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Fernandez CJ, Nagendra L, Alkhalifah M, Pappachan JM. Endocrine Hypertension: The Urgent Need for Greater Global Awareness. TOUCHREVIEWS IN ENDOCRINOLOGY 2023; 19:31-41. [PMID: 38187076 PMCID: PMC10769474 DOI: 10.17925/ee.2023.19.2.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/04/2023] [Indexed: 01/09/2024]
Abstract
Hypertension affects about 1.28 billion adults globally, and significantly increases the risk of chronic morbidity and mortality among sufferers. About 15% of these individuals have secondary hypertension, the majority of whom have dysfunction of one or more endocrine systems as the cause of hypertension. Although adrenal disorders are often identified as the cause of endocrine hypertension, extra-adrenal disease and pituitary disorders also can cause the disease. Timely diagnosis is of paramount importance, because of the potential for a surgical cure or optimal disease control with pharmacotherapy to prevent hypertensive complications. Even with its relatively high prevalence compared with many other chronic illnesses, the diagnosis of endocrine hypertension is often delayed or never made because of poor awareness about the disease among physicians. This review attempts to provide an overview of the disease, with some practical aspects of diagnosis and management of a few of the important disorders causing endocrine hypertension.
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Affiliation(s)
- Cornelius J Fernandez
- Department of Endocrinology and Metabolism, Pilgrim Hospital, United Lincolnshire Hospitals NHS Trust, Boston, UK
| | - Lakshmi Nagendra
- Department of Endocrinology, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, India
| | - Mohammed Alkhalifah
- Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, Preston, UK
- Department of Family Medicine & Diabetes, King Saud University Medical City, Riyad, Saudi Arabia
| | - Joseph M Pappachan
- Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, Preston, UK
- Faculty of Science, Manchester Metropolitan University, Manchester, UK
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Anceschi U, Mormando M, Flammia RS, Fiori C, Zappalà O, De Concilio B, Brassetti A, Carrara A, Ferriero MC, Tuderti G, Misuraca L, Prata F, Tufano A, Bove AM, Mastroianni R, Appetecchia M, Tirone G, Porpiglia F, Celia A, Simone G. The Therapeutic Intensity Score as Predictor of Clinical Outcomes after Total and Partial Adrenalectomy for Unilateral Primary Aldosteronism: Results of a Multicentric Series. J Clin Med 2023; 12:jcm12030997. [PMID: 36769646 PMCID: PMC9917842 DOI: 10.3390/jcm12030997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND To evaluate the ability of therapeutic intensity score (TIS) in predicting the clinical outcomes of partial (PA) and total adrenalectomy (TA) for UPA. METHODS Between 2011 and 2022, a four-center adrenalectomy dataset was queried for "unilateral adrenal mass" and "UPA" (n = 90). Preoperative TIS of each antihypertensive medication were individually calculated and merged to create a single, cumulative variable. Probability of complete clinical, partial, and absent pooled success rates according to TIS were assessed for the overall cohort by Kaplan-Meier. Cox analyses were used to identify predictors of complete clinical and partial/absent success, respectively. For all analyses, a two-sided p < 0.05 was considered significant. RESULTS At a median follow-up of 42 months (IQR 27-54) complete partial, and absent clinical success were observed in 60%, 17.7%, and 22.3%, respectively. On Kaplan-Meier analysis, TIS < 1 predicted higher complete success rates (p < 0.001), while TIS ≥ 1 was predictor of either partial and absent clinical success (p = 0.008). On multivariable analysis, TIS < 1 (HR 0.25; 95% CI 0.11-0.57; p = 0.001) and adenoma size (HR 1.11; 95% CI 1-1.23; p = 0.0049) were independent predictors of complete clinical success, while TIS ≥ 1 (HR 2.84; 95% CI 1.32-6.1; p = 0.007) was the only independent predictor of absent clinical success. CONCLUSIONS TIS score and adenoma size may help to identify patients who are likely to be at risk of persistent hypertension after surgery.
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Affiliation(s)
- Umberto Anceschi
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi, 00144 Rome, Italy
- Correspondence: ; Tel.: +39-339-583-6431 or +39-379-175-0925
| | - Marilda Mormando
- IRCCS “Regina Elena” National Cancer Institute, Oncologic Endocrinology Unit, Via Elio Chianesi, 00144 Rome, Italy
| | - Rocco Simone Flammia
- “La Sapienza” University of Rome, Department of Maternal Infant and Urologic Sciences, Policlinico Umberto I, Viale del Policlinico, 00161 Rome, Italy
| | - Cristian Fiori
- AOU San Luigi Gonzaga, Department of Urology, Regione Gonzole, 10043 Orbassano, Italy
| | - Orazio Zappalà
- APSS, Santa Chiara Regional Hospital, Department of General Surgery, Largo Medaglie d’Oro, 38122 Trento, Italy
| | - Bernardino De Concilio
- ULSS 7 Pedemontana, San Bassiano Hospital, Department of Urology, Via dei Lotti, 36061 Bassano del Grappa, Italy
| | - Aldo Brassetti
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi, 00144 Rome, Italy
| | - Alessandro Carrara
- APSS, Santa Maria del Carmine Hospital, Department of General Surgery, Corso Verona, 38068 Rovereto, Italy
| | - Maria Consiglia Ferriero
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi, 00144 Rome, Italy
| | - Gabriele Tuderti
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi, 00144 Rome, Italy
| | - Leonardo Misuraca
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi, 00144 Rome, Italy
| | - Francesco Prata
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi, 00144 Rome, Italy
| | - Antonio Tufano
- “La Sapienza” University of Rome, Department of Maternal Infant and Urologic Sciences, Policlinico Umberto I, Viale del Policlinico, 00161 Rome, Italy
| | - Alfredo Maria Bove
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi, 00144 Rome, Italy
| | - Riccardo Mastroianni
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi, 00144 Rome, Italy
| | - Marialuisa Appetecchia
- IRCCS “Regina Elena” National Cancer Institute, Oncologic Endocrinology Unit, Via Elio Chianesi, 00144 Rome, Italy
| | - Giuseppe Tirone
- APSS, Santa Chiara Regional Hospital, Department of General Surgery, Largo Medaglie d’Oro, 38122 Trento, Italy
| | - Francesco Porpiglia
- AOU San Luigi Gonzaga, Department of Urology, Regione Gonzole, 10043 Orbassano, Italy
| | - Antonio Celia
- ULSS 7 Pedemontana, San Bassiano Hospital, Department of Urology, Via dei Lotti, 36061 Bassano del Grappa, Italy
| | - Giuseppe Simone
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi, 00144 Rome, Italy
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Tabibzadeh N, Crambert G. Mechanistic insights into the primary and secondary alterations of renal ion and water transport in the distal nephron. J Intern Med 2023; 293:4-22. [PMID: 35909256 PMCID: PMC10087581 DOI: 10.1111/joim.13552] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The kidneys, by equilibrating the outputs to the inputs, are essential for maintaining the constant volume, pH, and electrolyte composition of the internal milieu. Inability to do so, either because of internal kidney dysfunction (primary alteration) or because of some external factors (secondary alteration), leads to pathologies of varying severity, leading to modification of these parameters and affecting the functions of other organs. Alterations of the functions of the collecting duct (CD), the most distal part of the nephron, have been extensively studied and have led to a better diagnosis, better management of the related diseases, and the development of therapeutic tools. Thus, dysfunctions of principal cell-specific transporters such as ENaC or AQP2 or its receptors (mineralocorticoid or vasopressin receptors) caused by mutations or by compounds present in the environment (lithium, antibiotics, etc.) have been demonstrated in a variety of syndromes (Liddle, pseudohypoaldosteronism type-1, diabetes insipidus, etc.) affecting salt, potassium, and water balance. In parallel, studies on specific transporters (H+ -ATPase, anion exchanger 1) in intercalated cells have revealed the mechanisms of related tubulopathies like distal renal distal tubular acidosis or Sjögren syndrome. In this review, we will recapitulate the mechanisms of most of the primary and secondary alteration of the ion transport system of the CD to provide a better understanding of these diseases and highlight how a targeted perturbation may affect many different pathways due to the strong crosstalk and entanglements between the different actors (transporters, cell types).
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Affiliation(s)
- Nahid Tabibzadeh
- Laboratoire de Physiologie Rénale et Tubulopathies, Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université Paris Cité, Paris, France.,EMR 8228 Unité Métabolisme et Physiologie Rénale, CNRS, Paris, France.,Assistance Publique Hôpitaux de Paris, Hôpital Bichât, Paris, France
| | - Gilles Crambert
- Laboratoire de Physiologie Rénale et Tubulopathies, Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université Paris Cité, Paris, France.,EMR 8228 Unité Métabolisme et Physiologie Rénale, CNRS, Paris, France
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The role of biomarker in pancreatic neuroendocrine tumor. JOURNAL OF PANCREATOLOGY 2021. [DOI: 10.1097/jp9.0000000000000076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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McCarthy J, Yang J, Clissold B, Young MJ, Fuller PJ, Phan T. Hypertension Management in Stroke Prevention: Time to Consider Primary Aldosteronism. Stroke 2021; 52:e626-e634. [PMID: 34428932 DOI: 10.1161/strokeaha.120.033990] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Primary aldosteronism confers a higher risk of stroke, atrial fibrillation, and cardiovascular disease than blood pressure matched essential hypertension. It is the most common endocrine cause of secondary hypertension with prevalence estimates of up to 13% in primary care and 30% in referral centers around the world. Unlike essential hypertension, primary aldosteronism has targeted medical treatment and potentially curative surgical solutions which can ameliorate the associated cardiovascular risks. This narrative review highlights an evidence gap in the optimal diagnosis and targeted treatment of primary aldosteronism in secondary stroke prevention. Over half of the patients suffering a stroke have blood pressure in the hypertensive range and less than a third achieve optimal blood pressure control. There are no guideline recommendations to test for primary aldosteronism in these patients, although up to 30% of patients with resistant hypertension may have this disease. The accurate diagnosis of primary aldosteronism could significantly improve blood pressure, simplify the medication regimen and reduce the overall cardiovascular risk in these patients. The challenges associated with screening for primary aldosteronism following stroke may be overcome by novel blood tests which are less affected by antihypertensive medications routinely used in stroke care. Approximately one-quarter of all strokes occur in patients who have previously had a stroke. Modifying hypertension, the leading modifiable risk factor, would, therefore, have significant public health implications. As clinicians, we must increase our awareness of primary aldosteronism in patients with stroke, particularly in those with resistant hypertension, to enable targeted therapy and reduce the risk of stroke recurrence.
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Affiliation(s)
| | - Jun Yang
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Australia (J.Y., M.J.Y., P.J.F.).,Departments of Endocrinology (J.Y., P.J.F.), Monash Health, Clayton, Australia.,Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia (J.Y., B.C., T.P.)
| | - Ben Clissold
- Neurology (B.C., T.P.), Monash Health, Clayton, Australia.,Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia (J.Y., B.C., T.P.)
| | - Morag J Young
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Australia (J.Y., M.J.Y., P.J.F.).,Baker Heart and Diabetes Institute, Melbourne, Australia (M.J.Y.)
| | - Peter J Fuller
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Australia (J.Y., M.J.Y., P.J.F.).,Departments of Endocrinology (J.Y., P.J.F.), Monash Health, Clayton, Australia
| | - Thanh Phan
- Neurology (B.C., T.P.), Monash Health, Clayton, Australia.,Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia (J.Y., B.C., T.P.)
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Endocrine hypertension secondary to adrenal tumors: clinical course and predictive factors of clinical remission. Langenbecks Arch Surg 2021; 406:2027-2035. [PMID: 34159439 DOI: 10.1007/s00423-021-02245-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 06/12/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Endocrinopathies constitute ~ 10% of secondary hypertension (SH) etiologies. Primary aldosteronism, pheochromocytoma (PHEO), and Cushing's syndrome are common causes. Early identification and treatment result in resolution/improvement of SH. The aim of this study was to characterize the clinical course, outcomes, and remission-associated prognostic factors of SH related to adrenal tumors. METHODS Retrospective cohort study including patients with SH who underwent adrenalectomy from 2000 to 2019. Postoperative outcomes were analyzed. Remission was defined as normalization of blood pressure without drug use. RESULTS Eighty-three patients with SH were included. Mean ± SD age was 38.8 ± 14.2 years and 75.9% were women. Diagnosis was PHEO in 35 patients (42.2%), aldosteronoma (APA) in 28 (33.7%), cortisol producing adenoma (CPA) in 16 (19.3%), and ACTH-dependent Cushing's in 4 (4.8%). Laparoscopic adrenalectomy was performed in 81 (97.6%) patients. Mean ± SD follow-up was 57.4 ± 49.6 months (range 1-232). Surgical morbidity occurred in 7.2% of patients and there was no mortality. Remission of SH occurred in 61(73.5%): 100% of ACTH-dependent Cushing's, 85.7% of PHEO, 68.8% of CPA, and 57.1% of APA. Biochemical phenotype and the combination of larger tumor size, number of antihypertensive drugs, male gender, older age, obesity, and preoperative SH for more than 5 years were associated with less likely clinical remission in patients with APA (p = 0.004), CPA (p < 0.0001), and PHEO (p < 0.0001). CONCLUSION SH remission rates are 57-100% after adrenalectomy. Several prognostic factors could be used to predict SH control. Adrenalectomy provides good clinical outcome and must be considered a treatment option in all surgical candidates.
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Libianto R, Menezes S, Kaur A, Gwini SM, Shen J, Narayan O, Fuller PJ, Yang J, Young MJ. Comparison of ambulatory blood pressure between patients with primary aldosteronism and other forms of hypertension. Clin Endocrinol (Oxf) 2021; 94:353-360. [PMID: 33270939 DOI: 10.1111/cen.14373] [Citation(s) in RCA: 3] [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: 07/03/2020] [Revised: 11/13/2020] [Accepted: 11/15/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Primary aldosteronism (PA) is a potentially curable cause of hypertension associated with worse cardiovascular prognosis than blood pressure-matched essential hypertension (EH). Effective targeted treatment for PA is available with the greatest benefit seen if treatment is started early, prior to the development of end-organ damage. However, PA is currently substantially under-diagnosed. The standard screening test for PA, the aldosterone-to-renin ratio (ARR), is performed infrequently in both primary and tertiary care. In contrast, ambulatory blood pressure monitoring (ABPM) is frequently utilized in the assessment of hypertension. The aim of this study was to compare ABPM parameters in hypertensive patients with and without PA, in order to identify features of ABPM associated with PA that can prompt screening. STUDY DESIGN Patients with PA (n = 55) were identified from a tertiary clinic specializing in the management of endocrine causes of hypertension whilst the controls (n = 389) were consecutive patients with hypertension but without a known diagnosis of PA who were referred for ABPM. RESULTS In this study, PA patients were younger and had higher 24-h, day, and night-time blood pressure compared with controls despite similar number of antihypertensive medications. However, there was no significant difference in nocturnal dipping or day-night blood pressure variability between the two groups. CONCLUSIONS An elevated ambulatory blood pressure in patients on multiple antihypertensives could suggest underlying PA but in the absence of other distinguishing features, ABPM could not reliably differentiate PA from other forms of hypertension. Routine biochemical screening for PA remained the most reliable way of detecting this treatable secondary cause of hypertension.
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Affiliation(s)
- Renata Libianto
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Vic, Australia
- Department of Endocrinology, Monash Health, Clayton, Vic, Australia
- Department of Medicine, Monash University, Clayton, Vic, Australia
| | - Serena Menezes
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Vic, Australia
| | - Amrina Kaur
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Vic, Australia
| | - Stella May Gwini
- Barwon Health, University Hospital Geelong, Geelong, Vic, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jimmy Shen
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Vic, Australia
- Department of Endocrinology, Monash Health, Clayton, Vic, Australia
| | - Om Narayan
- MonashHeart, Monash Health, Clayton, Vic, Australia
| | - Peter J Fuller
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Vic, Australia
- Department of Endocrinology, Monash Health, Clayton, Vic, Australia
| | - Jun Yang
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Vic, Australia
- Department of Endocrinology, Monash Health, Clayton, Vic, Australia
- Department of Medicine, Monash University, Clayton, Vic, Australia
| | - Morag J Young
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Vic, Australia
- Department of Medicine, Monash University, Clayton, Vic, Australia
- Baker Heart and Diabetes Institute, Melbourne, Australia
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Varzideh F, Kansakar U, Jankauskas SS, Gambardella J, Santulli G. Cardiovascular Endocrinology: Evolving Concepts and Updated Epidemiology of Relevant Diseases. Front Endocrinol (Lausanne) 2021; 12:772876. [PMID: 34675888 PMCID: PMC8524081 DOI: 10.3389/fendo.2021.772876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 09/14/2021] [Indexed: 01/10/2023] Open
Affiliation(s)
- Fahimeh Varzideh
- Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, NY, United States
- Department of Molecular Pharmacology, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein Institute for Neuroimmunology and Inflammation, Albert Einstein College of Medicine, New York, NY, United States
| | - Urna Kansakar
- Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, NY, United States
- Department of Molecular Pharmacology, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein Institute for Neuroimmunology and Inflammation, Albert Einstein College of Medicine, New York, NY, United States
| | - Stanislovas S. Jankauskas
- Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, NY, United States
- Department of Molecular Pharmacology, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein Institute for Neuroimmunology and Inflammation, Albert Einstein College of Medicine, New York, NY, United States
| | - Jessica Gambardella
- Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, NY, United States
- Department of Advanced Biomedical Science, “Federico II” University, and International Translational Research and Medical Education (ITME) Consortium, Naples, Italy
| | - Gaetano Santulli
- Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York, NY, United States
- Department of Molecular Pharmacology, Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein Institute for Neuroimmunology and Inflammation, Albert Einstein College of Medicine, New York, NY, United States
- Department of Advanced Biomedical Science, “Federico II” University, and International Translational Research and Medical Education (ITME) Consortium, Naples, Italy
- *Correspondence: Gaetano Santulli,
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Primary aldosteronism is a public health issue: challenges and opportunities. J Hum Hypertens 2020; 34:478-486. [PMID: 32341439 DOI: 10.1038/s41371-020-0336-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/23/2020] [Accepted: 03/27/2020] [Indexed: 12/26/2022]
Abstract
A significant proportion of hypertension (potentially more than 5% in the general population) is due to primary aldosteronism (PA) which carries a worse prognosis when compared with blood pressure-matched essential hypertension. Effective targeted treatments are available which mitigate many of the cardiovascular complications of untreated PA. Despite this, the detection rate of PA in primary care is sub-optimal. In this review, we explore the challenges contributing to the under-diagnosis of PA in the community, including uncertainties regarding its actual prevalence. In order to detect PA early and offer targeted treatment before adverse cardiovascular consequences develop, routine screening for PA at the time of a diagnosis of hypertension would seem desirable. However, this is limited by a lack of studies to establish whether routine screening in primary care is cost-effective. Newer techniques are also being developed which could lessen the complexity of diagnosing PA. Most importantly, a dramatic increase in awareness of PA, as a treatable cause of hypertension, is needed amongst clinicians who manage hypertension.
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Benenson I, Waldron F, Bradshaw M, Vitale T. Endocrine Hypertension: A Primer for Primary Care Nurse Practitioners. J Nurse Pract 2019. [DOI: 10.1016/j.nurpra.2019.08.028] [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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Vaychulis IA, Shaposhnik II. [The Main Provisions of the International Recommendations on Detection of Endocrine Hypertension]. KARDIOLOGIIA 2019; 59:88-96. [PMID: 31615391 DOI: 10.18087/cardio.2019.10.2669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 10/15/2019] [Indexed: 06/10/2023]
Abstract
In 2017 the Endocrine Society issued the Scientific Statement "Screening for Endocrine Hypertension" This document was developed by experts from different medical institutions of USA, Europe and Australia. Herein we present the main provisions of this Statement in the form of brief algorithm for the clinicians' actions for timely detection of secondary endocrine hypertension and rational referral of the patient for confirmational testing.The full text of the Scientific Statement in English is contained in the article. Young WF Jr., Calhoun DA, Lenders JW, Stowasser M, Textor SC. Screening for Endocrine Hypertension: An Endocrine Society Scientific Statement. Endocrine Reviews. 2017; 38 (2):103-122.URL: https://academic.oup.com/edrv/article/38/2/103/3104343.
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Geva GA, Gross DJ, Mazeh H, Atlan K, Ben-Dov IZ, Fischer M. Adrenocorticotropic Hormone Secreting Pheochromocytoma Underlying Glucocorticoid Induced Pheochromocytoma Crisis. Case Rep Endocrinol 2018; 2018:3963274. [PMID: 29675278 PMCID: PMC5838465 DOI: 10.1155/2018/3963274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 01/19/2018] [Accepted: 01/23/2018] [Indexed: 01/03/2023] Open
Abstract
CONTEXT Pheochromocytomas are hormone secreting tumors of the medulla of the adrenal glands found in 0.1-0.5% of patients with hypertension. The vast majority of pheochromocytomas secrete catecholamines, but they have been occasionally shown to also secrete interleukins, calcitonin, testosterone, and in rare cases adrenocorticotropic hormone. Pheochromocytoma crisis is a life threatening event in which high levels of catecholamines cause a systemic reaction leading to organ failure. CASE DESCRIPTION A 70-year-old man was admitted with acute myocardial ischemia following glucocorticoid administration as part of an endocrine workup for an adrenal mass. Cardiac catheterization disclosed patent coronary arteries and he was discharged. A year later he returned with similar angina-like chest pain. During hospitalization, he suffered additional events of chest pain, shortness of breath, and palpitations following administration of glucocorticoids as preparation for intravenous contrast administration. Throughout his admission, the patient demonstrated both signs of Cushing's syndrome and high catecholamine levels. Following stabilization of vital parameters and serum electrolytes, the adrenal mass was resected surgically and was found to harbor an adrenocorticotropic hormone secreting pheochromocytoma. This is the first documented case of adrenocorticotropic hormone secreting pheochromocytoma complicated by glucocorticoid induced pheochromocytoma crisis. CONCLUSION Care should be taken when administering high doses of glucocorticoids to patients with suspected pheochromocytoma, even in a patient with concomitant Cushing's syndrome.
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Affiliation(s)
- Gil A. Geva
- The Hebrew University Hadassah Medical School, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - David J. Gross
- Endocrinology & Metabolism Service, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Haggi Mazeh
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Karine Atlan
- Department of Pathology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Iddo Z. Ben-Dov
- Nephrology and Hypertension Services, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Matan Fischer
- Department of Internal Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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