralization procedures (mainly AVS, and alternatively NP-59) and their tips and tricks for confirmed PA patients who would consider to undergo surgical treatment (unilateral adrenalectomy) if the subtyping shows unilateral disease.
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Affiliation(s)
- Yun-Hsuan Yang
- Department of Medical Imaging, National Taiwan University Hospital, National Taiwan University College of Medicine, Taiwan
| | - Yu-Ling Chang
- Department of Medical Imaging, National Taiwan University Hospital, National Taiwan University College of Medicine, Taiwan
| | - Bo-Ching Lee
- Department of Medical Imaging, National Taiwan University Hospital, National Taiwan University College of Medicine, Taiwan
| | - Ching-Chu Lu
- Department of Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Ting Wang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan
| | - Ya-Hui Hu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, Taipei, Taiwan
| | - Han-Wen Liu
- Division of Endocrine and Metabolism, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan
| | - Yung-Hsiang Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Puzi, Chia-Yi, Taiwan
| | - Chin-Chen Chang
- Department of Medical Imaging, National Taiwan University Hospital, National Taiwan University College of Medicine, Taiwan; Department and Graduate Institute of Forensic Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Wan-Chen Wu
- Division of Endocrinology & Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Fen-Yu Tseng
- Division of Endocrinology & Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yen-Hung Lin
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan; Primary Aldosteronism Center at National Taiwan University Hospital, Taipei, Taiwan
| | - Vin-Cent Wu
- Primary Aldosteronism Center at National Taiwan University Hospital, Taipei, Taiwan; Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chii-Min Hwu
- Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan; Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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Lenzini L, Pintus G, Rossitto G, Seccia TM, Rossi GP. Primary Aldosteronism and Drug Resistant Hypertension: A "Chicken-Egg" Story. Exp Clin Endocrinol Diabetes 2023; 131:409-417. [PMID: 37054985 DOI: 10.1055/a-2073-3202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
Drug-resistant arterial hypertension (RH) is a major risk factor for cardiovascular disease, often due to overlooked underlying causes. Identification of such causes poses significant clinical challenges. In this setting, primary aldosteronism (PA) is a frequent cause of RH and its prevalence in RH patients is likely higher than 20%.The pathophysiological link between PA and the development and maintenance of RH involves target organ damage and the cellular and extracellular effects of aldosterone excess that promote pro-inflammatory and pro-fibrotic changes in the kidney and vasculature.The feasibility of adrenal vein sampling in PA patients with RH, and the clinical benefit achieved by adrenalectomy, further emphasize the need to implement systematic screening for this common form of secondary hypertension in the management of a high-risk population as RH patients.: We herein review the current knowledge of the factors that contribute to the RH phenotype with a focus on PA and discuss the issues regarding the screening for PA in this setting and the therapeutic approaches (surgical and medical) aimed at resolving RH caused by PA.
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Affiliation(s)
- L Lenzini
- Internal & Emergency Medicine Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - G Pintus
- Internal & Emergency Medicine Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - G Rossitto
- Internal & Emergency Medicine Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - T M Seccia
- Internal & Emergency Medicine Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy
| | - G P Rossi
- Internal & Emergency Medicine Unit, Department of Medicine - DIMED, University of Padua, Padua, Italy
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3
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Tang H, Hu Y, Deng J. Extracellular Vesicles and Hypertension. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1418:69-80. [PMID: 37603273 DOI: 10.1007/978-981-99-1443-2_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Hypertension implicates multiple organs and systems, accounting for the majority of cardiovascular diseases and cardiac death worldwide. Extracellular vesicles derived from various types of cells could transfer a variety of substances such as proteins, lipids, and nucleic acids from cells to cells, playing essential roles in both physiological and pathological processes. Extracellular vesicles are demonstrated to be closely associated with the development of essential hypertension by mediating the renin-angiotensin-aldosterone system and crosstalk between multiple vascular cells. Extracellular vesicles also participate in various kinds of pathogenesis of secondary hypertensions including acute kidney injury, renal parenchymal diseases, kidney transplantation, secretory diseases (primary aldosteronism, pheochromocytoma and paraganglioma, Cushing's syndrome), and obstructive sleep apnea. Extracellular vesicles have been proved to have the potential to be served as new biomarkers in the diagnosis, treatment, and prognosis assessment of hypertension. In the future, large multicenter cohorts are highly in demand for further verifying the sensitivity and specificity of extracellular vesicles as biomarkers.
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Affiliation(s)
- Heng Tang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yuxue Hu
- Shanghai Engineering Research Center of Organ Repair, School of Life Science, Shanghai University, Shanghai, China
| | - Jiali Deng
- Shanghai Engineering Research Center of Organ Repair, School of Life Science, Shanghai University, Shanghai, China.
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ATEŞ C, ADA G, MERCAN SARIDAŞ F, AYDEMİR E, HOCAOĞLU E, ÖZ GÜL Ö, CANDER S, ERSOY C, ERTÜRK E. Evaluation of Patients Performed with Saline Infusion Test with a Pre-Diagnosis of Primary Hyperaldosteronism. TURKISH JOURNAL OF INTERNAL MEDICINE 2022. [DOI: 10.46310/tjim.1072050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Lin X, Ullah MHE, Wu X, Xu F, Shan SK, Lei LM, Yuan LQ, Liu J. Cerebro-Cardiovascular Risk, Target Organ Damage, and Treatment Outcomes in Primary Aldosteronism. Front Cardiovasc Med 2022; 8:798364. [PMID: 35187110 PMCID: PMC8847442 DOI: 10.3389/fcvm.2021.798364] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/20/2021] [Indexed: 02/03/2023] Open
Abstract
Primary aldosteronism (PA) is the most common type of endocrine hypertension, and numerous experimental and clinical evidence have verified that prolonged exposure to excess aldosterone is responsible for an increased risk of cerebro-cardiovascular events and target organ damage (TOD) in patients with PA. Therefore, focusing on restoring the toxic effects of excess aldosterone on the target organs is very important to reduce cerebro-cardiovascular events. Current evidence convincingly demonstrates that both surgical and medical treatment strategies would benefit cerebro-cardiovascular outcomes and mortality in the long term. Understanding cerebro-cardiovascular risk in PA would help clinical doctors to achieve both early diagnosis and treatment. Therefore, in this review, we will summarize the cerebro-cardiovascular risk in PA, focusing on the TOD of aldosterone, including brain, heart, vascular system, renal, adipose tissues, diabetes, and obstructive sleep apnea (OSA). Furthermore, the various treatment outcomes of adrenalectomy and medical treatment for patients with PA will also be discussed. We hope this knowledge will help improve cerebro-cardiovascular prognosis and reduce the incidence and mortality of cerebro-cardiovascular events in patients with PA.
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Affiliation(s)
- Xiao Lin
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Muhammad Hasnain Ehsan Ullah
- Department of Endocrinology and Metabolism, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiong Wu
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Feng Xu
- Department of Endocrinology and Metabolism, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Su-Kang Shan
- Department of Endocrinology and Metabolism, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Li-Min Lei
- Department of Endocrinology and Metabolism, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ling-Qing Yuan
- Department of Endocrinology and Metabolism, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, Changsha, China
- Ling-Qing Yuan
| | - Jun Liu
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Medical Imaging in Hunan Province, Changsha, China
- Department of Radiology Quality Control Center in Hunan Province, Changsha, China
- *Correspondence: Jun Liu
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Carvajal CA, Tapia-Castillo A, Pérez JA, Fardella CE. Primary Aldosteronism, Aldosterone, and Extracellular Vesicles. Endocrinology 2022; 163:6433012. [PMID: 34918071 DOI: 10.1210/endocr/bqab240] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Indexed: 01/02/2023]
Abstract
Primary aldosteronism (PA) is an endocrine related condition leading to arterial hypertension due to inappropriately high and unregulated aldosterone concentration. Recently, a broad spectrum of PA has been recognized, which brings new challenges associated with early identification of this condition that affect renal epithelial and extrarenal tissues. Reports have shown the potential role of extracellular vesicles (EVs) and EV cargo as novel and complementary biomarkers in diagnosis and prognosis of PA. In vivo and in vitro studies have identified specific EV surface antigens, EV-proteins, and EV microRNAs that can be useful to develop novel diagnostic algorithms to detect, confirm, or follow up the PA. Moreover, the study of EVs in the field of PA provides further insight in the pathophysiological mechanism of the PA disease.
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Affiliation(s)
- Cristian A Carvajal
- Department of Endocrinology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute of Immunology and Immunotherapy (IMII-ICM), Santiago, Chile
- Centro Traslacional de Endocrinología UC (CETREN-UC), Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alejandra Tapia-Castillo
- Department of Endocrinology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute of Immunology and Immunotherapy (IMII-ICM), Santiago, Chile
- Centro Traslacional de Endocrinología UC (CETREN-UC), Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jorge A Pérez
- Department of Endocrinology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute of Immunology and Immunotherapy (IMII-ICM), Santiago, Chile
- Centro Traslacional de Endocrinología UC (CETREN-UC), Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carlos E Fardella
- Department of Endocrinology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute of Immunology and Immunotherapy (IMII-ICM), Santiago, Chile
- Centro Traslacional de Endocrinología UC (CETREN-UC), Pontificia Universidad Católica de Chile, Santiago, Chile
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Cai H, Chen SM, Ke ZB, Chen H, Zhu JM, Lin TT, Huang F, Wei Y, Zheng QS, Xue XY, Sun XL, Xu N. Development and Validation of Hub Genes for Adrenal Aldosterone-Producing Adenoma by Integrated Bioinformatics Analysis. Int J Gen Med 2021; 14:10003-10013. [PMID: 34984024 PMCID: PMC8702988 DOI: 10.2147/ijgm.s330956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 11/30/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To develop and validate hub genes involving in the development and progression of primary aldosteronism (PA) and adrenal aldosterone-producing adenoma (APA). MATERIALS AND METHODS A total of four datasets of gene expression profiles related to APA were downloaded from GEO datasets. GSE60042 and GSE8514 were used to identify DEGs. Weighted gene co-expression network analysis (WGCNA) and protein-protein interaction (PPI) network module analysis were conducted. GO and KEGG enrichment analysis was performed. GSE10927 and GSE33371 were used for further external validation. RESULTS We identified a total of 892 DEGs from GSE60042 and 1167 DEGs from GSE8514. WGCNA analysis demonstrated that the blue module (255 genes) and turquoise module (303 genes) were significantly correlated with APA. PPI networks were then constructed. GO term enrichment analysis suggested that cellular divalent inorganic cation homeostasis, calcium ion homeostasis, collagen-containing extracellular matrix, transport vesicle and metal ion transmembrane transporter activity were the vital annotations. KEGG pathway analysis found that these genes were significantly enriched in neuroactive ligand-receptor interaction, calcium signaling pathway. Finally, we identified a total of 11 candidate genes involving in the development and progression of APA and PA. Besides, two independent datasets (GSE10927 and GSE33371) were used for external validation, and there were seven hub genes successfully verified, including C3, GRM3, AVPR1A, WFS1, PTGFR, NTSR2, and JUN. CONCLUSION These newly identified genes could contribute to the understanding of potential mechanism in APA and PA and might be promising targets for the treatment of APA and PA.
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Affiliation(s)
- Hai Cai
- Department of Urology, Urology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, People’s Republic of China
| | - Shao-Ming Chen
- Department of Nuclear Medicine, First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, People's Republic of China
| | - Zhi-Bin Ke
- Department of Urology, Urology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, People’s Republic of China
| | - Hang Chen
- Department of Urology, Urology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, People’s Republic of China
| | - Jun-Ming Zhu
- Department of Urology, Urology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, People’s Republic of China
| | - Ting-Ting Lin
- Department of Urology, Urology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, People’s Republic of China
| | - Fei Huang
- Fujian Key Laboratory of Precision Medicine for Cancer, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, People’s Republic of China
- Central Lab, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, People’s Republic of China
| | - Yong Wei
- Department of Urology, Urology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, People’s Republic of China
| | - Qing-Shui Zheng
- Department of Urology, Urology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, People’s Republic of China
| | - Xue-Yi Xue
- Department of Urology, Urology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, People’s Republic of China
| | - Xiong-Lin Sun
- Department of Urology, Urology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, People’s Republic of China
| | - Ning Xu
- Department of Urology, Urology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, People’s Republic of China
- Fujian Key Laboratory of Precision Medicine for Cancer, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, People’s Republic of China
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In Silico Analysis of the Gene Expression Patterns between Aldosterone-Producing Adenoma and Nonfunctional Adrenocortical Adenoma. Genet Res (Camb) 2021; 2021:9553637. [PMID: 34690553 PMCID: PMC8505127 DOI: 10.1155/2021/9553637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 09/15/2021] [Indexed: 11/18/2022] Open
Abstract
Primary aldosteronism is the most common form of secondary hypertension, and aldosteronoma makes up a significant proportion of primary aldosteronism cases. Aldosteronoma is also called aldosterone-producing adenoma (APA). Although there have been many studies about APA, the pathogenesis of this disease is not yet fully understood. In this study, we aimed to find out the difference of gene expression patterns between APA and nonfunctional adrenocortical adenoma (NFAA) using a weighted gene coexpression network (WGCNA) and differentially expressed gene (DEG) analysis; only the genes that meet the corresponding standards of both methods were defined as real hub genes and then used for further analysis. Twenty-nine real hub genes were found out, most of which were enriched in the phospholipid metabolic process. WISP2, S100A10, SSTR5-AS1, SLC29A1, APOC1, and SLITRK4 are six real hub genes with the same gene expression pattern between the combined and validation datasets, three of which indirectly or directly participate in lipid metabolism including WISP2, S100A10, and APOC1. According to the gene expression pattern of DEGs, we speculated five candidate drugs with potential therapeutic value for APA, one of which is cycloheximide, an inhibitor for phospholipid biosynthesis. All the evidence suggests that phospholipid metabolism may be an important pathophysiological mechanism for APA. Our study provides a new perspective regarding the pathophysiological mechanism of APA and offers some small molecules that may possibly be effective drugs against APA.
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Salvetti M, Paini A, Bertacchini F, Aggiusti C, Stassaldi D, Capellini S, Arnoldi C, Rizzoni D, Agabiti Rosei C, De Ciuceis C, Muiesan ML. Myocardial mechano-energetic efficiency in primary aldosteronism. J Hypertens 2021; 39:318-324. [PMID: 32868642 DOI: 10.1097/hjh.0000000000002637] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Available data indicate that patients with primary aldosteronism have an increased risk of cardiovascular events and cardiovascular risk seems to be, at least in part, independent of blood pressure (BP) values. Patients with primary aldosteronism have a greater prevalence of left ventricular (LV) hypertrophy and subtle alterations of ventricular function, which might contribute to the increase in cardiovascular risk. Recently, a noninvasive approach for the estimation of LV mechanical efficiency, obtained by echocardiography has been proposed. AIM OF THE STUDY To evaluate the determinants of myocardial mechanoenergetic efficiency index (MEEi), in a large group of patients with primary aldosteronism (n = 99) and in a control group of essential hypertensive patients (n = 99) matched for age, sex and BP values. RESULTS No differences between groups for age, sex, BMI, BP values, glucose, lipid profile and renal function were observed. LV mass index was greater in primary aldosteronism vs. essential hypertensive patients (46.0 ± 16.7 vs. 36.9 ± 8.6 g/m2, P < 0.001); also relative wall thickness was greater in primary aldosteronism (0.36 ± 0.1 vs. 0.32 ± 0.4, P < 0.001). Left atrial dimensions were significantly greater in primary aldosteronism. Ejection fraction was not different between groups, while endocardial and midwall fractional shortening were lower in primary aldosteronism vs. essential hypertensive patients (40 ± 7 vs. 43 ± 6, and 18 ± 3 vs. 21 ± 2, both P < 0.01). MEEi was lower in primary aldosteronism vs. essential hypertensive patients (0.44 ± 0.14 vs. 0.52 ± 0.10 ml/s per g, P < 0.01). A negative correlation was observed between MEEi and aldosterone levels (r = -0.203, P < 0.05) and aldosterone : renin ratio (P = -0.172, P < 0.05); the correlation remained significant after adjustment for possible confounders. CONCLUSION In patients with primary aldosteronism myocardial MEEi is lower as compared with essential hypertensive patients. A reduced MEEi may reflect an impairment of production and utilization of energy in the myocardium, which could lead to the occurrence of cardiovascular complications and therefore these findings may contribute to explain the increased risk of cardiovascular events in patients with primary aldosteronism.
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Affiliation(s)
- Massimo Salvetti
- 2a Medicina ASST Spedali Civili di Brescia
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Anna Paini
- 2a Medicina ASST Spedali Civili di Brescia
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Fabio Bertacchini
- 2a Medicina ASST Spedali Civili di Brescia
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Carlo Aggiusti
- 2a Medicina ASST Spedali Civili di Brescia
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Deborah Stassaldi
- 2a Medicina ASST Spedali Civili di Brescia
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Sara Capellini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Chiara Arnoldi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Damiano Rizzoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Claudia Agabiti Rosei
- 2a Medicina ASST Spedali Civili di Brescia
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Carolina De Ciuceis
- 2a Medicina ASST Spedali Civili di Brescia
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Maria Lorenza Muiesan
- 2a Medicina ASST Spedali Civili di Brescia
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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Yalniz C, Morani AC, Waguespack SG, Elsayes KM. Imaging of Adrenal-Related Endocrine Disorders. Radiol Clin North Am 2020; 58:1099-1113. [PMID: 33040851 DOI: 10.1016/j.rcl.2020.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Endocrine disorders associated with adrenal pathologies can be caused by insufficient adrenal gland function or excess hormone secretion. Excess hormone secretion may result from adrenal hyperplasia or hormone-secreting (ie, functioning) adrenal masses. Based on the hormone type, functioning adrenal masses can be classified as cortisol-producing tumors, aldosterone producing tumors, and androgen-producing tumors, which originate in the adrenal cortex, as well as catecholamine-producing pheochromocytomas, which originate in the medulla. Nonfunctioning lesions can cause adrenal gland enlargement without causing hormonal imbalance. Evaluation of adrenal-related endocrine disorders requires clinical and biochemical workup associated with imaging evaluation to reach a diagnosis and guide management.
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Affiliation(s)
- Ceren Yalniz
- Department of Abdominal Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX 77030, USA
| | - Ajaykumar C Morani
- Department of Abdominal Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX 77030, USA
| | - Steven G Waguespack
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX 77030, USA
| | - Khaled M Elsayes
- Department of Abdominal Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX 77030, USA.
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Influence of antihypertensive drugs in the subtype diagnosis of primary aldosteronism by adrenal venous sampling. J Hypertens 2020; 37:1493-1499. [PMID: 31033727 DOI: 10.1097/hjh.0000000000002047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Because of the influence on the renin-angiotensin-aldosterone system, it is recommended to avoid, if possible, the use of angiotensin-converting-enzyme inhibitors, angiotensin II type 1 receptor blockers, diuretics, β-blockers, and mineralocorticoid receptor antagonists during the diagnostic period of primary aldosteronism. A laterality index more than 4 in adrenocorticotropic hormone (ACTH)-stimulated adrenal venous sampling (ACTH-AVS) is a widely used classification of the unilateral subtype that can benefit from adrenalectomy. Here, we revealed clinical features of patients taking drugs that could affect the primary aldosteronism diagnosis (DAPD) and investigated whether the classification with laterality index more than 4 in ACTH-AVS is applicable to these patients. PATIENTS AND METHODS Using a large database of primary aldosteronism patients in Japan, we analyzed 2122 patients with successful ACTH-AVS. RESULTS Patients who received any DAPD (n = 209) showed higher prevalence of comorbidity burdens and took more antihypertensive drugs compared with patients without DAPD. In patients taking DAPD, those with laterality index more than 4 had a higher prevalence of hypokalemia, a higher aldosterone-to-renin ratio and a higher prevalence of adrenal mass than those with laterality index of 4 or less. Adrenalectomy was performed in 76% patients with laterality index more than 4 and 20% with laterality index of 4 or less. Patients who underwent adrenalectomy showed biochemical cure in 89% with laterality index more than 4 and 50% with laterality index of 4 or less (P = 0.001). Multivariate regression analysis showed that laterality index more than 4 was an independent predictor of a biochemical cure. Biochemical cure rate in patients with laterality index more than 4 was consistently high, irrespective of the potential effect of individual DAPD on laterality index. CONCLUSION Our findings suggest that in primary aldosteronism patients to whom DAPD were administrated due to severe clinical features, laterality index more than 4 in ACTH-AVS could accurately predict a biochemical cure after adrenalectomy.
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12
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Rossi GP. Primary Aldosteronism: JACC State-of-the-Art Review. J Am Coll Cardiol 2020; 74:2799-2811. [PMID: 31779795 DOI: 10.1016/j.jacc.2019.09.057] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 09/13/2019] [Accepted: 09/24/2019] [Indexed: 12/22/2022]
Abstract
Primary aldosteronism (PA) is a common, but frequently overlooked, cause of arterial hypertension and excess cardiovascular events, particularly atrial fibrillation. As timely diagnosis and treatment can provide a cure of hyperaldosteronism and hypertension, even when the latter is resistant to drug treatment, strategies to screen patients for PA early with a simplified diagnostic algorithm are justified. They can be particularly beneficial in some subgroups of hypertensive patients, as those who are at highest cardiovascular risk. However, identification of the surgically curable cases of PA and achievement of optimal results require subtyping with adrenal vein sampling, which, as it is technically challenging and currently performed only in tertiary referral centers, represents the bottleneck in the work-up of PA. Measures aimed at improving the clinical use of adrenal vein sampling and at developing alternative techniques for subtyping, alongside recommendations for drug treatment, including new development in the field, and for follow-up are discussed.
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Affiliation(s)
- Gian Paolo Rossi
- Hypertension Unit, Department of Medicine, DIMED, University of Padova, Padova, Italy.
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13
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10 good reasons why adrenal vein sampling is the preferred method for referring primary aldosteronism patients for adrenalectomy. J Hypertens 2020; 37:603-611. [PMID: 30431526 DOI: 10.1097/hjh.0000000000001939] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
: Nowadays most patients diagnosed with surgically curable primary aldosteronism have small or micro aldosterone-producing adenoma or unilateral micronodular hyperplasia, which are undetectable with available imaging technologies. Therefore, a negative imaging test by no means excludes unilateral primary aldosteronism. Moreover, about 10% of the subjects above the age of 35 years have nonfunctioning adrenal tumors, regardless of being hypertensive or not, with a prevalence that raises with aging. Hence, the finding of an adrenal mass at imaging does not reliably detect the culprit of primary aldosteronism. On the other hand, when primary aldosteronism patients are selected for adrenalectomy on the basis of demonstration of lateralized aldosterone excess at adrenal vein sampling (AVS), close to 100% are biochemically cured from the hyperaldosteronism, about 45% are cured of arterial hypertension and an additional 52% are markedly improved in terms of blood pressure control. By contrast, patients referred for surgery based on imaging alone often fail to reach these successful outcomes, indicating that surgery was unnecessary or, even worse, performed on the wrong side. For these reasons, and because of the lack of accurate and widely available alternative methods, all current guidelines recommend that AVS be offered to all primary aldosteronism patients with only few exceptions, mainly in patients unable or unwilling to undergo surgery and those with germ-line mutations causing familial primary aldosteronism. The main argument against systematic use of AVS entails its suboptimal performance, partly justified by its intrinsic technical difficulty, and its limited availability. This led to propose skipping AVS strategies for predicting surgically curable primary aldosteronism, but success has been inconsistent. The most urgent standing issue is, therefore, not to find loopholes to avoid AVS, but rather to improve its use, which means improving the rate of AVS success, through formal training of interventionists, selection of appropriate cutoffs and exploitation of a standardized procedure.
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14
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Yang T, He M, Zhang H, Barrett PQ, Hu C. L- and T-type calcium channels control aldosterone production from human adrenals. J Endocrinol 2020; 244:237-247. [PMID: 31652415 PMCID: PMC7108971 DOI: 10.1530/joe-19-0259] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 10/25/2019] [Indexed: 11/08/2022]
Abstract
Aldosterone, which plays a key role in the regulation of blood pressure, is produced by zona glomerulosa (ZG) cells of the adrenal cortex. Exaggerated overproduction of aldosterone from ZG cells causes primary hyperaldosteronism. In ZG cells, calcium entry through voltage-gated calcium channels plays a central role in the regulation of aldosterone secretion. Previous studies in animal adrenals and human adrenal adrenocortical cell lines suggest that the T-type but not the L-type calcium channel activity drives aldosterone production. However, recent clinical studies show that somatic mutations in L-type calcium channels are the second most prevalent cause of aldosterone-producing adenoma. Our objective was to define the roles of T and L-type calcium channels in regulating aldosterone secretion from human adrenals. We find that human adrenal ZG cells mainly express T-type CaV3.2/3.3 and L-type CaV1.2/1.3 calcium channels. TTA-P2, a specific inhibitor of T-type calcium channel subtypes, reduced basal aldosterone secretion from acutely prepared slices of human adrenals. Surprisingly, nifedipine, the prototypic inhibitor of L-type calcium channels, also decreased basal aldosterone secretion, suggesting that L-type calcium channels are active under basal conditions. In addition, TTA-P2 or nifedipine also inhibited aldosterone secretion stimulated by angiotensin II- or elevations in extracellular K+. Remarkably, blockade of either L- or T-type calcium channels inhibits basal and stimulated aldosterone production to a similar extent. Low concentrations of TTA-P2 and nifedipine showed additive inhibitory effect on aldosterone secretion. We conclude that T- and L-type calcium channels play equally important roles in controlling aldosterone production from human adrenals.
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Affiliation(s)
- Tingting Yang
- Department of Physiology and Biophysics, School of Life Sciences, Institutes of Brain Science, Fudan University, Shanghai, China
| | - Min He
- Department of Physiology and Biophysics, School of Life Sciences, Institutes of Brain Science, Fudan University, Shanghai, China
| | - Hailiang Zhang
- Department of Urology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan university, shanghai, China
- corresponding author and person to whom reprint requests should be addressed: Changlong Hu (), or Hailiang Zhang (), Department of Physiology and Biophysics, School of Life Sciences, Institutes of Brain Science, Fudan University, 2005 Songhu Road, Shanghai 200438, China. Tel:(86)-21-31246652
| | - Paula Q. Barrett
- Department of Pharmacology, University of Virginia, Charlottesville, Virginia, USA
| | - Changlong Hu
- Department of Physiology and Biophysics, School of Life Sciences, Institutes of Brain Science, Fudan University, Shanghai, China
- corresponding author and person to whom reprint requests should be addressed: Changlong Hu (), or Hailiang Zhang (), Department of Physiology and Biophysics, School of Life Sciences, Institutes of Brain Science, Fudan University, 2005 Songhu Road, Shanghai 200438, China. Tel:(86)-21-31246652
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15
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Abstract
Adrenal venous sampling is the gold standard test to identify surgically curable primary aldosteronism, but it is markedly underused in clinical practice being perceived as a technically challenging and invasive procedure and, moreover, as difficult to interpret. This review provides updated information on current indications to adrenal venous sampling and how to perform and interpret adrenal venous sampling.
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Affiliation(s)
- Gian Paolo Rossi
- Arterial Hypertension Unit, Clinica dell'Ipertensione Arteriosa, Department of Medicine, DIMED University Hospital, University of Padova, Via Giustiniani, 2, Padova 35126, Italy.
| | - Giuseppe Maiolino
- Clinica dell'Ipertensione Arteriosa, Department of Medicine, DIMED, University of Padova, Via Giustiniani, 2, Padova 35126, Italy
| | - Teresa M Seccia
- Clinica dell'Ipertensione Arteriosa, Department of Medicine, DIMED, University of Padova, Via Giustiniani, 2, Padova 35126, Italy
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16
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Rossi GP, Caroccia B, Seccia TM. Role of estrogen receptors in modulating aldosterone biosynthesis and blood pressure. Steroids 2019; 152:108486. [PMID: 31499072 DOI: 10.1016/j.steroids.2019.108486] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 08/23/2019] [Accepted: 09/03/2019] [Indexed: 12/28/2022]
Abstract
Blood pressure is lower in premenopausal women than in age-matched men; after menopause blood pressure values and the prevalence of hypertension show opposite trends indicating that estrogens contribute to maintaining normal blood pressure values in women. In experimental studies menopause increases aldosterone levels, an effect alleviated by estrogen treatment. We have recently discovered a role of estrogen receptors (ER) in controlling aldosterone biosynthesis in the human adrenocortical zona glomerulosa, which expresses both the classical ERα and β receptors and G protein-coupled estrogen receptor (GPER). We have also identified that GPER mediates an aldosterone-induced aldosterone response. We found that 17 β-estradiol exerts a dual effect: it blunts aldosterone production via ERβ, but displays a potent aldosterone secretagogue effect via GPER activation after ERβ blockade. Thus, in premenopausal women high estrogen levels might tonically blunt aldosterone synthesis via ERβ, thereby maintaining normal blood pressure; after menopause loss of this estrogen-mediated inhibition can contribute to increasing blood pressure via GPER-mediated aldosterone release. The additional findings that GPER mediates an aldosterone-induced stimulation of aldosterone biosynthesis and that GPER predominates in aldosterone-producing adenomas strongly involves this receptor in the pathophysiology of primary aldosteronism. Our purpose here was to provide an update on estrogen receptor function in the normal adrenal cortex and its relevance for the sex differences in blood pressure in light of the newly discovered role of GPER in regulating aldosterone synthesis. The implications of the novel knowledge for the treatment of estrogen-dependent malignancies with ER modulators are also discussed.
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17
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CaF 2 nanoparticles as peroxidase mimics for rapid and sensitive detection of aldosterone. Anal Chim Acta 2019; 1078:119-124. [PMID: 31358209 DOI: 10.1016/j.aca.2019.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 05/28/2019] [Accepted: 06/03/2019] [Indexed: 12/21/2022]
Abstract
In this work, CaF2 nanoparticles were successfully synthesized by a simple direct precipitation method and firstly used as a peroxidase mimics for rapid and high sensitive colorimetric detection of aldosterone. The CaF2 nanoparticles were characterized by scanning electron microscope (SEM), transmission electron microscopy (TEM) and powder X-ray diffraction (XRD). The CaF2 nanoparticles can oxidize 3,3',5,5'-tetramethylbenzidine (TMB) to produce a blue product oxidized TMB (oxTMB) in the presence of H2O2 and this peroxidase-like activity of CaF2 is found out to follow Michaelis-Menten kinetics. Experiments showed that the catalytic mechanism of CaF2 nanoparticles was attributed to that it could result in the decomposition of H2O2 to produce hydroxyl radicals (•OH). The absorbance change value of the reaction system was linear with the aldosterone concentration in the range of 2.0-40.0 nM, and the detection limit was 0.6 nM. Moreover, the developed method was applied to detect aldosterone in human serum samples. It provides a new platform for enzyme functional simulation and analytical sensing research.
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18
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Vorselaars WM, van Beek DJ, Postma EL, Spiering W, Borel Rinkes IH, Valk GD, Vriens MR, Zarnegar R, Drake FT, Duh QY, Talutis SD, McAneny DB, McManus C, Lee JA, Grant SB, Grogan RH, Romero Arenas MA, Perrier ND, Peipert BJ, Mongelli MN, Castelino T, Mitmaker EJ, Parente DN, Pasternak JD, Engelsman AF, Sywak M, D’Amato G, Raffaelli M, Schuermans V, Bouvy ND, Eker HH, Bonjer HJ, Vaarzon Morel NM, Nieveen van Dijkum EJ, Metman MJ, Kruijff S. Clinical outcomes after surgery for primary aldosteronism: Evaluation of the PASO-investigators’ consensus criteria within a worldwide cohort of patients. Surgery 2019; 166:61-68. [DOI: 10.1016/j.surg.2019.01.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/02/2019] [Accepted: 01/23/2019] [Indexed: 12/28/2022]
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19
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Akasaka H, Yamamoto K, Rakugi H, Nagasawa M, Nakamaru R, Ichijo T, Takeda Y, Kurihara I, Katabami T, Tsuiki M, Wada N, Ogawa Y, Kawashima J, Sone M, Kamemura K, Yoshimoto T, Matsuda Y, Fujita M, Kobayashi H, Watanabe M, Tamura K, Okamura S, Miyauchi S, Izawa S, Chiba Y, Tanabe A, Naruse M. Sex Difference in the Association Between Subtype Distribution and Age at Diagnosis in Patients With Primary Aldosteronism. Hypertension 2019; 74:368-374. [PMID: 31230553 DOI: 10.1161/hypertensionaha.119.13006] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Primary aldosteronism (PA) is the most frequent cause of secondary hypertension. Adrenal vein sampling (AVS) is an established method for finding patients with the unilateral subtype of PA, for which adrenalectomy is an applicable treatment. In this study, we analyzed a large database of patients with PA who underwent adrenal vein sampling, to investigate the sex differences in the impact of age at diagnosis on the subtype and cause of PA. In 2122 patients, women with the unilateral subtype were younger than men with the same subtype and women with the bilateral subtype. Younger age and older age were associated with unilateral PA in women and men, respectively. After stratification by tertiles of age, there was a trend of decreased and increased incidence of unilateral PA with aging in women and men, respectively. Male sex was a predictor of unilateral PA in middle-aged and older patients but not in younger patients. We also found that obesity, a known factor associated with idiopathic hyperaldosteronism, was positively associated with bilateral PA in younger patients but not in older patients. These findings suggest that the proportion of operable patients with unilateral PA differs depending on the combination of sex and age, and that other than obesity, the cause of PA is also associated with the bilateral subtype in older patients.
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Affiliation(s)
- Hiroshi Akasaka
- From the Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (H.A., K.Y., H.R., M.N., R.N.)
| | - Koichi Yamamoto
- From the Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (H.A., K.Y., H.R., M.N., R.N.)
| | - Hiromi Rakugi
- From the Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (H.A., K.Y., H.R., M.N., R.N.)
| | - Motonori Nagasawa
- From the Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (H.A., K.Y., H.R., M.N., R.N.)
| | - Ryo Nakamaru
- From the Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (H.A., K.Y., H.R., M.N., R.N.)
| | - Takamasa Ichijo
- Department of Diabetes and Endocrinology, Saiseikai Yokohama Tobu Hospital, Japan (T.I.)
| | - Yoshiyu Takeda
- Department of Health Promotion and Medicine of the Future, Graduate School of Medical Science, Kanazawa University, Japan (Y.T.)
| | - Isao Kurihara
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Tokyo, Japan (I.K.)
| | - Takuyuki Katabami
- Division of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital, Japan (T.K.)
| | - Mika Tsuiki
- Division of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Japan (M.T., M.N.)
| | - Norio Wada
- Department of Diabetes and Endocrinology, Sapporo City General Hospital, Japan (N.W.)
| | - Yoshihiro Ogawa
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan (Y.O.)
| | - Junji Kawashima
- Department of Metabolic Medicine, Kumamoto University Faculty of Life Sciences, Japan (J.K.)
| | - Masakatsu Sone
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Japan (M.S.)
| | - Kohei Kamemura
- Department of Cardiology, Shinko Hospital, Kobe, Japan (K.K.)
| | - Takanobu Yoshimoto
- Department of Molecular Endocrinology and Metabolism, Tokyo Medical and Dental University Graduate School of Medicine, Japan (T.Y.)
| | - Yuichi Matsuda
- Department of Cardiology, Sanda City Hospital, Japan (Y.M.)
| | - Megumi Fujita
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Japan (M.F.)
| | - Hiroki Kobayashi
- Division of Nephrology, Hypertension and Endocrinology, Nihon University School of Medicine, Tokyo, Japan (H.K.)
| | - Minemori Watanabe
- Department of Endocrinology and Diabetes, Okazaki City Hospital, Japan (M.W.)
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Japan (K.T.)
| | - Shintaro Okamura
- Department of Endocrinology, Tenri Yorozu Hospital, Japan (S.O.)
| | - Shozo Miyauchi
- Department of Diabetes and Endocrinology, Ehime Prefectural Central Hospital, Matsuyama, Japan (S.M.)
| | - Shoichiro Izawa
- Department of Molecular Medicine and Therapeutics, Tottori University School of Medicine, Yonago, Japan (S.I.)
| | - Yoshiro Chiba
- Endovascular Treatment Group, Mito Saiseikai General Hospital, Japan (Y.C.)
| | - Akiyo Tanabe
- Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine, Tokyo, Japan (A.T.)
| | - Mitsuhide Naruse
- Division of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Japan (M.T., M.N.)
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Combined effects of the rs9810888 polymorphism in calcium voltage-gated channel subunit alpha1 D (CACNA1D) and lifestyle behaviors on blood pressure level among Chinese children. PLoS One 2019; 14:e0216950. [PMID: 31145748 PMCID: PMC6542524 DOI: 10.1371/journal.pone.0216950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 05/01/2019] [Indexed: 11/29/2022] Open
Abstract
Backgrounds A recent GWAS Study found a new locus (rs9810888 in CACNA1D) was associated with blood pressure (BP) in Chinese adults. But whether the association exists in children is unknown. Whether lifestyle behaviors could interact with rs9810888 on BP is not clear. This study aimed to identify the association between rs9810888 and BP in children, and also explore the gene-lifestyle interaction. Methods A case-control study was conducted among 2030 Chinese children aged 7 to 18 years. Genotyping was conducted by using the matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Lifestyle behaviors were investigated with questionnaire. Results With adjustment for age, age square, sex, study group and body mass index (BMI), rs9810888 was significantly associated with diastolic BP (DBP) (b = 1.69, p = 0.021) and mean arterial BP (MAP) (b = 1.56, p = 0.010). Stratified analysis showed that the rs9810888 GG genotype carriers had higher DBP than GT/TT carriers (b = 3.78, p = 0.023) in the subgroup having protein intake (meat/fish/soybeans/egg) <twice/day, but not in the subgroup ≥twice/day. In addition, in the subgroup with screen time≥2h/day, the rs9810888 GG genotype carriers had higher DBP than GT/TT carriers (b = 5.49, p = 0.012), but not in the subgroup with screen time<2h/day. For MAP, in the subgroup having either fruits or vegetables < twice/day, the rs9810888 GG genotype carriers had higher MAP than GT/TT carriers (b = 2.64, p = 0.037), but not in the subgroup with both fruits and vegetables intake ≥twice/day. Additionally, in the subgroup with screen time≥2h/day, the rs9810888 GG genotype carriers had higher MAP than GT/TT carriers (b = 4.80, p = 0.017), but not in those with screen time<2h/day. Conclusions The CACNA1D rs9810888 polymorphism was significantly associated with DBP and MAP. In addition, unhealthy lifestyle behaviors and rs9810888 GG genotype had combined effects on BP level among Chinese children.
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21
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Fava C, Cattazzo F, Bernasconi R, Romano S, Minuz P. Unusual presentation of primary aldosteronism with advanced target organ damage: A case report. Radiol Case Rep 2019; 14:814-818. [PMID: 31024637 PMCID: PMC6477188 DOI: 10.1016/j.radcr.2019.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/05/2019] [Accepted: 04/07/2019] [Indexed: 11/17/2022] Open
Abstract
Patients with primary aldosteronism have greater cardiovascular morbidity and mortality than patients with primary hypertension and a comparable cardiovascular risk profile. Herein we present the case of a patient who developed multiple end-organ damage due to unrecognized and uncontrolled hypertension caused by an aldosterone-producing adrenal adenoma. Clinical and radiological evaluation revealed hypertensive encephalopathy, cardiomyopathy, retinopathy and nephropathy which required hemodialysis. Blood pressure control before surgery was difficult due to renal impairment that precluded the administration of anti-aldosterone drugs. Primary aldosteronism was cured by laparoscopic adrenalectomy and all antihypertensive drugs were suspended. A remarkable aspect of this case is the discordant results at screening test for primary aldosteronism: even though aldosterone-to-renin ratio is the most reliable method to identify possible cases of primary aldosteronism it can be misleading especially in case of multiple comorbidities and concomitant antihypertensive treatment. Furthermore, anti-aldosterone drugs are worrisome to use when renal damage is advanced but can be reconsidered when hemodialysis begins.
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Affiliation(s)
- Cristiano Fava
- Department of Medicine, General Medicine & Hypertension Unit, University of Verona, Piazzale LA Scuro 10, 37134 Verona, Italy
| | - Filippo Cattazzo
- Department of Medicine, General Medicine & Hypertension Unit, University of Verona, Piazzale LA Scuro 10, 37134 Verona, Italy
| | - Riccardo Bernasconi
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Piazzale LA Scuro 10, 37134 Verona, Italy
| | - Simone Romano
- Department of Medicine, General Medicine & Hypertension Unit, University of Verona, Piazzale LA Scuro 10, 37134 Verona, Italy
| | - Pietro Minuz
- Department of Medicine, General Medicine & Hypertension Unit, University of Verona, Piazzale LA Scuro 10, 37134 Verona, Italy
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22
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Vorselaars WMCM, Nell S, Postma EL, Zarnegar R, Drake FT, Duh QY, Talutis SD, McAneny DB, McManus C, Lee JA, Grant SB, Grogan RH, Romero Arenas MA, Perrier ND, Peipert BJ, Mongelli MN, Castelino T, Mitmaker EJ, Parente DN, Pasternak JD, Engelsman AF, Sywak M, D'Amato G, Raffaelli M, Schuermans V, Bouvy ND, Eker HH, Bonjer HJ, Vaarzon Morel NM, Nieveen van Dijkum EJM, Vrielink OM, Kruijff S, Spiering W, Borel Rinkes IHM, Valk GD, Vriens MR. Clinical Outcomes After Unilateral Adrenalectomy for Primary Aldosteronism. JAMA Surg 2019; 154:e185842. [PMID: 30810749 DOI: 10.1001/jamasurg.2018.5842] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Importance In addition to biochemical cure, clinical benefits after surgery for primary aldosteronism depend on the magnitude of decrease in blood pressure (BP) and use of antihypertensive medications with a subsequent decreased risk of cardiovascular and/or cerebrovascular morbidity and drug-induced adverse effects. Objective To evaluate the change in BP and use of antihypertensive medications within an international cohort of patients who recently underwent surgery for primary aldosteronism. Design, Setting, and Participants A cohort study was conducted across 16 referral medical centers in Europe, the United States, Canada, and Australia. Patients who underwent unilateral adrenalectomy for primary aldosteronism between January 2010 and December 2016 were included. Data analysis was performed from August 2017 to June 2018. Unilateral disease was confirmed using computed tomography, magnetic resonance imaging, and/or adrenal venous sampling. Patients with missing or incomplete preoperative or follow-up data regarding BP or corresponding number of antihypertensive medications were excluded. Main Outcomes and Measures Clinical success was defined based on postoperative BP and number of antihypertensive medications. Cure was defined as normotension without antihypertensive medications, and clear improvement as normotension with lower or equal use of antihypertensive medications. In patients with preoperative normotensivity, improvement was defined as postoperative normotension with lower antihypertensive use. All other patients were stratified as no clear success because the benefits of surgery were less obvious, mainly owing to postoperative, persistent hypertension. Clinical outcomes were assessed at follow-up closest to 6 months after surgery. Results On the basis of inclusion and exclusion criteria, a total of 435 patients (84.6%) from a cohort of 514 patients who underwent unilateral adrenalectomy were eligible. Of these patients, 186 (42.3%) were women; mean (SD) age at the time of surgery was 50.7 (11.4) years. Cure was achieved in 118 patients (27.1%), clear improvement in 135 (31.0%), and no clear success in 182 (41.8%). In the subgroup classified as no clear success, 166 patients (91.2%) had postoperative hypertension. However, within this subgroup, the mean (SD) systolic and diastolic BP decreased significantly by 9 (22) mm Hg (P < .001) and 3 (15) mm Hg (P = .04), respectively. Also, the number of antihypertensive medications used decreased from 3 (range, 0-7) to 2 (range, 0-6) (P < .001). Moreover, in 75 of 182 patients (41.2%) within this subgroup, the decrease in systolic BP was 10 mm Hg or greater. Conclusions and Relevance In this study, for most patients, adrenalectomy was associated with a postoperative normotensive state and reduction of antihypertensive medications. Furthermore, a significant proportion of patients with postoperative, persistent hypertension may benefit from adrenalectomy given the observed clinically relevant and significant reduction of BP and antihypertensive medications.
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Affiliation(s)
- Wessel M C M Vorselaars
- Department of Surgical Oncology and Endocrine Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Sjoerd Nell
- Department of Surgical Oncology and Endocrine Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Emily L Postma
- Department of Surgical Oncology and Endocrine Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.,Department of Endocrine and Minimally Invasive Surgery, Weill Cornell Medical College, New York, New York
| | - Rasa Zarnegar
- Department of Endocrine and Minimally Invasive Surgery, Weill Cornell Medical College, New York, New York
| | - F Thurston Drake
- Department of Surgery, University of California, San Francisco.,Department of Surgery, Boston University School of Medicine, Boston, Massachusetts.,Department of Graduate Medical Sciences, Boston University School of Medicine, Boston, Massachusetts
| | - Quan-Yang Duh
- Department of Surgery, University of California, San Francisco
| | - Stephanie D Talutis
- Department of Surgery, Boston University School of Medicine, Boston, Massachusetts.,Department of Graduate Medical Sciences, Boston University School of Medicine, Boston, Massachusetts
| | - David B McAneny
- Department of Surgery, Boston University School of Medicine, Boston, Massachusetts.,Department of Graduate Medical Sciences, Boston University School of Medicine, Boston, Massachusetts
| | - Catherine McManus
- Department of Endocrine Surgery, New York-Presbyterian-Columbia University, New York
| | - James A Lee
- Department of Endocrine Surgery, New York-Presbyterian-Columbia University, New York
| | - Scott B Grant
- Department of Surgery, University of Chicago Medical Center, Chicago, Illinois
| | - Raymon H Grogan
- Department of Endocrine Surgery, Baylor St Luke's Medical Center, Houston, Texas
| | | | - Nancy D Perrier
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston
| | - Benjamin J Peipert
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael N Mongelli
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Tanya Castelino
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Québec, Canada
| | - Elliot J Mitmaker
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Québec, Canada
| | - David N Parente
- Department of Surgery, University Health Network-Toronto General Hospital, Toronto, Ontario, Canada
| | - Jesse D Pasternak
- Department of Surgery, University Health Network-Toronto General Hospital, Toronto, Ontario, Canada
| | - Anton F Engelsman
- Department of Endocrine Surgery, Royal North Shore Hospital, Sydney, Australia
| | - Mark Sywak
- Department of Endocrine Surgery, Royal North Shore Hospital, Sydney, Australia
| | - Gerardo D'Amato
- Department of Endocrine and Metabolic Surgery, Policlinico Universitario A Gemelli-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Raffaelli
- Department of Endocrine and Metabolic Surgery, Policlinico Universitario A Gemelli-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valerie Schuermans
- Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Nicole D Bouvy
- Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Hasan H Eker
- Department of Surgery, VU Medical Center, Amsterdam, the Netherlands
| | - H Jaap Bonjer
- Department of Surgery, VU Medical Center, Amsterdam, the Netherlands
| | - N M Vaarzon Morel
- Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Otis M Vrielink
- Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Schelto Kruijff
- Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Wilko Spiering
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Inne H M Borel Rinkes
- Department of Surgical Oncology and Endocrine Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Gerlof D Valk
- Department of Endocrine Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Menno R Vriens
- Department of Surgical Oncology and Endocrine Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
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23
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Keeping primary aldosteronism in mind: Deficiencies in screening at-risk hypertensives. Surgery 2019; 165:221-227. [DOI: 10.1016/j.surg.2018.05.085] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 05/02/2018] [Accepted: 05/02/2018] [Indexed: 11/16/2022]
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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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25
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Peng KY, Chang HM, Lin YF, Chan CK, Chang CH, Chueh SCJ, Yang SY, Huang KH, Lin YH, Wu VC, Wu KD. miRNA-203 Modulates Aldosterone Levels and Cell Proliferation by Targeting Wnt5a in Aldosterone-Producing Adenomas. J Clin Endocrinol Metab 2018; 103:3737-3747. [PMID: 30085132 DOI: 10.1210/jc.2018-00746] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 07/27/2018] [Indexed: 02/13/2023]
Abstract
CONTEXT The aberrant expression or alternation of miRNA in the pathogenesis of aldosterone-producing adenomas (APAs) is still largely unknown. OBJECTIVE We investigated the role of miRNA-203 (screened from miRNA microarrays) and elucidated its effects on the Wnt/β-catenin pathway regarding aldosterone production and cell proliferation in APAs. METHODS miR-203 expression was upregulated or downregulated by transfecting miR-203 mimics or inhibitors into primary APA cells, the human adrenocortical cell line HAC15, and C57BL/6 mice. In vitro and biochemical data were correlated with the respective clinical parameters of APAs to evaluate their clinical importance. RESULTS The expression of miR-203 in human APA samples was significantly lower than that of peritumor adrenal samples. Tumoral miR-203 abundance correlated negatively with both plasma aldosterone level and tumor size in patients with APAs. miR-203 inhibitors increased aldosterone production and cell proliferation in HAC15 cells, and restoration of expression via miR-203 mimics showed decreased cell proliferation and aldosterone hypersecretion in APA cell cultures. In vivo selective inhibition of miR-203 via intra-adrenal injection of miR-203 inhibitors in mice led to a substantial increase in systolic blood pressure and plasma aldosterone levels. Additionally, the dual-luciferase reporter assay demonstrated that WNT5A is a direct target of miR-203. Furthermore, plasma Wnt5a levels in adrenal vein sampling were helpful in differentiating tumor localization, and preoperative plasma Wnt5a levels predicted the cure of hypertension after adrenalectomy. CONCLUSION We have demonstrated that attenuated miR-203 expression in APAs increases aldosterone production and the tumorigenesis of adrenal cells by activating the Wnt5a/β-catenin pathway.
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Affiliation(s)
- Kang-Yung Peng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Huang-Ming Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Feng Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chieh-Kai Chan
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin Chu, Taiwan
| | - Chia-Hui Chang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, Hualien, Taiwan
| | - Shih-Chieh Jeff Chueh
- Cleveland Clinic Lerner College of Medicine and Glickman Urological and Kidney Institute, Cleveland Clinic, Ohio
| | - Shao-Yu Yang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Kuo-How Huang
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yen-Hung Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- TAIPAI (Taiwan Primary Aldosteronism Investigation), Taipei, Taiwan
| | - Vin-Cent Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- TAIPAI (Taiwan Primary Aldosteronism Investigation), Taipei, Taiwan
| | - Kwan-Dun Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- TAIPAI (Taiwan Primary Aldosteronism Investigation), Taipei, Taiwan
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Abstract
PURPOSE OF REVIEW Current guidelines recommend adrenal venous sampling (AVS) to identify the surgically curable causes of hyperaldosteronism. In contrast with this recommendation, AVS remains markedly underutilized in clinical practice, which leads to deny curative adrenalectomy, to many patients with primary aldosteronism. The purpose of this review is to challenge the views that AVS is a technically challenging, invasive and risky procedure, which moreover, is difficult to interpret. RECENT FINDINGS Several studies, including a large international survey on how AVS is being performed and used at major referral centres worldwide the AVIS-1 Study - and a randomized clinical trial comparing and AVS and a computed tomography based strategy, will be examined. SUMMARY The results of these studies have sound implications for clinical practice in that they allow to define what to do and what not to do for proper performance and interpretation of AVS and avoidance of the main concern, for example the risk of adrenal vein rupture.
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Affiliation(s)
- Gian Paolo Rossi
- Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED - University of Padova, Padova, Italy
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27
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Ierardi AM, Petrillo M, Patella F, Biondetti P, Fumarola EM, Angileri SA, Pesapane F, Pinto A, Dionigi G, Carrafiello G. Interventional radiology of the adrenal glands: current status. Gland Surg 2018; 7:147-165. [PMID: 29770310 DOI: 10.21037/gs.2018.01.04] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
As more and more adrenal neoplasms are found incidentally or symptomatically, the need for interventional procedures has being increasing. In recent years these procedures registered continued steady expansion. Interventional radiology of the adrenal glands comprises angiographic and percutaneous procedures. They may be applied both in benign and in malignant pathologies. The present review reports the current status of indications, techniques results and complications of the image-guided procedures.
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Affiliation(s)
- Anna Maria Ierardi
- Diagnostic and Intervention Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Mario Petrillo
- Diagnostic and Intervention Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Francesca Patella
- Diagnostic and Intervention Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Pierpaolo Biondetti
- Diagnostic and Intervention Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Enrico Maria Fumarola
- Diagnostic and Intervention Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | | | - Filippo Pesapane
- Diagnostic and Intervention Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Antonio Pinto
- Department of Radiology, Cardarelli Hospital, Naples, Italy
| | - Gianlorenzo Dionigi
- Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital, Policlinico "G. Martino", University of Messina, Messina, Italy
| | - Gianpaolo Carrafiello
- Diagnostic and Intervention Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
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Regulation of aldosterone production by ion channels: From basal secretion to primary aldosteronism. Biochim Biophys Acta Mol Basis Dis 2018; 1864:871-881. [DOI: 10.1016/j.bbadis.2017.12.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 12/05/2017] [Accepted: 12/23/2017] [Indexed: 01/07/2023]
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Seccia TM, Caroccia B, Adler GK, Maiolino G, Cesari M, Rossi GP. Arterial Hypertension, Atrial Fibrillation, and Hyperaldosteronism: The Triple Trouble. Hypertension 2018; 69:545-550. [PMID: 28264920 DOI: 10.1161/hypertensionaha.116.08956] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Teresa M Seccia
- From the Clinica dell'Ipertensione Arteriosa, Department of Medicine-DIMED, University of Padua, Italy (T.M.S., B.C., G.M., M.C., G.P.R.); and Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (G.K.A.)
| | - Brasilina Caroccia
- From the Clinica dell'Ipertensione Arteriosa, Department of Medicine-DIMED, University of Padua, Italy (T.M.S., B.C., G.M., M.C., G.P.R.); and Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (G.K.A.)
| | - Gail K Adler
- From the Clinica dell'Ipertensione Arteriosa, Department of Medicine-DIMED, University of Padua, Italy (T.M.S., B.C., G.M., M.C., G.P.R.); and Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (G.K.A.)
| | - Giuseppe Maiolino
- From the Clinica dell'Ipertensione Arteriosa, Department of Medicine-DIMED, University of Padua, Italy (T.M.S., B.C., G.M., M.C., G.P.R.); and Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (G.K.A.)
| | - Maurizio Cesari
- From the Clinica dell'Ipertensione Arteriosa, Department of Medicine-DIMED, University of Padua, Italy (T.M.S., B.C., G.M., M.C., G.P.R.); and Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (G.K.A.)
| | - Gian Paolo Rossi
- From the Clinica dell'Ipertensione Arteriosa, Department of Medicine-DIMED, University of Padua, Italy (T.M.S., B.C., G.M., M.C., G.P.R.); and Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (G.K.A.).
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Caroccia B, Seccia TM, Barton M, Rossi GP. Estrogen Signaling in the Adrenal Cortex: Implications for Blood Pressure Sex Differences. Hypertension 2018; 68:840-8. [PMID: 27600178 DOI: 10.1161/hypertensionaha.116.07660] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Brasilina Caroccia
- From the Molecular Internal Medicine, University of Zurich, Switzerland (M.B.); and Department of Medicine-DIMED, University of Padua, Italy (B.C., T.M.S., G.P.R.)
| | - Teresa M Seccia
- From the Molecular Internal Medicine, University of Zurich, Switzerland (M.B.); and Department of Medicine-DIMED, University of Padua, Italy (B.C., T.M.S., G.P.R.)
| | - Matthias Barton
- From the Molecular Internal Medicine, University of Zurich, Switzerland (M.B.); and Department of Medicine-DIMED, University of Padua, Italy (B.C., T.M.S., G.P.R.)
| | - Gian Paolo Rossi
- From the Molecular Internal Medicine, University of Zurich, Switzerland (M.B.); and Department of Medicine-DIMED, University of Padua, Italy (B.C., T.M.S., G.P.R.).
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31
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Congenital adrenal hyperplasia causing hypertension: an illustrative review. J Hum Hypertens 2017; 32:150-157. [PMID: 29255217 DOI: 10.1038/s41371-017-0002-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/07/2017] [Accepted: 08/24/2017] [Indexed: 11/08/2022]
Abstract
Congenital adrenal hyperplasia (CAH) is often considered a pediatric endocrinology condition, but we present two cases of young adults who presented with hypertension. An 18-year-old woman was found to have hypertension and hypokalemia when she presented for gonadectomy for 46, XY gonadal dysgenesis. She was subsequently found to have low cortisol, elevated progesterone, and elevated aldosterone. Genetic testing confirmed 17-alpha hydroxylase deficiency (17OHD). Her case was unique in that 17OHD usually presents with hypoaldosteronism. We also present the case of a 15-year-old man (46, XX) with resistant hypertension due to 11-beta hydroxylase deficiency (11OHD) who underwent bilateral adrenalectomy for control of hypertension. The relevant literature is reviewed including the pathophysiology, clinical presentation, and treatment of the hypertensive variants of congenital adrenal hyperplasia. We also review the unique areas of hyperaldosteronism in 17OHD and the use of bilateral adrenalectomy for control of hypertension in CAH.
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Subtyping of primary aldosteronism with adrenal vein sampling: Hormone- and side-specific effects of cosyntropin and metoclopramide. Surgery 2017; 163:789-795. [PMID: 29198769 DOI: 10.1016/j.surg.2017.09.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/31/2017] [Accepted: 09/13/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Cosyntropin and metoclopramide can affect the subtyping of primary aldosteronism when used with adrenal vein sampling by exerting hormone- and side-specific effects on cortisol and aldosterone secretion. We investigated how these stimuli affect the selectivity index, the relative aldosterone secretion index, and the lateralization index in consecutive primary aldosteronism patients submitted to adrenal vein sampling. METHODS We recruited 171 patients; of these, 149 underwent adrenal vein sampling before and after stimulation with cosyntropin (250 µg intravenous bolus, n= 53, 73% with an aldosterone-producing adenoma) or with metoclopramide (10 mg intravenous bolus, n= 96, 65% aldosterone-producing adenoma), and 32 with an aldosterone-producing adenoma were investigated for the relative gene expression of dopamine, melanocortin 2, and 5-hydroxytryptamine (serotonin) 4 receptor with microarrays. Cosyntropin increased the selectivity index similarly on both sides; metoclopramide did not. Cosyntropin decreased relative aldosterone secretion index on the aldosterone-producing adenoma side but not contralaterally. Metoclopramide did not affect the selectivity index, but increased the relative aldosterone secretion index similarly on both sides. Because of these changes, cosyntropin decreased the lateralization index, while metoclopramide did not affect it. The relative gene expression of melanocortin 2, albeit heterogeneous across tumors, was 35% less (P<.0001) in aldosterone-producing adenoma than in the normal adrenal cortex, while dopamine receptor D2 and 5-hydroxytryptamine (serotonin) 4 receptors did not differ between tissues. CONCLUSION Cosyntropin, while facilitating ascertainment of selectivity, lessens the lateralization, likely because of a blunted melanocortin 2 expression in aldosterone-producing adenoma. The similar expression of dopamine and 5-hydroxytryptamine (serotonin) 4 receptors in aldosterone-producing adenoma and the normal adrenal cortex can explain why metoclopramide increased the relative aldosterone secretion index on both sides and, therefore, failed to increase the lateralization index.
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Maiolino G, Rossitto G, Bisogni V, Cesari M, Seccia TM, Plebani M, Rossi GP. Quantitative Value of Aldosterone-Renin Ratio for Detection of Aldosterone-Producing Adenoma: The Aldosterone-Renin Ratio for Primary Aldosteronism (AQUARR) Study. J Am Heart Assoc 2017; 6:JAHA.117.005574. [PMID: 28529209 PMCID: PMC5524101 DOI: 10.1161/jaha.117.005574] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background Current guidelines recommend use of the aldosterone‐renin ratio (ARR) for the case detection of primary aldosteronism followed by confirmatory tests to exclude false‐positive results from further diagnostic workup. We investigated the hypothesis that this could be unnecessary in patients with a high ARR value if the quantitative information carried by the ARR is taken into due consideration. Methods and Results We interrogated 2 large data sets of prospectively collected patients studied with the same predefined protocol, which included the captopril challenge test. We used an unambiguous diagnosis of aldosterone‐producing adenoma as reference index. We also assessed whether the post‐captopril ARR and plasma aldosterone concentration fall furnished a diagnostic gain over baseline ARR values. We found that the false‐positive rate fell exponentially, and, conversely, the specificity increased with rising ARR values. At receiver operating characteristics curves and diagnostic odds ratio analysis, the high baseline ARR values implied very high positive likelihood ratio and diagnostic odds ratio values. The baseline and post‐captopril ARR showed similar diagnostic accuracy (area under the receiver operating characteristics curve) in both the exploratory and validation cohorts, indicating lack of diagnostic gain with this confirmatory test (between‐area under the curve difference, 0.005; 95% CI, −0.031 to 0.040; P=0.7 for comparison, and 0.05; 95% CI, −0.061 to 0.064; P=0.051 for comparison, respectively). Conclusions These results indicate that the ARR conveys key quantitative information that, if properly used, can simplify the diagnostic workup, resulting in saving of money and resources. This can offer the chance of diagnosis and ensuing adrenalectomy to a larger number of hypertensive patients, ultimately resulting in better control of blood pressure.
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Affiliation(s)
- Giuseppe Maiolino
- Clinica dell'Ipertensione Arteriosa, and Laboratory Medicine, University of Padua, Italy
| | - Giacomo Rossitto
- Clinica dell'Ipertensione Arteriosa, and Laboratory Medicine, University of Padua, Italy
| | - Valeria Bisogni
- Clinica dell'Ipertensione Arteriosa, and Laboratory Medicine, University of Padua, Italy
| | - Maurizio Cesari
- Clinica dell'Ipertensione Arteriosa, and Laboratory Medicine, University of Padua, Italy
| | - Teresa Maria Seccia
- Clinica dell'Ipertensione Arteriosa, and Laboratory Medicine, University of Padua, Italy
| | - Mario Plebani
- Department of Medicine - DIMED, University of Padua, Italy
| | - Gian Paolo Rossi
- Clinica dell'Ipertensione Arteriosa, and Laboratory Medicine, University of Padua, Italy
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Abstract
Studies involving adoptive families and twins have demonstrated the genetic basis of hypertension and shown that genetic factors account for about 40% of the variance in blood pressure among individuals. Arterial hypertension is genetically complex: multiple genes influence the blood pressure phenotype through allelic effects from single genes and gene-gene interactions. Moreover, environmental factors also modify the blood pressure phenotype. This complexity explains why the identification of the underlying genes has not been as successful in hypertension as in other diseases (such as type 1 and type 2 diabetes mellitus). The identification of the genetic determinants of hypertension has been most successful in endocrine forms of hypertension, which have well-defined phenotypes that permit a precise patient stratification into homogeneous cohorts. A promising area for the application of genetic testing to personalized medicine is the prediction of responses and adverse reactions to antihypertensive drugs. The identification of genetic markers of drug response will enable the design of randomized controlled trials in much smaller series of patients than is currently possible, decreasing the costs and times from drug design to clinical use and ultimately providing patients and doctors with a larger number of tools to combat hypertension, the most important risk factor for cardiovascular disease. This Review focuses on the rapidly developing field of genetic testing in patients with arterial hypertension.
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Affiliation(s)
- Gian Paolo Rossi
- Clinica dell'Ipertensione Arteriosa, Department of Medicine (DIMED), University of Padua, Via Giustiniani 2, 35126 Padua, Italy
| | - Giulio Ceolotto
- Clinica dell'Ipertensione Arteriosa, Department of Medicine (DIMED), University of Padua, Via Giustiniani 2, 35126 Padua, Italy
| | - Brasilina Caroccia
- Clinica dell'Ipertensione Arteriosa, Department of Medicine (DIMED), University of Padua, Via Giustiniani 2, 35126 Padua, Italy
| | - Livia Lenzini
- Clinica dell'Ipertensione Arteriosa, Department of Medicine (DIMED), University of Padua, Via Giustiniani 2, 35126 Padua, Italy
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Peng HM, Auchus RJ. Molecular Recognition in Mitochondrial Cytochromes P450 That Catalyze the Terminal Steps of Corticosteroid Biosynthesis. Biochemistry 2017; 56:2282-2293. [DOI: 10.1021/acs.biochem.7b00034] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Hwei-Ming Peng
- Division of Metabolism, Endocrinology,
and Diabetes, Department of Internal Medicine, and Department of Pharmacology, University of Michigan Health System, Ann Arbor, Michigan 48109, United States
| | - Richard J. Auchus
- Division of Metabolism, Endocrinology,
and Diabetes, Department of Internal Medicine, and Department of Pharmacology, University of Michigan Health System, Ann Arbor, Michigan 48109, United States
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Adrenal Vein Sampling for Primary Aldosteronism: A 2-Week Protocol for Withdrawal of Renin-Stimulating Antihypertensives. Cardiovasc Intervent Radiol 2017; 40:1367-1371. [DOI: 10.1007/s00270-017-1637-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 03/22/2017] [Indexed: 10/19/2022]
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37
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Suh YS, Kim HO, Cheon YH, Jo W, Hong J, Lee SI. Ankylosing spondylitis associated with primary aldosteronism in a middle-aged woman. Korean J Intern Med 2017; 32:374-377. [PMID: 26842104 PMCID: PMC5339458 DOI: 10.3904/kjim.2015.116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 06/14/2015] [Accepted: 07/10/2015] [Indexed: 11/27/2022] Open
Affiliation(s)
| | | | | | | | | | - Sang-Il Lee
- Correspondence to Sang-Il Lee, M.D. Division of Rheumatology, Department of Internal Medicine and Institute of Health Science, Gyeongsang National University School of Medicine, 15 Jinju-daero 816beon-gil, Jinju 52727, Korea Tel: +82-55-750-8853 Fax: +82-55-758-9122 E-mail:
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A useful tool to improve the case detection rate of primary aldosteronism: the aldosterone-renin ratio (ARR)-App. J Hypertens 2016; 34:1019-21. [PMID: 26870884 DOI: 10.1097/hjh.0000000000000892] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aldosterone-renin ratio is the most popular test for the case detection of primary aldosteronism, which entails the most common, albeit overlooked, form of endocrine secondary hypertension. A major hindrance to the clinical use of the aldosterone-renin ratio depends on the difficulty of achieving the calculation of this ratio, given that laboratories provide plasma aldosterone in different units of measurement, and renin is measured as plasma renin activity or direct active renin. We have therefore developed an App, which can be downloaded from the ESH website and the Apple store, to assist practising physicians in performing this calculation. Our hope is that this simple tool will help in increasing the detection rate of primary aldosteronism and ultimately the long-term cure of many hypertensive patients.
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Jacovic S, Zivkovic-Radojevic M, Petrovic D. Secondary Hypertension: Differential Diagnosis and Basic Principles of Treatment. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2016. [DOI: 10.1515/sjecr-2015-0056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Secondary hypertension occurs in 5-10% of cases in the patient population with primary hypertension. The most common forms of secondary hypertension are as follows: parenchymal renal disease (renoparenchymal hypertension), renal artery stenosis (renovascular hypertension), adrenal gland adenoma (primary hyperaldosteronism), a tumour of the adrenal gland marrow (pheochromocytoma) and adenoma of adrenal and pituitary glands (Cushing’s syndrome). In patients with a typical clinical picture of secondary hypertension, the appropriate diagnostic tests should be conducted based on the suspected form of secondary hypertension. Determining a diagnosis of secondary hypertension is gradual. First, the appropriate screening tests are performed. If the screening test is positive, then additional tests to confirm the forms of secondary hypertension are conducted. Once a diagnosis of the appropriate form of secondary hypertension is confirmed, tests to distinguish causes and laterality tests to determine the precise localisation of the pathological process are applied to evaluate the response to therapy. Analysing the results of endocrine diagnostic tests provides an accurate diagnosis and selection of optimal therapeutic procedures.
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Affiliation(s)
- Sasa Jacovic
- Medicines and Medical Devices Agency of Serbia, 458 Vojvode Stepe Street, 11221 Belgrade, Serbia
| | | | - Dejan Petrovic
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia Serbia
- Center of Nephrology and Dialysis, Department of Urology and Nephrology, Clinical Center Kragujevac, Kragujevac, Serbia
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Mendichovszky IA, Powlson AS, Manavaki R, Aigbirhio FI, Cheow H, Buscombe JR, Gurnell M, Gilbert FJ. Targeted Molecular Imaging in Adrenal Disease-An Emerging Role for Metomidate PET-CT. Diagnostics (Basel) 2016; 6:diagnostics6040042. [PMID: 27869719 PMCID: PMC5192517 DOI: 10.3390/diagnostics6040042] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 11/08/2016] [Accepted: 11/09/2016] [Indexed: 11/17/2022] Open
Abstract
Adrenal lesions present a significant diagnostic burden for both radiologists and endocrinologists, especially with the increasing number of adrenal ‘incidentalomas’ detected on modern computed tomography (CT) or magnetic resonance imaging (MRI). A key objective is the reliable distinction of benign disease from either primary adrenal malignancy (e.g., adrenocortical carcinoma or malignant forms of pheochromocytoma/paraganglioma (PPGL)) or metastases (e.g., bronchial, renal). Benign lesions may still be associated with adverse sequelae through autonomous hormone hypersecretion (e.g., primary aldosteronism, Cushing’s syndrome, phaeochromocytoma). Here, identifying a causative lesion, or lateralising the disease to a single adrenal gland, is key to effective management, as unilateral adrenalectomy may offer the potential for curing conditions that are typically associated with significant excess morbidity and mortality. This review considers the evolving role of positron emission tomography (PET) imaging in addressing the limitations of traditional cross-sectional imaging and adjunctive techniques, such as venous sampling, in the management of adrenal disorders. We review the development of targeted molecular imaging to the adrenocortical enzymes CYP11B1 and CYP11B2 with different radiolabeled metomidate compounds. Particular consideration is given to iodo-metomidate PET tracers for the diagnosis and management of adrenocortical carcinoma, and the increasingly recognized utility of 11C-metomidate PET-CT in primary aldosteronism.
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Affiliation(s)
- Iosif A Mendichovszky
- Department of Radiology, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.
| | - Andrew S Powlson
- Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.
| | - Roido Manavaki
- Department of Radiology, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.
| | - Franklin I Aigbirhio
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 1TN, UK.
| | - Heok Cheow
- Department of Radiology, University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.
| | - John R Buscombe
- Department of Nuclear Medicine, Cambridge University Hospitals, Cambridge CB2 0QQ, UK.
| | - Mark Gurnell
- Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.
| | - Fiona J Gilbert
- Department of Radiology, University of Cambridge and NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.
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Fabian E, Schiller D, Tomaschitz A, Langner C, Pilz S, Quasthoff S, Raggam RB, Schoefl R, Krejs GJ. Clinical-Pathological Conference Series from the Medical University of Graz : Case No 160: 33-year-old woman with tetraparesis on Easter Sunday. Wien Klin Wochenschr 2016; 128:719-727. [PMID: 27682153 PMCID: PMC5052289 DOI: 10.1007/s00508-016-1085-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 08/19/2016] [Indexed: 11/24/2022]
Affiliation(s)
- Elisabeth Fabian
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Dietmar Schiller
- Department of Internal Medicine IV, Elisabethinen Hospital, Linz, Austria
| | - Andreas Tomaschitz
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Cord Langner
- Department of Pathology, Medical University of Graz, Graz, Austria
| | - Stefan Pilz
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Stefan Quasthoff
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Reinhard B Raggam
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Rainer Schoefl
- Department of Internal Medicine IV, Elisabethinen Hospital, Linz, Austria
| | - Guenter J Krejs
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
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Reply. J Hypertens 2016; 34:1882-3. [DOI: 10.1097/hjh.0000000000001027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Petrovic D, Sreckovic M, Nikolic T, Zivkovic-Radojevic M, Miloradovic V. Renovascular Hypertension: Clinical Features, Differential Diagnoses and Basic Principles of Treatment. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2016. [DOI: 10.1515/sjecr-2016-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Renovascular hypertension is caused by renal artery stenosis. Its prevalence in populations of hypertensive patients is 1-8%, and in populations of patients with resistant hypertension, it is up to 20%. The two main causes of stenosis are atherosclerosis and fibromuscular dysplasia of the renal artery. The main clinical consequences of renal artery stenosis include renovascular hypertension, ischemic nephropathy and “flash” acute pulmonary oedema. Unilateral stenosis of the renal artery causes angiotensin II-dependent hypertension, and bilateral stenosis of the renal arteries produces volume-dependent hypertension. Renovascular aetiology of hypertension should be questioned in patients with resistant hypertension, hypertension with a murmur identified upon auscultation of the renal arteries, and a noticeable side-to-side difference in kidney size. Non-invasive diagnostic tests include the determination of concentrations of peripheral vein plasma renin activity, the captopril test, captopril scintigraphy, colour Doppler ultrasonography, computed tomography angiography, and nuclear resonance angiography. Renovasography represents the gold standard for the diagnosis of renovascular hypertension. The indications for revascularization of the renal artery include haemodynamically significant renal artery stenosis (with a systolic pressure gradient at the site of stenosis of - ΔP ≥ 20 mmHg, along with the ratio of the pressure in the distal part of the renal artery (Pd) and aortic pressure (Pa) less than 0.9 (Pd/Pa < 0.9)), resistant hypertension, loss of renal function after administration of ACE inhibitors or angiotensin receptor II blockers, and recurrent flash pulmonary oedema associated with bilateral renal artery stenosis. The contraindications for renal artery revascularization include a longitudinal diameter of the affected kidney that is less than 8.0 cm, the resistance index measured from the segmental arteries peak blood flow (RI) > 0.8, chronic kidney disease (GFR <30 ml/min/1.73 m2) and negative captopril scintigraphy (lack of lateralization).
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Affiliation(s)
- Dejan Petrovic
- Clinic for Urology and Nephrology, Clinical Center Kragujevac, Kragujevac
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Miodrag Sreckovic
- Clinic for Cardiology, Clinical Center Kragujevac, Kragujevac, Serbia
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Tomislav Nikolic
- Clinic for Urology and Nephrology, Clinical Center Kragujevac, Kragujevac
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | | | - Vladimir Miloradovic
- Clinic for Cardiology, Clinical Center Kragujevac, Kragujevac, Serbia
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
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Berra E, Azizi M, Capron A, Høieggen A, Rabbia F, Kjeldsen SE, Staessen JA, Wallemacq P, Persu A. Evaluation of Adherence Should Become an Integral Part of Assessment of Patients With Apparently Treatment-Resistant Hypertension. Hypertension 2016; 68:297-306. [DOI: 10.1161/hypertensionaha.116.07464] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Elena Berra
- From the Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P., E.B.); Department of Medical Sciences, Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, Turin, Italy (F.R., E.B.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (A.P.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular
| | - Michel Azizi
- From the Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P., E.B.); Department of Medical Sciences, Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, Turin, Italy (F.R., E.B.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (A.P.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular
| | - Arnaud Capron
- From the Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P., E.B.); Department of Medical Sciences, Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, Turin, Italy (F.R., E.B.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (A.P.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular
| | - Aud Høieggen
- From the Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P., E.B.); Department of Medical Sciences, Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, Turin, Italy (F.R., E.B.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (A.P.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular
| | - Franco Rabbia
- From the Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P., E.B.); Department of Medical Sciences, Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, Turin, Italy (F.R., E.B.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (A.P.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular
| | - Sverre E. Kjeldsen
- From the Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P., E.B.); Department of Medical Sciences, Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, Turin, Italy (F.R., E.B.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (A.P.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular
| | - Jan A. Staessen
- From the Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P., E.B.); Department of Medical Sciences, Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, Turin, Italy (F.R., E.B.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (A.P.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular
| | - Pierre Wallemacq
- From the Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P., E.B.); Department of Medical Sciences, Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, Turin, Italy (F.R., E.B.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (A.P.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular
| | - Alexandre Persu
- From the Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P., E.B.); Department of Medical Sciences, Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, Turin, Italy (F.R., E.B.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (A.P.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular
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Yang T, Zhang HL, Liang Q, Shi Y, Mei YA, Barrett PQ, Hu C. Small-Conductance Ca2+-Activated Potassium Channels Negatively Regulate Aldosterone Secretion in Human Adrenocortical Cells. Hypertension 2016; 68:785-95. [PMID: 27432863 DOI: 10.1161/hypertensionaha.116.07094] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 05/05/2016] [Indexed: 01/23/2023]
Abstract
Aldosterone, which plays a key role in maintaining water and electrolyte balance, is produced by zona glomerulosa cells of the adrenal cortex. Autonomous overproduction of aldosterone from zona glomerulosa cells causes primary hyperaldosteronism. Recent clinical studies have highlighted the pathological role of the KCNJ5 potassium channel in primary hyperaldosteronism. Our objective was to determine whether small-conductance Ca(2+)-activated potassium (SK) channels may also regulate aldosterone secretion in human adrenocortical cells. We found that apamin, the prototypic inhibitor of SK channels, decreased membrane voltage, raised intracellular Ca(2+) and dose dependently increased aldosterone secretion from human adrenocortical H295R cells. By contrast, 1-Ethyl-2-benzimidazolinone, an agonist of SK channels, antagonized apamin's action and decreased aldosterone secretion. Commensurate with an increase in aldosterone production, apamin increased mRNA expression of steroidogenic acute regulatory protein and aldosterone synthase that control the early and late rate-limiting steps in aldosterone biosynthesis, respectively. In addition, apamin increased angiotensin II-stimulated aldosterone secretion, whereas 1-Ethyl-2-benzimidazolinone suppressed both angiotensin II- and high K(+)-stimulated production of aldosterone in H295R cells. These findings were supported by apamin-modulation of basal and angiotensin II-stimulated aldosterone secretion from acutely prepared slices of human adrenals. We conclude that SK channel activity negatively regulates aldosterone secretion in human adrenocortical cells. Genetic association studies are necessary to determine whether mutations in SK channel subtype 2 genes may also drive aldosterone excess in primary hyperaldosteronism.
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Affiliation(s)
- Tingting Yang
- From the Department of Physiology and Biophysics, School of Life Sciences, Institutes of Brain Science (T.Y., Q.L., Y.-A.M., C.H.) and Department of Oncology, Shanghai Medical College (H.-L.Z.), Fudan University, China; Department of Urology, Fudan University Shanghai Cancer Center, China (H.-L.Z.); and Department of Pharmacology, University of Virginia, Charlottesville (Y.S., P.Q.B.)
| | - Hai-Liang Zhang
- From the Department of Physiology and Biophysics, School of Life Sciences, Institutes of Brain Science (T.Y., Q.L., Y.-A.M., C.H.) and Department of Oncology, Shanghai Medical College (H.-L.Z.), Fudan University, China; Department of Urology, Fudan University Shanghai Cancer Center, China (H.-L.Z.); and Department of Pharmacology, University of Virginia, Charlottesville (Y.S., P.Q.B.)
| | - Qingnan Liang
- From the Department of Physiology and Biophysics, School of Life Sciences, Institutes of Brain Science (T.Y., Q.L., Y.-A.M., C.H.) and Department of Oncology, Shanghai Medical College (H.-L.Z.), Fudan University, China; Department of Urology, Fudan University Shanghai Cancer Center, China (H.-L.Z.); and Department of Pharmacology, University of Virginia, Charlottesville (Y.S., P.Q.B.)
| | - Yingtang Shi
- From the Department of Physiology and Biophysics, School of Life Sciences, Institutes of Brain Science (T.Y., Q.L., Y.-A.M., C.H.) and Department of Oncology, Shanghai Medical College (H.-L.Z.), Fudan University, China; Department of Urology, Fudan University Shanghai Cancer Center, China (H.-L.Z.); and Department of Pharmacology, University of Virginia, Charlottesville (Y.S., P.Q.B.)
| | - Yan-Ai Mei
- From the Department of Physiology and Biophysics, School of Life Sciences, Institutes of Brain Science (T.Y., Q.L., Y.-A.M., C.H.) and Department of Oncology, Shanghai Medical College (H.-L.Z.), Fudan University, China; Department of Urology, Fudan University Shanghai Cancer Center, China (H.-L.Z.); and Department of Pharmacology, University of Virginia, Charlottesville (Y.S., P.Q.B.)
| | - Paula Q Barrett
- From the Department of Physiology and Biophysics, School of Life Sciences, Institutes of Brain Science (T.Y., Q.L., Y.-A.M., C.H.) and Department of Oncology, Shanghai Medical College (H.-L.Z.), Fudan University, China; Department of Urology, Fudan University Shanghai Cancer Center, China (H.-L.Z.); and Department of Pharmacology, University of Virginia, Charlottesville (Y.S., P.Q.B.)
| | - Changlong Hu
- From the Department of Physiology and Biophysics, School of Life Sciences, Institutes of Brain Science (T.Y., Q.L., Y.-A.M., C.H.) and Department of Oncology, Shanghai Medical College (H.-L.Z.), Fudan University, China; Department of Urology, Fudan University Shanghai Cancer Center, China (H.-L.Z.); and Department of Pharmacology, University of Virginia, Charlottesville (Y.S., P.Q.B.).
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Romero DG, Yanes Cardozo LL. Clinical Practice Guideline for Management of Primary Aldosteronism: What is New in the 2016 Update? ACTA ACUST UNITED AC 2016; 2. [PMID: 28018978 PMCID: PMC5175479 DOI: 10.16966/2380-548x.129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Primary Aldosteronism is the single most common cause of secondary hypertension and is associated with increased target organ injury. The Endocrine Society has recently released the updated Clinical Practice Guideline for Primary Aldosteronism entitled “The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline”. We review the updated Clinical Practice Guideline, highlighting the new recommendations and the implications that they may have in clinical practice. The recognition by the Endocrine Society’s Task Force that Primary Aldosteronism is a public health issue and that the population at risk for screening should be significantly expanded will surely have an impact in the clinical practice which hopefully will translate in better detection, diagnosis and treatment of patients with Primary Aldosteronism.
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Affiliation(s)
- Damian G Romero
- Department of Biochemistry, University of Mississippi Medical Center Jackson, USA; Women's Health Research Center, University of Mississippi Medical Center and Jackson, USA; Cardio-Renal Research Center, University of Mississippi Medical Center Jackson, USA
| | - Licy L Yanes Cardozo
- Women's Health Research Center, University of Mississippi Medical Center and Jackson, USA; Cardio-Renal Research Center, University of Mississippi Medical Center Jackson, USA; Department of Physiology and Biophysics, University of Mississippi Medical Center Jackson, USA; Department of Medicine, University of Mississippi Medical Center Jackson, USA
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Abstract
Aldosterone-producing adenomas (APAs) vary in phenotype and genotype. Zona
glomerulosa (ZG)-like APAs frequently have mutations of an L-type calcium channel
(LTCC) CaV1.3. Using a novel antagonist of CaV1.3, compound
8, we investigated the role of CaV1.3 on steroidogenesis in
the human adrenocortical cell line, H295R, and in primary human adrenal cells. This
investigational drug was compared with the common antihypertensive drug nifedipine,
which has 4.5-fold selectivity for the vascular LTCC, CaV1.2, over
CaV1.3. In H295R cells transfected with wild-type or mutant
CaV1.3 channels, the latter produced more aldosterone than wild-type,
which was ameliorated by 100 μM of compound 8. In primary
adrenal and non-transfected H295R cells, compound 8 decreased aldosterone
production similar to high concentration of nifedipine (100 μM).
Selective CaV1.3 blockade may offer a novel way of treating primary
hyperaldosteronism, which avoids the vascular side effects of
CaV1.2-blockade, and provides targeted treatment for ZG-like APAs with
mutations of CaV1.3.
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48
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Aldosterone-induced oxidative stress: a potential mechanism of aldosterone autonomy in primary aldosteronism. J Hypertens 2016; 32:2280-1. [PMID: 25271919 DOI: 10.1097/hjh.0000000000000375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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49
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The Aldosterone Renin Ratio (ARR) APP as Tool to Enhance the Detection Rate of Primary Aldosteronism. High Blood Press Cardiovasc Prev 2016; 23:147-9. [PMID: 26883242 DOI: 10.1007/s40292-016-0132-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 02/09/2016] [Indexed: 10/22/2022] Open
Abstract
Primary aldosteronism is one of the most common forms of secondary hypertension, but it is often under diagnosed, which leads to the development of cardiovascular damage, and excess costs for long-term drug treatment and management of complications. The aldosterone to renin ratio (ARR) is a key step for early detection of primary aldosteronism, but unfortunately is not easily estimated. This is because plasma aldosterone and renin are measured with different assays, which provide results in different units of measure, with ensuing difficulty of obtaining the calculation of the ARR in the proper units and impossibility of interpreting results with reference to established cut off values. Therefore, doctors are often unable to draw unambiguous conclusions to be used for the clinical decision-making. To the aim of making the diagnostic work-up easier, we have developed an Application that provide a swift calculation of the ARR regardless of the units of measure used for plasma aldosterone and renin values. If the concomitant serum potassium level is available the App also provides the patient's probability of having an aldosterone-producing adenoma based on a validated logistic discriminant analysis.
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50
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Hong AR, Kim JH, Song YS, Lee KE, Seo SH, Seong MW, Shin CS, Kim SW, Kim SY. Genetics of Aldosterone-Producing Adenoma in Korean Patients. PLoS One 2016; 11:e0147590. [PMID: 26807823 PMCID: PMC4726589 DOI: 10.1371/journal.pone.0147590] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 01/06/2016] [Indexed: 11/18/2022] Open
Abstract
Objectives Recently, somatic mutations in KCNJ5, ATP1A1, ATP2B3, and CACNA1D genes were found to be associated with the pathogenesis of aldosterone-producing adenoma (APA). This study aimed to investigate the prevalence of somatic mutations in KCNJ5, ATP1A1, ATP2B3, and CACNA1D and examine the correlations between these mutations and the clinical and biochemical characteristics in Korean patients with APA. Methods We performed targeted gene sequencing in 66 patients with APA to detect somatic mutations in these genes. Results Somatic KCNJ5 mutations were found in 47 (71.2%) of the 66 patients with APA (31 cases of p.G151R and 16 cases of p.L168R); these two mutations were mutually exclusive. Somatic mutations in the ATP1A1, ATP2B3, and CACNA1D genes were not observed. Somatic KCNJ5 mutations were more prevalent in female patients (66% versus 36.8%, respectively; P = 0.030). Moreover, patients with KCNJ5 mutations comprised a significantly higher proportion of patients younger than 35 years of age (19.1% versus 0%, respectively; P = 0.040). There were no significant differences in pre-operative blood pressure, plasma aldosterone, serum potassium, lateralization index, and adenoma size according to mutational status. Patients with KCNJ5 mutations were less likely to need antihypertensive medications after adrenalectomy compared with those without mutation (36.2% versus 63.2%; P = 0.045). Conclusions The present study demonstrated the high prevalence of somatic KCNJ5 mutations in Korean patients with APA. Carriers of somatic KCNJ5 mutations were more likely to be female. Early diagnosis and better therapeutic outcomes were associated with somatic KCNJ5 mutations in APA.
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Affiliation(s)
- A. Ram Hong
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung Hee Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young Shin Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyu Eun Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Soo Hyun Seo
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Moon-Woo Seong
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chan Soo Shin
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang Wan Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
- * E-mail: (SYK); (SWK)
| | - Seong Yeon Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- * E-mail: (SYK); (SWK)
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