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Mulatero P, Scholl UI, Fardella CE, Charmandari E, Januszewicz A, Reincke M, Gomez-Sanchez CE, Stowasser M, Dekkers OM. Familial hyperaldosteronism: an European Reference Network on Rare Endocrine Conditions clinical practice guideline. Eur J Endocrinol 2024; 190:G1-G14. [PMID: 38571460 DOI: 10.1093/ejendo/lvae041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 03/15/2024] [Indexed: 04/05/2024]
Abstract
We describe herein the European Reference Network on Rare Endocrine Conditions clinical practice guideline on diagnosis and management of familial forms of hyperaldosteronism. The guideline panel consisted of 10 experts in primary aldosteronism, endocrine hypertension, paediatric endocrinology, and cardiology as well as a methodologist. A systematic literature search was conducted, and because of the rarity of the condition, most recommendations were based on expert opinion and small patient series. The guideline includes a brief description of the genetics and molecular pathophysiology associated with each condition, the patients to be screened, and how to screen. Diagnostic and treatment approaches for patients with genetically determined diagnosis are presented. The recommendations apply to patients with genetically proven familial hyperaldosteronism and not to families with more than one case of primary aldosteronism without demonstration of a responsible pathogenic variant.
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Affiliation(s)
- Paolo Mulatero
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, 10126 Torino, Italy
| | - Ute I Scholl
- Center of Functional Genomics, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, 10115 Berlin, Germany
| | - Carlos E Fardella
- Department of Endocrinology, School of Medicine, Centro Traslacional de Endocrinología Universidad Católica (CETREN-UC), Pontificia Universidad Católica de Chile, 8330033 Santiago, Chile
| | - Evangelia Charmandari
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, Athens 11527, Greece
- Division of Endocrinology and Metabolism, Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens 11527, Greece
| | - Andrzej Januszewicz
- Department of Hypertension, National Institute of Cardiology, 02-628 Warsaw, Poland
| | - Martin Reincke
- Department of Medicine 4, LMU University Hospital, LMU Munich, Munich D-80336, Germany
| | - Celso E Gomez-Sanchez
- Research Service, G. V. (Sonny) Montgomery VA Medical Center, Jackson, MS 39216, United States
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, 39216 MS, United States
| | - Michael Stowasser
- Endocrine Hypertension Research Centre, University of Queensland Frazer Institute, Greenslopes and Princess Alexandra Hospitals, Brisbane, 4102 Queensland, Australia
| | - Olaf M Dekkers
- Departments of Clinical Epidemiology and Internal Medicine, Leiden University Medical Centre, 2311 Leiden, The Netherlands
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2
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Miller JJ, Bohn MK, Higgins V, Nichols M, Mohammed-Ali Z, Henderson T, Selvaratnam R, Sepiashvili L, Adeli K. Pediatric reference intervals for endocrine markers in healthy children and adolescents on the Liaison XL (DiaSorin) immunoassay system. Clin Biochem 2023; 120:110644. [PMID: 37673294 DOI: 10.1016/j.clinbiochem.2023.110644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVES Prominent physiological changes occurring throughout childhood and adolescence necessitate the consideration of age and sex in biomarker interpretation. Critical gaps exist in pediatric reference intervals (RIs) for specialized endocrine markers, despite expected influence of growth and development. The current study aimed to establish and/or verify RIs for six specialized endocrine markers on a specialized immunoassay system. METHODS Samples were collected from healthy children and adolescents (5 to <19 years) and apparently healthy outpatients (0 to <5 years) as part of the Canadian Laboratory Initiative on Pediatric Reference Intervals (CALIPER). Serum samples were analysed for aldosterone, renin (plasma), thyroglobulin, anti-thyroglobulin, growth hormone, and insulin-like growth factor-1 (IGF-1) on the Liaison XL (DiaSorin) immunoassay platform. RIs (2.5th and 97.5th percentiles) were established for aldosterone, renin, thyroglobulin, anti-thyroglobulin, and growth hormone. Manufacturer-recommended pediatric RIs for IGF-1 were verified. RESULTS Age-specific RIs were established for aldosterone, renin, and thyroglobulin, while no age-specific differences were observed for anti-thyroglobulin or growth hormone. IGF-1 was the only endocrine marker studied that demonstrated significant sex-specific differences. Manufacturer-recommended IGF-1 RIs were verified for children aged 6 to <19 years, while those for children aged 0 to <6 years did not verify. CONCLUSIONS This study marks the first time that pediatric RIs for aldosterone and renin were established in the CALIPER cohort and highlights the dynamic changes that occur in water and sodium homeostasis during the first years of life. Overall, these data will assist pediatric clinical laboratories in test result interpretation and improve clinical decision-making for patients tested using Liaison immunoassays.
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Affiliation(s)
- J J Miller
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Canada
| | - M K Bohn
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Canada; CALIPER Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - V Higgins
- DynaLIFE Medical Labs, Edmonton, AB, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - M Nichols
- Department of Pathology and Laboratory Medicine, Schulich Medicine and Dentistry, Western University, London, ON, Canada
| | | | - T Henderson
- CALIPER Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - R Selvaratnam
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Canada; Laboratory Medicine Program, Division of Clinical Biochemistry, University Health Network, Toronto, ON, Canada
| | - L Sepiashvili
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Canada; CALIPER Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - K Adeli
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Canada; CALIPER Program, The Hospital for Sick Children, Toronto, ON, Canada.
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3
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Xiong Y, Zeng Z, Liang T, Yang P, Lu Q, Yang J, Zhang J, Fang W, Luo P, Hu Y, Zhang M, Zhou D. Unequal crossing over between CYP11B2 and CYP11B1 causes 11 β -hydroxylase deficiency in a consanguineous family. J Steroid Biochem Mol Biol 2023; 233:106375. [PMID: 37572761 DOI: 10.1016/j.jsbmb.2023.106375] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/14/2023] [Accepted: 08/08/2023] [Indexed: 08/14/2023]
Abstract
Cytochrome P450 (CYP) family CYP11B2/CYP11B1 chimeric genes have been shown to arise from unequal crossing over of the genes encoding aldosterone synthase (CYP11B2) and 11β-hydroxylase (CYP11B1) during meiosis. The activity deficiency or impaired activity of aldosterone synthase and 11β-hydroxylase resulting from these chimeric genes are important reasons for 11β-hydroxylase deficiency (11β-OHD). Here,two patients with pseudoprecocious puberty and hypokalemia hypertension and three carriers in a consanguineous marriage family were studied. A single CYP11B2/CYP11B1 chimera consisting of the promoter and exons 1 through 5 of CYP11B2, exons 8 and 9 of CYP11B1, and a breakpoint consisting of part of exon 6 of CYP11B2 and part of exon 6, intron 6, and exon 7 of CYP11B1 were detected in the patients and carriers. At the breakpoint of the chimera, a c 0.1086 G > C ( p.Leu.362 =) synonymous mutation in exon 6 of CYP11B2, a c 0.1157 C>G(p. A386V) missense mutation in exon 7 of CYP11B1, and an intronic mutation in intron 6 were detected. The allele model of the CYP11B2/CYP11B1 chimera demonstrated homozygosity and heterozygosity in the patients and the carriers, respectively. Molecular docking and enzymatic activity analyses indicated that the CYP11B2/CYP11B1 chimeric protein interacted with the catalytic substrate of aldosterone synthase and had similar enzymatic activity to aldosterone synthase. Our study indicated that deletion of CYP11B1 and CYP11B2 abolished the enzymatic activity of 11 β-hydroxylase and aldosterone synthase; however, the compensation of the enzymatic activity of aldosterone synthase by the CYP11B2/CYP11B1 chimeric protein maintained normal aldosterone levels in vitro. All of the above findings explained the 11β-OHD phenotypes of the proband and patients in the family.
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Affiliation(s)
- Yu Xiong
- School of Clinical Laboratory Science, Guizhou Medical University, Guiyang, Guizhou, 550004, PR China; Clinical Research Center, the Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, PR China
| | - Zhen Zeng
- School of Clinical Laboratory Science, Guizhou Medical University, Guiyang, Guizhou, 550004, PR China; Clinical Research Center, the Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, PR China
| | - Tingting Liang
- Clinical College, Guizhou Medical University, Guiyang, Guizhou 550004, PR China; Endocrine Metabolism Department, the Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, PR China
| | - Pingping Yang
- School of Clinical Laboratory Science, Guizhou Medical University, Guiyang, Guizhou, 550004, PR China; Clinical Research Center, the Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, PR China
| | - Qingxiang Lu
- School of Clinical Laboratory Science, Guizhou Medical University, Guiyang, Guizhou, 550004, PR China; Clinical Research Center, the Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, PR China
| | - Jingye Yang
- School of Clinical Laboratory Science, Guizhou Medical University, Guiyang, Guizhou, 550004, PR China; Clinical Research Center, the Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, PR China
| | - Jing Zhang
- Clinical Research Center, the Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, PR China
| | - Wen Fang
- School of Clinical Laboratory Science, Guizhou Medical University, Guiyang, Guizhou, 550004, PR China
| | - Panyu Luo
- Endocrine Metabolism Department, the Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, PR China
| | - Ying Hu
- Endocrine Metabolism Department, the Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, PR China
| | - Miao Zhang
- Endocrine Metabolism Department, the Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, PR China.
| | - Ding'an Zhou
- Clinical Research Center, the Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, PR China; Key Laboratory of Medical Molecular Biology,Guizhou province; Key Laboratory of Eedimic and Ethnic Disease, Ministry of Education; Key Laboratory of Medical Molecular Biology, Guizhou Medical University, PR China.
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4
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Otto ME, Burckhardt M, Szinnai G, Pfister M, Gotta V. Semimechanistic modeling of copeptin and aldosterone kinetics and dynamics in response to rehydration treatment for diabetic ketoacidosis in children. CPT Pharmacometrics Syst Pharmacol 2022; 12:207-220. [PMID: 36510706 PMCID: PMC9931437 DOI: 10.1002/psp4.12891] [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: 05/08/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 12/15/2022] Open
Abstract
Diabetic ketoacidosis (DKA), a frequent complication of type 1 diabetes (T1D), is characterized by hyperosmolar hypovolemia. The response of water-regulating hormones arginine vasopressin (AVP; antidiuretic hormone) and aldosterone to DKA treatment in children is not well understood, although they may have potential as future diagnostic, prognostic, and/or treatment monitoring markers in diabetic patients. We aimed to characterize the dynamics of the response in copeptin (marker for AVP) and aldosterone secretion to rehydration treatment in pediatric patients with DKA. Data originated from a prospective, observational, multicenter study including 28 pediatric T1D patients treated for DKA (median age, 11.5 years; weight, 35 kg). Serial measurements of hormone levels were obtained during 72 h following rehydration start. Semimechanistic pharmacometric modeling was used to analyze the kinetic/dynamic relationship of copeptin and aldosterone secretion in response to the correction of hyperosmolality and hypovolemia, respectively. Modeling revealed different sensitivities for osmolality-dependent copeptin secretion during the first 72 h of rehydration, possibly explained by an osmotic shift introduced by hypovolemia. Response in aldosterone secretion to the correction of hypovolemia seemed to be delayed, which was well described by an extra upstream turnover compartment, possibly representing chronic upregulation of aldosterone synthase (cytochrome P450 11B2). In conclusion, semimechanistic modeling provided novel physiological insights in hormonal water regulation in pediatric patients during DKA treatment, providing rationale to further evaluate the potential of monitoring copeptin, but not aldosterone due to its delayed response, for future optimization of rehydration treatment to reduce the risk of acute complications such as cerebral edema.
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Affiliation(s)
- Marije E. Otto
- Pediatric Pharmacology and PharmacometricsUniversity Children's Hospital Basel, University of BaselBaselSwitzerland,Leiden Academic Centre for Drug ResearchLeiden UniversityLeidenThe Netherlands
| | - Marie‐Anne Burckhardt
- Pediatric Endocrinology and DiabetologyUniversity Children's Hospital Basel, University of BaselBaselSwitzerland,Department of Clinical ResearchUniversity Hospital Basel, University of BaselBaselSwitzerland
| | - Gabor Szinnai
- Pediatric Endocrinology and DiabetologyUniversity Children's Hospital Basel, University of BaselBaselSwitzerland,Department of Clinical ResearchUniversity Hospital Basel, University of BaselBaselSwitzerland
| | - Marc Pfister
- Pediatric Pharmacology and PharmacometricsUniversity Children's Hospital Basel, University of BaselBaselSwitzerland,CertaraPrincetonNew JerseyUSA
| | - Verena Gotta
- Pediatric Pharmacology and PharmacometricsUniversity Children's Hospital Basel, University of BaselBaselSwitzerland
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5
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Khandelwal P, Deinum J. Monogenic forms of low-renin hypertension: clinical and molecular insights. Pediatr Nephrol 2022; 37:1495-1509. [PMID: 34414500 DOI: 10.1007/s00467-021-05246-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 07/16/2021] [Accepted: 07/19/2021] [Indexed: 11/25/2022]
Abstract
Monogenic disorders of hypertension are a distinct group of diseases causing dysregulation of the renin-angiotensin-aldosterone system and are characterized by low plasma renin activity. These can chiefly be classified as causing (i) excessive aldosterone synthesis (familial hyperaldosteronism), (ii) dysregulated adrenal steroid metabolism and action (apparent mineralocorticoid excess, congenital adrenal hyperplasia, activating mineralocorticoid receptor mutation, primary glucocorticoid resistance), and (iii) hyperactivity of sodium and chloride transporters in the distal tubule (Liddle syndrome and pseudohypoaldosteronism type 2). The final common pathway is plasma volume expansion and catecholamine/sympathetic excess that causes urinary potassium wasting; hypokalemia and early-onset refractory hypertension are characteristic. However, several single gene defects may show phenotypic heterogeneity, presenting with mild hypertension with normal electrolytes. Evaluation is based on careful attention to family history, physical examination, and measurement of blood levels of potassium, renin, and aldosterone. Genetic sequencing is essential for precise diagnosis and individualized therapy. Early recognition and specific management improves prognosis and prevents long-term sequelae of severe hypertension.
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Affiliation(s)
- Priyanka Khandelwal
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Jaap Deinum
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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6
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Kuai Y, Huang H, Dai X, Zhang Z, Bai Z, Chen J, Fang F, Pan J, Li X, Wang J, Li Y. In PICU acute kidney injury stage 3 or mortality is associated with early excretion of urinary renin. Pediatr Res 2022; 91:1149-1155. [PMID: 34083760 DOI: 10.1038/s41390-021-01592-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 05/12/2021] [Accepted: 05/17/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Urinary renin is proposed to be a novel prognostic biomarker of acute kidney injury (AKI) in adults. The intention of our study was to evaluate the early predictive value of urinary renin for AKI and pediatric intensive care unit (PICU) mortality in critically ill children. METHODS The first available urine sample during the first 24 h after admission was collected upon PICU admission for the measurement of renin using ELISA. Urinary renin concentrations were corrected for urinary creatinine (urinary renin-to-creatinine ratio, uRenCR). AKI was defined based on KDIGO criteria. RESULTS Of the 207 children, 22 developed AKI, including 6 with stage 1, 6 with stage 2, and 10 with stage 3, and 14 died during PICU stay. There was a significant difference in uRenCR between non-AKI children and those with AKI stage 3 (P = 0.001), but not with AKI stage 1 or 2. The uRenCR remained associated with AKI stage 3 and PICU mortality after adjustment for potential confounders. The area under the receiver operating characteristic curve of uRenCR for discrimination of AKI stage 3 was 0.805, and PICU mortality was 0.801. CONCLUSIONS Urinary renin was associated with the increased risk for AKI stage 3 and PICU mortality in critically ill children. IMPACT Urinary renin is proposed to be a novel prognostic biomarker of AKI in adult patients. There are some differences between children and adults in physiological and pathophysiological characteristics. This study demonstrated that urinary renin was associated with the increased risk for AKI stage 3 and PICU mortality in critically ill children. Accurate identification of patients with severe renal injury or at high risk for mortality early in the disease course could augment the efficacy of available interventions and improve patient outcomes.
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Affiliation(s)
- Yuxian Kuai
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, Suzhou, Jiangsu province, China
| | - Hui Huang
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, Suzhou, Jiangsu province, China
| | - Xiaomei Dai
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, Suzhou, Jiangsu province, China
| | - Zhongyue Zhang
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, Suzhou, Jiangsu province, China
| | - Zhenjiang Bai
- Pediatric Intensive Care Unit, Children's Hospital of Soochow University, Suzhou, Jiangsu province, China
| | - Jiao Chen
- Pediatric Intensive Care Unit, Children's Hospital of Soochow University, Suzhou, Jiangsu province, China
| | - Fang Fang
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu province, China
| | - Jian Pan
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu province, China
| | - Xiaozhong Li
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, Suzhou, Jiangsu province, China
| | - Jian Wang
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu province, China
| | - Yanhong Li
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, Suzhou, Jiangsu province, China. .,Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu province, China.
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7
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Pastén V, Tapia-Castillo A, Fardella CE, Leiva A, Carvajal CA. Aldosterone and renin concentrations were abnormally elevated in a cohort of normotensive pregnant women. Endocrine 2022; 75:899-906. [PMID: 34826118 DOI: 10.1007/s12020-021-02938-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 11/02/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND During pregnancy, the renin-angiotensin-aldosterone system (RAAS) undergoes major changes to preserve normal blood pressure (BP) and placental blood flow and to ensure a good pregnancy outcome. Abnormal aldosterone-renin metabolism is a risk factor for arterial hypertension and cardiovascular risk, but its association with pathological conditions in pregnancy remains unknown. Moreover, potential biomarkers associated with these pathological conditions should be identified. AIM To study a cohort of normotensive pregnant women according to their serum aldosterone and plasma renin levels and assay their small extracellular vesicles (sEVs) and a specific protein cargo (LCN2, AT1R). METHODS A cohort of 54 normotensive pregnant women at term gestation was included. We determined the BP, serum aldosterone, and plasma renin concentrations. In a subgroup, we isolated their plasma sEVs and semiquantitated two EV proteins (AT1R and LCN2). RESULTS We set a normal range of aldosterone and renin based on the interquartile range. We identified 5/54 (9%) pregnant women with elevated aldosterone and low renin levels and 5/54 (9%) other pregnant women with low aldosterone and elevated renin levels. No differences were found in sEV-LCN2 or sEV-AT1R. CONCLUSION We found that 18% of normotensive pregnant women had either high aldosterone or high renin levels, suggesting a subclinical status similar to primary aldosteronism or hyperreninemia, respectively. Both could evolve to pathological conditions by affecting the maternal vascular and renal physiology and further the BP. sEVs and their specific cargo should be further studied to clarify their role as potential biomarkers of RAAS alterations in pregnant women.
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Affiliation(s)
- Valentina Pastén
- Department of Endocrinology, School of Medicine, 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 on Immunology and Immunotherapy (IMII-ICM), Santiago, Chile
- Centro Traslacional de Endocrinología UC (CETREN), Santiago, Chile
| | - Carlos E Fardella
- Department of Endocrinology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy (IMII-ICM), Santiago, Chile
- Centro Traslacional de Endocrinología UC (CETREN), Santiago, Chile
| | - Andrea Leiva
- Division of Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
- School of Medical Technology, Health Sciences Faculty, Universidad San Sebastian, Santiago, Chile.
| | - Cristian A Carvajal
- Department of Endocrinology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
- Millennium Institute on Immunology and Immunotherapy (IMII-ICM), Santiago, Chile.
- Centro Traslacional de Endocrinología UC (CETREN), Santiago, Chile.
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8
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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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9
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Yang J, May Gwini S, Beilin LJ, Schlaich M, Stowasser M, Young MJ, Fuller PJ, Mori TA. Relationship Between the Aldosterone-to-Renin Ratio and Blood Pressure in Young Adults: A Longitudinal Study. Hypertension 2021; 78:387-396. [PMID: 34120455 DOI: 10.1161/hypertensionaha.121.17336] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Jun Yang
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia (J.Y., P.J.F.).,Department of Medicine (J.Y.), Monash University, Clayton, Victoria, Australia
| | - Stella May Gwini
- Department of Epidemiology, School of Public Health and Preventive Medicine (S.M.G.), Monash University, Clayton, Victoria, Australia.,University Hospital Geelong, Barwon Health, Victoria, Australia (S.M.G.)
| | - Lawrence J Beilin
- Medical School, The University of Western Australia (L.J.B., T.A.M.)
| | - Markus Schlaich
- Dobney Hypertension Centre, Medical School, The University of Western Australia, Royal Perth Hospital Campus (M. Schlaich).,Departments of Cardiology and Nephrology, Royal Perth Hospital, Australia (M. Schlaich).,Neurovascular Hypertension and Kidney Disease Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia (M. Schlaich)
| | - Michael Stowasser
- Endocrine Hypertension Research Centre, University of Queensland Diamantina Institute, Princess Alexandra Hospital, Brisbane, Australia (M. Stowasser)
| | - Morag J Young
- Cardiovascular Endocrinology Laboratory, Baker Heart and Diabetes Institute, Victoria, Australia (M.J. Young)
| | - Peter J Fuller
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia (J.Y., P.J.F.)
| | - Trevor A Mori
- Medical School, The University of Western Australia (L.J.B., T.A.M.)
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10
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Urinary sodium-to-potassium ratio and plasma renin and aldosterone concentrations in normotensive children: implications for the interpretation of results. J Hypertens 2021; 38:671-678. [PMID: 31790052 DOI: 10.1097/hjh.0000000000002324] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To identify associations among the plasma renin concentration (PRC), plasma aldosterone and urinary sodium (Na)/potassium (K) ratio, and to integrate these variables into a nomogram with the aim of estimating the expected versus observed aldosterone concentration. METHODS We studied 40 healthy normotensive children (5-8 years old, 57.5% girls) who were born at term and were adequate for their gestational age. Following overnight fasting, the PRC and plasma aldosterone in blood samples were measured, and the Na/K ratio was calculated from a simultaneously obtained urinary spot sample. A mathematical function was defined with these three variables, and a nomogram was built that would return the expected aldosterone concentration from the obtained plasma renin and urinary Na/K ratio values. RESULTS The PRC (B = 5.9, P < 0.001) and urinary Na/K ratio (B = -98.1, P = 0.003) were significant independent predictors of plasma aldosterone. The correlation between the observed plasma aldosterone and the expected plasma aldosterone, as obtained from the nomogram, was r = 0.88, P < 0.001. The average difference between the observed and expected plasma aldosterone was -0.89, with a standard deviation of ±30%. CONCLUSION The strong correlation between the urinary Na/K ratio, from urine samples taken at the same as the blood samples, and plasma renin and aldosterone concentrations allowed us to build a nomogram to predict aldosterone levels. This approach may be useful for evaluating the renin-angiotensin-aldosterone system (RAAS) in pediatric patients with hypertension and RAAS dysfunction.
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Mashmoushi A, Choudhary A, Thomas CP, Wolf MT. A rare case of hyporeninemic hypertension: Answers. Pediatr Nephrol 2021; 36:569-573. [PMID: 32607771 PMCID: PMC7772256 DOI: 10.1007/s00467-020-04667-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/09/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Ahmad Mashmoushi
- Pediatric Nephrology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Abha Choudhary
- Pediatric Endocrinology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Christie P. Thomas
- Division of Nephrology, Department of Internal Medicine, University of Iowa Health Care, Iowa City, IA, USA
| | - Matthias T.F. Wolf
- Pediatric Nephrology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Veldhuizen GP, Alnazer RM, Kroon AA, de Leeuw PW. Confounders of the aldosterone-to-renin ratio when used as a screening test in hypertensive patients: A critical analysis of the literature. J Clin Hypertens (Greenwich) 2020; 23:201-207. [PMID: 33368994 PMCID: PMC8030008 DOI: 10.1111/jch.14117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 12/21/2022]
Abstract
The aldosterone‐to‐renin ratio (ARR) is a common screening test for primary aldosteronism in hypertensives. However, there are many factors which could confound the ARR test result and reduce the accuracy of this test. The present review's objective is to identify these factors and to describe to what extent they affect the ARR. Our analysis revealed that sex, age, posture, and sodium‐intake influence the ARR, whereas assay techniques do not. Race and body mass index have an uncertain effect on the ARR. We conclude that several factors can affect the ARR. Not taking these factors into account could lead to misinterpretation of the ARR.
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Affiliation(s)
- Gregory P Veldhuizen
- Department of Internal Medicine, Maastricht University Medical Center & Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Rawan M Alnazer
- Department of Internal Medicine, Maastricht University Medical Center & Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Abraham A Kroon
- Department of Internal Medicine, Maastricht University Medical Center & Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Peter W de Leeuw
- Department of Internal Medicine, Maastricht University Medical Center & Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
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Mulatero P, Monticone S, Deinum J, Amar L, Prejbisz A, Zennaro MC, Beuschlein F, Rossi GP, Nishikawa T, Morganti A, Seccia TM, Lin YH, Fallo F, Widimsky J. Genetics, prevalence, screening and confirmation of primary aldosteronism: a position statement and consensus of the Working Group on Endocrine Hypertension of The European Society of Hypertension. J Hypertens 2020; 38:1919-1928. [PMID: 32890264 DOI: 10.1097/hjh.0000000000002510] [Citation(s) in RCA: 142] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
: Autonomous aldosterone overproduction represents the underlying condition of 5-10% of patients with arterial hypertension and carries a significant burden of mortality and morbidity. The diagnostic algorithm for primary aldosteronism is sequentially based on hormonal tests (screening and confirmation tests), followed by lateralization studies (adrenal CT scanning and adrenal venous sampling) to distinguish between unilateral and bilateral disease. Despite the recommendations of the Endocrine Society guideline, primary aldosteronism is largely underdiagnosed and undertreated with high between-centre heterogeneity. Experts from the European Society of Hypertension have critically reviewed the available literature and prepared a consensus document constituting two articles to summarize current knowledge on the epidemiology, diagnosis, treatment, and complications of primary aldosteronism.
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Affiliation(s)
- Paolo Mulatero
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Silvia Monticone
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, Torino, Italy
| | - Jaap Deinum
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Medicine III, University Hospital Carl Gustav Carus at the TU Dresden, Dresden, Germany
| | - Laurence Amar
- Hypertension Unit, Assistance Publique-Hôpitaux de Paris, Hôpital européen Georges-Pompidou, Université de Paris, PARCC, Inserm, Paris, France
| | - Aleksander Prejbisz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| | - Maria-Christina Zennaro
- Université de Paris, PARCC, INSERM, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Génétique, Paris, France
| | - Felix Beuschlein
- Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, Universitätsspital Zürich, Zürich, Switzerland
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
| | - Gian Paolo Rossi
- Hypertension Unit and Specialized Center for Blood Pressure Disorders - Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Tetsuo Nishikawa
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Yokohama, Japan
| | - Alberto Morganti
- Centro Fisiologia Clinica e Ipertensione, Ospedale Policlinico, Università di Milano, Milan, Italy
| | - Teresa Maria Seccia
- Hypertension Unit and Specialized Center for Blood Pressure Disorders - Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Yen-Hung Lin
- Division of cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Francesco Fallo
- Department of Medicine -DIMED, University of Padova, Padova, Italy
| | - Jiri Widimsky
- 3rd Department of Medicine, Center for Hypertension, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
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Mulatero P, Burrello J, Williams TA, Monticone S. Primary Aldosteronism in the Elderly. J Clin Endocrinol Metab 2020; 105:5821545. [PMID: 32303754 DOI: 10.1210/clinem/dgaa206] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 04/15/2020] [Indexed: 12/16/2022]
Abstract
CONTEXT The clinical spectrum and knowledge of the molecular mechanisms underlying primary aldosteronism (PA), the most frequent form of endocrine hypertension, has evolved over recent years. In accordance with the Endocrine Society guidelines and in light of the growing evidence showing adverse cardiovascular outcomes, it is expected that a progressively wider population of patients affected by hypertension will be screened for PA, including the elderly. EVIDENCE ACQUISITION A systematic search of PubMed was undertaken for studies related to the renin-angiotensin-aldosterone system (RAAS), PA, and adrenal histopathology in the elderly population. EVIDENCE SYNTHESIS Several studies showed an age-dependent decrease in the activity of RAAS, together with a progressive decrease of the aldosterone response to sodium intake, particularly after the sixth decade of life. The positive correlation between age and serum aldosterone during liberal sodium intake over serum aldosterone during sodium restriction is paralleled by histological changes in adrenal aldosterone synthase (CYP11B2) expression patterns. Immunohistochemical studies showed a progressive loss of the continuous expression of CYP11B2 in the adrenal zona glomerulosa with aging and a concomitant increase of aldosterone-producing cell clusters, which might be responsible for relatively autonomous aldosterone production. Additionally, following PA confirmation and subtype diagnosis, older age is correlated with a lower benefit after adrenalectomy for unilateral PA. CONCLUSIONS Accumulating evidence suggests that RAAS physiology and regulation show age-related changes. Further studies may investigate to what extent these variations might affect the diagnostic workup of patients affected by PA.
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Affiliation(s)
- Paolo Mulatero
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Jacopo Burrello
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Tracy Ann Williams
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Turin, Italy
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Silvia Monticone
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Turin, Italy
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Lee S, Choi YH, Cho YJ, Cheon JE, Park JE, Kim WS, Kim IO. Diagnostic Role of Renal Doppler Ultrasound and Plasma Renin Activity as Screening Tools for Renovascular Hypertension in Children. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2651-2657. [PMID: 30779189 DOI: 10.1002/jum.14966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 01/14/2019] [Accepted: 01/19/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES The diagnostic role of an ultrasound (US) and plasma renin activity (PRA) combination is unknown, despite the usefulness of Doppler US as a screening tool for renovascular hypertension (RVHT). The purpose of this study was to evaluate the diagnostic usefulness of US for RVHT in children stratified according to PRA. METHODS We identified 336 children who underwent renal Doppler US examinations for hypertension and divided them into a high-renin group (n = 177) and a normal-renin group (n = 159) based on PRA and stratified them by age. The Doppler US findings were retrospectively reviewed, and computed tomographic angiography (CTA) for the same children was used as the reference standard. RESULTS In the high-renin group, 36 patients had positive Doppler US findings that were confirmed by CTA in 32 cases. The sensitivity and specificity values for Doppler US in the high-renin group were 84.2% and 93.6%, respectively. In the normal-renin group, 10 patients had positive Doppler US findings; these positive findings were confirmed by CTA in 9 cases. The sensitivity and specificity values for US in the normal-renin group were 100.0% and 100.0%. There were anatomic variations (n = 3) and segmental artery stenosis (n = 2) among the cases with false-negative US findings, which were confirmed by CTA. CONCLUSIONS If patients have high PRA, a Doppler US examination should be performed with caution to avoid false-negative detection. If patients have normal PRA, renal Doppler US might be adequate for diagnosis of RVHT to avoid unnecessary CTA.
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Affiliation(s)
- Seunghyun Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Young Hun Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Yeon Jin Cho
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Jung-Eun Cheon
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Ji Eun Park
- Department of Radiology, Kyung Hee University Hospital, Seoul, Korea
| | - Woo Sun Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - In-One Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
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16
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O'Shea PM, Griffin TP, Denieffe S, Fitzgibbon MC. The aldosterone to renin ratio in the diagnosis of primary aldosteronism: Promises and challenges. Int J Clin Pract 2019; 73:e13353. [PMID: 31009143 DOI: 10.1111/ijcp.13353] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 03/16/2019] [Accepted: 04/18/2019] [Indexed: 12/20/2022] Open
Abstract
The complexity of evaluating patients for secondary treatable causes of hypertension is underappreciated. Primary aldosteronism (PA) is the most prevalent cause of secondary hypertension (3%-32% of hypertensive patients). The recent endocrine society clinical practice guideline (ESCPG), "The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment", differs from the previous version in the explicit recognition of PA as a major public health issue. Despite this, PA is underdiagnosed. The guidelines call on physicians to substantially ramp up the screening of hypertensive patients at risk of PA. Further, it recommends the plasma aldosterone to renin ratio (ARR), as the test of choice for screening for PA. However, the ARR is a highly variable test with reported diagnostic sensitivities and specificities ranging from 66% to 100% and 61% to 100%, respectively. Variability of the ARR can be attributed to the high degree of within-subject variation, differences in sampling protocols, laboratory assays, reporting units, the effect of medications and the population characteristics used to establish the decision thresholds. These factors render the possibility of false positive and false negative results-which have the potential to adversely impact patients. The limitations and caveats to the use of the ARR necessitate an effective clinic-laboratory interface, with specialist physician and clinical scientist collaboration for ARR result interpretation. Improvement in the diagnostic sensitivity and specificity of the ARR is predicated on harmonisation of pretesting patient preparation criteria, knowledge of the analytical methods used to derive the ratio and the method-specific threshold for PA.
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Affiliation(s)
- Paula M O'Shea
- Department of Clinical Biochemistry, Galway University Hospitals, Galway, Ireland
| | - Tomás P Griffin
- Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
| | - Stephanie Denieffe
- University College Dublin and Department of Clinical Biochemistry & Diagnostic Endocrinology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Maria C Fitzgibbon
- Department of Clinical Biochemistry & Diagnostic Endocrinology, Mater Misericordiae University Hospital, Dublin, Ireland
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Pons Fernández N, Moreno F, Morata J, Moriano A, León S, De Mingo C, Zuñiga Á, Calvo F. Familial hyperaldosteronism type III a novel case and review of literature. Rev Endocr Metab Disord 2019; 20:27-36. [PMID: 30569443 DOI: 10.1007/s11154-018-9481-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Less than 15% of hypertension cases in children are secondary to a primary hyperaldosteronism. This is idiopathic in 60% of the cases, secondary to a unilateral adenoma in 30% and 10% remaining by primary adrenal hyperplasia, familial hyperaldosteronism, ectopic aldosterone production or adrenocortical carcinoma.To date, four types of familial hyperaldosteronism (FH I to FH IV) have been reported. FH III is caused by germline mutations in KCNJ5, encoding the potassium channel Kir3.4. The mutations cause the channel to lose its selectivity for potassium, allowing large quantities of sodium to enter the cell. As a consequence, the membrane depolarizes, voltage-gated calcium channels open, calcium enters the cell, initiating the cascade that leads to aldosterone synthesis. Somatic mutations in KCNJ5 has also been described in aldosterone-producing adenomas. The most frequent presentation of FH III is with severe hyperaldosteronism symptoms and resistance to pharmacological therapy which leads to bilateral adrenalectomy. We will review current literature and describe a child with FH III due to a novel de novo deletion in KCNJ5 with wild phenotype as a sign of clinical variability of this disease.
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Affiliation(s)
- Natividad Pons Fernández
- Department of Pediatrics, Hospital Lluís Alcanyís de Xàtiva, Ctra. Xàtiva a Silla km 2, 46800, Xàtiva, Valencia, Spain.
| | - Francisca Moreno
- Hospital Universitario y Politécnico la Fe de Valencia, Valencia, Spain
| | - Julia Morata
- Department of Pediatrics, Hospital Lluís Alcanyís de Xàtiva, Ctra. Xàtiva a Silla km 2, 46800, Xàtiva, Valencia, Spain
| | - Ana Moriano
- Department of Pediatrics, Hospital Lluís Alcanyís de Xàtiva, Ctra. Xàtiva a Silla km 2, 46800, Xàtiva, Valencia, Spain
| | - Sara León
- Hospital Universitario y Politécnico la Fe de Valencia, Valencia, Spain
| | - Carmen De Mingo
- Hospital Universitario y Politécnico la Fe de Valencia, Valencia, Spain
| | - Ángel Zuñiga
- Hospital Universitario y Politécnico la Fe de Valencia, Valencia, Spain
| | - Fernando Calvo
- Department of Pediatrics, Hospital Lluís Alcanyís de Xàtiva, Ctra. Xàtiva a Silla km 2, 46800, Xàtiva, Valencia, Spain
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18
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Carvajal CA, Tapia-Castillo A, Valdivia CP, Allende F, Solari S, Lagos CF, Campino C, Martínez-Aguayo A, Vecchiola A, Pinochet C, Godoy C, Iturrieta V, Baudrand R, Fardella CE. Serum Cortisol and Cortisone as Potential Biomarkers of Partial 11β-Hydroxysteroid Dehydrogenase Type 2 Deficiency. Am J Hypertens 2018; 31:910-918. [PMID: 29617893 DOI: 10.1093/ajh/hpy051] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 03/29/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Pathogenic variations in HSD11B2 gene triggers the apparent mineralocorticoid excess syndrome (AME). There is scarce information regarding the phenotypes of subjects carrying heterozygous pathogenic variants in HSD11B2 gene. We investigated if serum cortisol/cortisone (F/E) ratio and cortisone are useful for identifying partial 11βHSD2 deficiency in those heterozygous subjects. METHODS We studied two patients diagnosed with AME and their families carrying either D223N or R213C mutation. We also evaluated 32 healthy control subjects (13 children and 19 adults) to obtain normal references ranges for all measured variables. Case 1: A boy carrying D223N mutation in HSD11B2 gene and Case 2: A girl carrying R213C mutation. We assessed serum F/E ratio and cortisone by HPLC-MS/MS, aldosterone, plasma-renin-activity(PRA), electrolytes, and HSD11B2 genetic analyses. RESULTS The normal values (median [interquartile range]) in children for serum F/E and cortisone (µg/dl) were 2.56 [2.21-3.69] and 2.54 [2.35-2.88], and in adults were 4.42 [3.70-4.90] and 2.23 [1.92-2.57], respectively. Case 1 showed a very high serum F/E 28.8 and low cortisone 0.46 µg/dl. His mother and sister were normotensives and heterozygous for D223N mutation with high F/E (13.2 and 6.0, respectively) and low cortisone (2.0 and 2.2, respectively). Case 2 showed a very high serum F/E 175 and suppressed cortisone 0.11 µg/dl. Her parents and sister were heterozygous for the R213C mutation with normal phenotype, but high F/E and low cortisone. Heterozygous subjects showed normal aldosterone, PRA, but lower fractional excretion of sodium and urinary Na/K ratio than controls. CONCLUSION Serum F/E ratio and cortisone allow to identify partial 11βHSD2 deficiencies, as occurs in heterozygous subjects, who would be susceptible to develop arterial hypertension.
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Affiliation(s)
- Cristian A Carvajal
- Department of Endocrinology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy (IMII), Santiago, Chile
| | - Alejandra Tapia-Castillo
- Department of Endocrinology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy (IMII), Santiago, Chile
- Faculty of Medicine, Universidad del Desarrollo, Santiago, Chile
| | - Carolina P Valdivia
- Department of Endocrinology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Fidel Allende
- Department of Clinical Laboratories, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sandra Solari
- Department of Clinical Laboratories, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carlos F Lagos
- Department of Endocrinology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy (IMII), Santiago, Chile
- Facultad de Ciencia, Universidad San Sebastián, Santiago, Chile
| | - Carmen Campino
- Department of Endocrinology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy (IMII), Santiago, Chile
| | - Alejandro Martínez-Aguayo
- Endocrinology Pediatrics Division, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Andrea Vecchiola
- Department of Endocrinology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy (IMII), Santiago, Chile
| | - Constanza Pinochet
- Endocrinology Pediatrics Division, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Claudia Godoy
- Endocrinology Pediatrics Division, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Virginia Iturrieta
- Department of Endocrinology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rene Baudrand
- Department of Endocrinology, School of Medicine, 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 on Immunology and Immunotherapy (IMII), Santiago, Chile
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Girişgen İ, Sönmez F. Çocukluk çağı primer hipertansiyonuna etki eden faktörlerin araştırılması. EGE TIP DERGISI 2018. [DOI: 10.19161/etd.414341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Genovesi S, Antolini L, Orlando A, Tassistro E, Giussani M, Nava E, Turolo L, Manolopoulou J, Parati G, Morganti A. Aldosterone-to-renin ratio depends on age and sex in children attending a clinic for cardiovascular risk assessment. J Hypertens 2018; 36:344-352. [DOI: 10.1097/hjh.0000000000001571] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cortisol/cortisone ratio and matrix metalloproteinase-9 activity are associated with pediatric primary hypertension. J Hypertens 2017; 34:1808-14. [PMID: 27488551 DOI: 10.1097/hjh.0000000000001017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To identify novel biomarkers associated with pediatric primary hypertension. METHODS We recruited 350 participants (4-16 years). Anthropometric parameters and aldosterone, plasma renin activity, cortisol, cortisone, Homeostasis Model Assessment Insulin Resistance (HOMA-IR), high-sensitivity C-reactive protein, adiponectin, IL-6, plasminogen activator inhibitor type 1 levels and matrix metalloproteinase-9 and matrix metalloproteinase-2 (MMP-9 and MMP-2) activities were measured. Genomic DNA was isolated. Patients with altered glucose metabolism, severe obesity [BMI-SD score (BMI-SDS) > 2.5], renovascular disease, primary aldosteronism and apparent mineralocorticoid excess syndrome were excluded. RESULTS In selected participants (n = 320), SBP was positively correlated with BMI-SDS (r = 0.382, P < 0.001), HOMA-IR (r = 0.211, P < 0.001), MMP-9 activity (r = 0.215, P < 0.001) and the cortisol/cortisone ratio (r = 0.231, P < 0.001). DBP showed similar correlations with these variables. No correlation was observed with aldosterone or plasma renin activity. Participants were categorized as hypertensive (n = 59) or nonhypertensive (n = 261). In the univariate analysis, hypertensive patients had higher BMI-SDS (P < 0.001), HOMA-IR (P < 0.001), high-sensitivity C-reactive protein (P < 0.001), MMP-9 activity (P < 0.001), plasminogen activator inhibitor type 1 (P < 0.001) and cortisol/cortisone ratio (P < 0.001) than nonhypertensive patients. Multiple regression analysis showed that the variables that remained associated with hypertension were higher BMI-SDS [odds ratio (OR) = 3.74; 95% confidence interval (CI) = 1.84-7.58], a higher cortisol/cortisone ratio (OR = 3.92; 95% CI = 1.98-7.71) and increased MMP-9 activity (OR = 4.23; 95% CI = 2.15-8.32). CONCLUSION We report that MMP-9 activity and the cortisol/cortisone ratio were higher in pediatric primary hypertensive patients, and these associations were independent of the effect of obesity. The potential role of these novel biomarkers in predicting hypertension risk and blood pressure regulation warrants further investigation.
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Postnatal height and adiposity gain, childhood blood pressure and prehypertension risk in an Asian birth cohort. Int J Obes (Lond) 2017; 41:1011-1017. [PMID: 28186098 DOI: 10.1038/ijo.2017.40] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 01/06/2017] [Accepted: 01/31/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE There have been hypotheses that early life adiposity gain may influence blood pressure (BP) later in life. We examined associations between timing of height, body mass index (BMI) and adiposity gains in early life with BP at 48 months in an Asian pregnancy-birth cohort. METHODS In 719 children, velocities for height, BMI and abdominal circumference (AC) were calculated at five intervals [0-3, 3-12, 12-24, 24-36 and 36-48 months]. Triceps (TS) and subscapular skinfold (SS) velocities were calculated between 0-18, 18-36 and 36-48 months. Systolic (SBP) and diastolic blood pressure (DBP) was measured at 48 months. Growth velocities at later periods were adjusted for growth velocities in preceding intervals, as well as measurements at birth. RESULTS After adjusting for confounders and child height at BP measurement, each unit z-score gain in BMI, AC, TS and SS velocities at 36-48 months were associated with 2.3 (95% CI:1.6, 3.1), 2.1 (1.3, 2.8), 1.4 (0.6, 2.2) and 1.8 (1, 2.6) mmHg higher SBP respectively, and 0.9 (0.4, 1.4), 0.9 (0.4, 1.3), 0.6 (0.1, 1.1) and 0.8 (0.3, 1.3) mmHg higher DBP respectively. BMI and adiposity velocities (AC, TS or SS) at various intervals in the first 36 months however, were not associated with BP. Faster BMI, AC, TS and SS velocities, but not height, at 36-48 months were associated with 0.22 (0.15, 0.29), 0.17 (0.10, 0.24), 0.11 (0.04, 0.19) and 0.15 (0.08, 0.23) units higher SBP z-score respectively, and OR=1.46 (95% CI: 1.13-1.90), 1.49 (1.17-1.92), 1.45 (1.09-1.92) and 1.43 (1.09, 1.88) times higher risk of prehypertension/hypertension respectively at 48 months. CONCLUSIONS Our results indicated that faster BMI and adiposity (AC, TS or SS) velocities only at the preceding interval before 48 months (36-48 months), but not at earlier intervals in the first 36 months, are predictive of BP and prehypertension/hypertension at 48 months.
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Muñoz-Durango N, Fuentes CA, Castillo AE, González-Gómez LM, Vecchiola A, Fardella CE, Kalergis AM. Role of the Renin-Angiotensin-Aldosterone System beyond Blood Pressure Regulation: Molecular and Cellular Mechanisms Involved in End-Organ Damage during Arterial Hypertension. Int J Mol Sci 2016; 17:E797. [PMID: 27347925 PMCID: PMC4964362 DOI: 10.3390/ijms17070797] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/02/2016] [Accepted: 05/10/2016] [Indexed: 01/07/2023] Open
Abstract
Arterial hypertension is a common condition worldwide and an important predictor of several complicated diseases. Arterial hypertension can be triggered by many factors, including physiological, genetic, and lifestyle causes. Specifically, molecules of the renin-angiotensin-aldosterone system not only play important roles in the control of blood pressure, but they are also associated with the genesis of arterial hypertension, thus constituting a need for pharmacological interventions. Chronic high pressure generates mechanical damage along the vascular system, heart, and kidneys, which are the principal organs affected in this condition. In addition to mechanical stress, hypertension-induced oxidative stress, chronic inflammation, and the activation of reparative mechanisms lead to end-organ damage, mainly due to fibrosis. Clinical trials have demonstrated that renin-angiotensin-aldosterone system intervention in hypertensive patients lowers morbidity/mortality and inflammatory marker levels as compared to placebo patients, evidencing that this system controls more than blood pressure. This review emphasizes the detrimental effects that a renin-angiotensin-aldosterone system (RAAS) imbalance has on health considerations above and beyond high blood pressure, such as fibrotic end-organ damage.
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Affiliation(s)
- Natalia Muñoz-Durango
- Millenium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, 8330025 Santiago, Chile.
| | - Cristóbal A Fuentes
- Millenium Institute on Immunology and Immunotherapy, Departamento de Endocrinología, Escuela de Medicina, Pontificia Universidad Católica de Chile, 8330074 Santiago, Chile.
| | - Andrés E Castillo
- Millenium Institute on Immunology and Immunotherapy, Departamento de Endocrinología, Escuela de Medicina, Pontificia Universidad Católica de Chile, 8330074 Santiago, Chile.
| | - Luis Martín González-Gómez
- Millenium Institute on Immunology and Immunotherapy, Departamento de Endocrinología, Escuela de Medicina, Pontificia Universidad Católica de Chile, 8330074 Santiago, Chile.
| | - Andrea Vecchiola
- Millenium Institute on Immunology and Immunotherapy, Departamento de Endocrinología, Escuela de Medicina, Pontificia Universidad Católica de Chile, 8330074 Santiago, Chile.
| | - Carlos E Fardella
- Millenium Institute on Immunology and Immunotherapy, Departamento de Endocrinología, Escuela de Medicina, Pontificia Universidad Católica de Chile, 8330074 Santiago, Chile.
| | - Alexis M Kalergis
- Millenium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, 8330025 Santiago, Chile.
- Millenium Institute on Immunology and Immunotherapy, Departamento de Endocrinología, Escuela de Medicina, Pontificia Universidad Católica de Chile, 8330074 Santiago, Chile.
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Valdivia C, Carvajal CA, Campino C, Allende F, Martinez-Aguayo A, Baudrand R, Vecchiola A, Lagos CF, Tapia-Castillo A, Fuentes CA, Aglony M, Solari S, Kalergis AM, García H, Owen GI, Fardella CE. Citosine-Adenine-Repeat Microsatellite of 11β-hydroxysteroid dehydrogenase 2 Gene in Hypertensive Children. Am J Hypertens 2016; 29:25-32. [PMID: 25907225 DOI: 10.1093/ajh/hpv052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 01/17/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The impairment of 11β-hydroxysteroid dehydrogenase type 2 enzyme (11βHSD2) results in an inefficient conversion of cortisol to cortisone, which triggers hypertension. Cytosine-adenine repeat (CA repeat) microsatellite has been associated with low HSD11B2 gene expression. AIM To determine whether the CA-repeat length in intron 1 affect the serum cortisol to cortisone (F/E) ratio and/or blood pressure (BP) levels in pediatric subjects. SUBJECTS AND METHODS Eighty-one hypertensive (HT) and 117 normotensive (NT) subjects participated in this study. We measured BP levels, as well as the F and E and F/E ratio in morning sera and 12-hour urine samples. The length of CA repeats was determined through fragment analysis. We compared the allele distribution between the HT and NT groups, and the patients were dichotomized into groups with short alleles (S) (<21 CA repeats) or long alleles (L), and also in groups according genotype (allele combination: S/S and S/L + L/L). RESULTS We found no differences in the distribution of CA-repeat allelic length between the NT and HT groups (P = 0.7807), and there was no correlation between the CA-repeat allelic length and BP (P = 0.1151) levels or the serum F/E ratio (P = 0.6778). However, the serum F/E ratio was higher in the HT group than in the NT group (P = 0.0251). The serum F/E ratio was associated with systolic BP index independent of body mass index only in HT group. CONCLUSIONS The CA-repeat length did not influence BP levels or serum F/E ratios in pediatric subjects. However, the serum F/E ratio was associated with BP, suggesting a role of 11βHSD2 in mineralocorticoid hypertension.
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Affiliation(s)
- Carolina Valdivia
- Departamento de Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cristian A Carvajal
- Departamento de Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Millennium Institute on Immunology and Immunotherapy, Santiago, Chile
| | - Carmen Campino
- Departamento de Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Millennium Institute on Immunology and Immunotherapy, Santiago, Chile
| | - Fidel Allende
- Departamento de Laboratorios Clínicos, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alejandro Martinez-Aguayo
- Unidad de Endocrinología, División de Pediatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rene Baudrand
- Departamento de Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Andrea Vecchiola
- Departamento de Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Millennium Institute on Immunology and Immunotherapy, Santiago, Chile
| | - Carlos F Lagos
- Departamento de Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Millennium Institute on Immunology and Immunotherapy, Santiago, Chile; Facultad de Ciencia, Universidad San Sebastián, Santiago, Chile
| | - Alejandra Tapia-Castillo
- Departamento de Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cristobal A Fuentes
- Departamento de Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Millennium Institute on Immunology and Immunotherapy, Santiago, Chile
| | - Marlene Aglony
- Unidad de Endocrinología, División de Pediatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sandra Solari
- Departamento de Laboratorios Clínicos, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alexis M Kalergis
- Millennium Institute on Immunology and Immunotherapy, Santiago, Chile; Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile
| | - Hernan García
- Unidad de Endocrinología, División de Pediatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Gareth I Owen
- Departamento de Fisiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carlos E Fardella
- Departamento de Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Millennium Institute on Immunology and Immunotherapy, Santiago, Chile;
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Tapia-Castillo A, Carvajal CA, Campino C, Hill C, Allende F, Vecchiola A, Carrasco C, Bancalari R, Valdivia C, Lagos C, Martinez-Aguayo A, Garcia H, Aglony M, Baudrand RF, Kalergis AM, Michea LF, Riedel CA, Fardella CE. The Expression of RAC1 and Mineralocorticoid Pathway-Dependent Genes are Associated With Different Responses to Salt Intake. Am J Hypertens 2015; 28:722-8. [PMID: 25430696 DOI: 10.1093/ajh/hpu224] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 10/13/2014] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Rac1 upregulation has been implicated in salt-sensitive hypertension as a modulator of mineralocorticoid receptor (MR) activity. Rac1 could affect the expression of oxidative stress markers, such as hemoxigenase-1 (HO-1) or nuclear factor-B (NF-κB), and the expression of neutrophil gelatinase-associated lipocalin (NGAL), a cytokine upregulated upon MR activation. AIM We evaluated RAC1 expression in relation of high salt intake and association with MR, NGAL, HO-1, and NF-κB expression, mineralo- and glucocorticoids levels, and inflammatory parameters. SUBJECTS AND METHODS We studied 147 adult subjects. A food survey identified the dietary sodium (Na) intake. RAC1 expression was considered high or low according to the value found in normotensive subjects with low salt intake. We determined the gene expression of RAC1, MR, NGAL, HO-1, NF-κB, and 18S, isolated from peripheral leukocytes. We measured aldosterone, cortisol, sodium, potassium excretion, metalloproteinase (MMP9 y MMP2), and C-reactive protein. RESULTS We identified 126 subjects with high Na-intake, 18 subjects had high, and 108 low-RAC1 expression. The subjects with high-RAC1 expression showed a significant increase in MR (P = 0.0002), NGAL (P < 0.0001) HO-1 (P = 0.0004), and NF-κB (P < 0.0001) gene expression. We demonstrated an association between RAC1 expression and MR (R sp 0.64; P < 0.0001), NGAL (R sp 0.48; P < 0.0001), HO-1 (R sp 0.53; P < 0.0001), and NF-κB (R sp0.52; P < 0.0001). We did not identify any association between RAC1 and clinical or biochemical variables. CONCLUSIONS RAC1 expression was associated with an increase in MR, NGAL, NF-κB, and HO-1 expression, suggesting that RAC1 could be a mediator of cardiovascular damage induced by sodium, and may also useful to identify subjects with different responses to salt intake.
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Affiliation(s)
| | - Cristian A Carvajal
- Endocrinology, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile; Millenium Institute in Immunology and Immunotherapy, Santiago, Chile
| | - Carmen Campino
- Endocrinology, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile; Millenium Institute in Immunology and Immunotherapy, Santiago, Chile
| | - Caroline Hill
- Endocrinology, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Fidel Allende
- Servicios de Laboratorios Clinicos, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Andrea Vecchiola
- Endocrinology, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile; Millenium Institute in Immunology and Immunotherapy, Santiago, Chile
| | - Carmen Carrasco
- Endocrinology, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Rodrigo Bancalari
- Pediatrics, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Carolina Valdivia
- Endocrinology, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Carlos Lagos
- Endocrinology, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | | | - Hernan Garcia
- Pediatrics, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Marlene Aglony
- Pediatrics, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Rene F Baudrand
- Endocrinology, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Alexis M Kalergis
- Millenium Institute in Immunology and Immunotherapy, Santiago, Chile; Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas. Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luis F Michea
- Millenium Institute in Immunology and Immunotherapy, Santiago, Chile; Laboratory of Integrative Physiology, ICBM, Universidad de Chile, Santiago, Chile
| | - Claudia A Riedel
- Millenium Institute in Immunology and Immunotherapy, Santiago, Chile; Departamento de Ciencias Biológicas, Facultad Ciencias Biológicas y Facultad de Medicina Universidad Andrés Bello, Santiago, Chile
| | - Carlos E Fardella
- Endocrinology, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile; Millenium Institute in Immunology and Immunotherapy, Santiago, Chile;
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Washburn LK, Brosnihan KB, Chappell MC, Diz DI, Gwathmey TM, Nixon PA, Russell GB, Snively BM, O'Shea TM. The renin-angiotensin-aldosterone system in adolescent offspring born prematurely to mothers with preeclampsia. J Renin Angiotensin Aldosterone Syst 2014; 16:529-38. [PMID: 24737639 DOI: 10.1177/1470320314526940] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 01/28/2014] [Indexed: 11/16/2022] Open
Abstract
HYPOTHESIS/INTRODUCTION Preeclampsia is associated with alterations in the maternal renin-angiotensin-aldosterone system (RAAS), increased blood pressure (BP), and cardiovascular risk in the offspring. We hypothesized that preeclampsia is associated with alterations in the RAAS in the offspring that persist into adolescence. MATERIALS AND METHODS We compared components of the circulating (n = 111) and renal (n = 160) RAAS in adolescents born prematurely with very low birth weight (VLBW) of preeclamptic (PreE) and normotensive (NoHTN) pregnancies. Multivariable linear regression was used to evaluate potential confounding and intermediate variables. Analyses were stratified by sex. RESULTS Adjusting for race and antenatal steroid exposure, male offspring of PreE mothers had higher circulating aldosterone than those of NoHTN mothers (adjusted mean difference = 109; 95% confidence limits: -9, 227 pmol/L). Further adjustment for current BMI attenuated this difference (adjusted mean difference: 93; 95% confidence limits: -30, 215 pmol/L). CONCLUSION Among male preterm VLBW infants, maternal preeclampsia is associated with increased circulating aldosterone level in adolescence, which appears to be mediated in part by higher BMI.
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Affiliation(s)
- Lisa K Washburn
- Department of Pediatrics, Wake Forest School of Medicine, USA Hypertension and Vascular Research Center, Wake Forest School of Medicine, USA
| | - K Bridget Brosnihan
- Hypertension and Vascular Research Center, Wake Forest School of Medicine, USA
| | - Mark C Chappell
- Hypertension and Vascular Research Center, Wake Forest School of Medicine, USA
| | - Debra I Diz
- Hypertension and Vascular Research Center, Wake Forest School of Medicine, USA
| | - TanYa M Gwathmey
- Hypertension and Vascular Research Center, Wake Forest School of Medicine, USA
| | - Patricia A Nixon
- Department of Pediatrics, Wake Forest School of Medicine, USA Health and Exercise Science, Wake Forest School of Medicine, USA
| | - Gregory B Russell
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, USA
| | - Beverly M Snively
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, USA
| | - T Michael O'Shea
- Department of Pediatrics, Wake Forest School of Medicine, USA Hypertension and Vascular Research Center, Wake Forest School of Medicine, USA
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Tapia-Castillo A, Carvajal CA, Campino C, Vecchiola A, Allende F, Solari S, García L, Lavanderos S, Valdivia C, Fuentes C, Lagos CF, Martínez-Aguayo A, Baudrand R, Aglony M, García H, Fardella CE. Polymorphisms in the RAC1 gene are associated with hypertension risk factors in a Chilean pediatric population. Am J Hypertens 2014; 27:299-307. [PMID: 24487980 DOI: 10.1093/ajh/hpt277] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The GTPase Rac1 has been implicated in hypertension as a modulator of mineralocorticoid receptor activity. Our aim is to investigate the frequency of polymorphisms rs10951982 (intron 1, G>A) and rs836478 (intron 3, T>C) in the RAC1 gene and perform association studies with clinical and biochemical parameters in a Chilean pediatric cohort. METHODS Two hundred two normotensive (NT) subjects (aged 4-16 years) were divided into 2 groups: NT subjects with hypertensive parents (NH; n = 103) and NT subjects with NT parents (NN; n = 99). We measured markers of inflammation (high-sensitivity C-reactive protein, interleukin 6 (IL-6), interleukin 8, and tumor necrosis factor α), endothelial damage (Plasminogen activator inhibitor-1 metalloproteinase-9, and metalloproteinase-2), and oxidative stress (malondialdehyde). Data were expressed as median and interquartile range (IQR). RESULTS We found differences in polymorphism rs836478 (intron 3, C>T) in both genotypic (χ(2) = 15.2, 2 df; P = 0.0005) and allelic (X(2)=5.5, 1 df; P = 0.01) frequencies in NH vs. NN subjects. NH subjects with a TT genotype showed increase MMP9 expression (median = 2.3, IQR - 1.6-3.2; vs. median = 1.6, IQR = 1.6-2.3 AU; P = 0.01) and lower IL-6 expression (median = 8.8, IQR = 7.0-11.8; vs. median = 12.1, IQR = 8.2-14.7 pg/ml; P = 0.02) compared with subjects with TC/CC genotype. No difference in the allelic frequency distribution was seen in the polymorphism rs10951982 (NH vs. NN: χ(2)=0.2, 1 df; P = 0.6). For this SNP, NN subjects with GA/AA genotype showed decreased diastolic BP indexes compared with subjects with native GG genotype (median = 1.08, IQR = 1.0-1.2; vs. median = 0.99, IQR = 0.94-1.1; P = 0.02). CONCLUSIONS We report the frequency of polymorphisms rs836478 and rs10951982 of the RAC1 gene in a Spanish-Amerindian cohort. The polymorphism rs836478 was associated with an increased expression in markers of inflammation and endothelial damage (MMP9 and IL-6) in pediatric subjects with a hypertensive genetic background.
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Affiliation(s)
- Alejandra Tapia-Castillo
- Department of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Fardella B. CE, Carvajal CA, Campino C, Tapia A, García H, Martínez-Aguayo A. Hipertensión arterial mineralocorticoidea. REVISTA MÉDICA CLÍNICA LAS CONDES 2013. [DOI: 10.1016/s0716-8640(13)70225-6] [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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Loureiro C, Campino C, Martinez-Aguayo A, Godoy I, Aglony M, Bancalari R, Garcia H, Carvajal CA, Fardella C. Positive association between aldosterone-renin ratio and carotid intima-media thickness in hypertensive children. Clin Endocrinol (Oxf) 2013; 78:352-7. [PMID: 22803613 DOI: 10.1111/j.1365-2265.2012.04503.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 04/14/2012] [Accepted: 07/12/2012] [Indexed: 11/30/2022]
Abstract
INTRODUCTION From an early age, hypertension can damage blood vessels through multiple mechanisms. The aim of this study was to evaluate the presence of vascular damage and whether it is associated with the mineralo- and glucocorticoid profiles of hypertensive children. SUBJECTS AND METHODS We studied 64 hypertensive children. Anthropometric parameters and serum aldosterone (SA), plasma renin activity (PRA), aldosterone/renin ratio (ARR), cortisol (F) and cortisone (E) were measured. The serum F/E ratio was calculated to estimate the activity of the enzyme 11β-HSD2. Vascular damage was determined by carotid intima-media thickness (cIMT) and flow-mediated dilation of the brachial artery (FMD) on ultrasound. RESULTS (median; Q1-Q3) Of the patients observed, 39% were females, and the median value for age (years) was 11.2 (9.1-13.3), for BMI (SDS) was 1.36 (0.84-1.80), for body fat mass (%) was 28.3 (17.8-36.0), for SBP index was 1.17 (1.12-1.25) and for the DBP index was 1.27 (1.16-1.36). Measurements revealed an SA level higher than 491 pmol/l in 4/64 patients, a PRA value lower than 0.5 ng/ml/h in 2/64, an ARR higher than 10 in 3/64 and serum F/E ratio higher than 4.3 in 10/64. The median brachial FMD (%) was 8.41 (5.61-10.91), and the median cIMT (mm) was 0.40 (0.37-0.43). The ARR was the only variable that explained changes in cIMT (β = 0.571, R(2 ) = 0.315, P < 0.0001). CONCLUSION Our results showed a positive association between cIMT and the ARR, suggesting an important role of the renin-aldosterone axis in the regulation of early vascular damage in hypertensive children.
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Affiliation(s)
- Carolina Loureiro
- Endocrinology Unit, Division of Paediatrics, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
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Abstract
Arterial hypertension in childhood is less frequent as compared to adulthood but is more likely to be secondary to an underlying disorder. After ruling out more obvious causes, some patients still present with strongly suspected secondary hypertension of yet unknown etiology. A number of these children have hypertension due to single gene mutations inherited in an autosomal dominant or recessive fashion. The finding of abnormal potassium levels (low or high) in the presence of suppressed renin secretion, and metabolic alkalosis or acidosis should prompt consideration of these familial diseases. However, mild hypertension and the absence of electrolyte abnormalities do not exclude hereditary conditions. In monogenic hypertensive disorders, three distinct mechanisms leading to the common final pathway of increased sodium reabsorption, volume expansion, and low plasma renin activity are documented. The first mechanism relates to gain-of-function mutations with a subsequent hyperactivity of renal sodium and chloride reabsorption leading to plasma volume expansion (e.g., Liddle's syndrome, Gordon's syndrome). The second mechanism involves deficiencies of enzymes that regulate adrenal steroid hormone synthesis and deactivation (e.g., subtypes of congenital adrenal hyperplasia, apparent mineralocorticoid excess (AME)). The third mechanism is characterized by excessive aldosterone synthesis that escapes normal regulatory mechanisms and leading to volume-dependent hypertension in the presence of suppressed renin release (glucocorticoid remediable aldosteronism). Hormonal studies coupled with genetic testing can help in the early diagnosis of these disorders.
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Baker PR, Nanduri P, Gottlieb PA, Yu L, Klingensmith GJ, Eisenbarth GS, Barker JM. Predicting the onset of Addison's disease: ACTH, renin, cortisol and 21-hydroxylase autoantibodies. Clin Endocrinol (Oxf) 2012; 76:617-24. [PMID: 22066755 PMCID: PMC4963152 DOI: 10.1111/j.1365-2265.2011.04276.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
CONTEXT Autoantibodies to 21-hydroxylase (21OH-AA) precede onset of autoimmune Addison's disease (AD). Progression to AD can take months to years, and early detection of metabolic decompensation may prevent morbidity and mortality. OBJECTIVE To define optimal methods of predicting progression to overt AD (defined by subnormal peak cortisol response to Cosyntropin) in 21OH-AA+ individuals. DESIGN, SETTING AND PARTICIPANTS Individuals were screened for 21OH-AA at the Barbara Davis Center from 1993 to 2011. Subjects positive for 21OH-AA (n = 87) were tested, and the majority prospectively followed for the development of Addison's disease, including seven diagnosed with AD upon 21OH-AA discovery (discovered), seven who progressed to AD (progressors) and 73 nonprogressors. MAIN OUTCOME MEASURED Plasma renin activity (PRA), ACTH, baseline cortisol, peak cortisol and 21OH-AA were measured at various time points relative to diagnosis of AD or last AD-free follow-up. RESULTS Compared with nonprogressors, in the time period 2 months-2 years prior to the onset of AD, progressors were significantly more likely to have elevated ACTH (11-22 pM, P < 1E-4), with no significant differences in mean PRA (P = 0·07) or baseline cortisol (P = 0·08), and significant but less distinct differences seen with 21OH-AA levels (P < 1E-4) and poststimulation cortisol levels (P = 6E-3). CONCLUSION Moderately elevated ACTH is a more useful early indicator of impending AD than 21OH-AA, PRA or peak cortisol, in the 2 months-2 years preceding the onset of AD.
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Affiliation(s)
- Peter R. Baker
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, CO, USA
| | - Priyaanka Nanduri
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, CO, USA
| | - Peter A. Gottlieb
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, CO, USA
| | - Liping Yu
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, CO, USA
| | | | - George S. Eisenbarth
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, CO, USA
| | - Jennifer M. Barker
- Department of Pediatric Endocrinology, University of Colorado Denver, Aurora, CO, USA
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Costa S, Cota F, Romagnoli C, Latella C, Maggio L, Tesfagabir MG, Gallini F. Early urinary aldosterone excretion in very low birth weight infants. J Renin Angiotensin Aldosterone Syst 2012; 13:254-8. [PMID: 22361573 DOI: 10.1177/1470320312437069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED HYPOTHESIS/ INTRODUCTION: In the neonatal period, many factors may interfere with aldosterone production but data currently available are few and controversial. In this study we aim to assess the early urinary aldosterone excretion (UAE) in very low birth weight (VLBW) infants and to identify some possible clinical and biochemical variables that may influence this excretion. MATERIALS AND METHODS We conducted a prospective study in 30 VLBW infants. Aldosterone was measured in the first 72 hours of life in the urine and plasma and urinary electrolytes were determined. Demographic and clinical data were also recorded. RESULTS The exploratory analysis showed that a significant positive correlation exists between UAE and gestational age and birth weight and that infants with respiratory distress syndrome have higher urinary aldosterone levels than infants without respiratory distress, but only plasma sodium resulted a significant independent factor that negatively influenced UAE at linear regression analysis (coefficient -0.02, 95% confidence interval [-0.03; -0.004]; adjusted R(2) 0.33). CONCLUSIONS The renin-angiotensin-aldosterone system of VLBW infants seems to be able, even immediately after birth, to respond to variations of plasma sodium concentrations; measurement of UAE constitutes an interesting method to determine aldosterone production, avoiding blood sampling in neonates so small and frail as VLBW infants.
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Affiliation(s)
- Simonetta Costa
- Division of Neonatology, Department of Paediatrics, University Hospital Agostino Gemelli-Catholic University Sacred Heart, Rome, Italy.
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Carvajal CA, Campino C, Martinez-Aguayo A, Tichauer JE, Bancalari R, Valdivia C, Trejo P, Aglony M, Baudrand R, Lagos CF, Mellado C, Garcia H, Fardella CE. A New Presentation of the Chimeric CYP11B1/CYP11B2 Gene With Low Prevalence of Primary Aldosteronism and Atypical Gene Segregation Pattern. Hypertension 2012; 59:85-91. [DOI: 10.1161/hypertensionaha.111.180513] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Familial hyperaldosteronism type I is caused by an unequal crossover of 11β-hydroxylase (CYP11B1) and aldosterone synthase (CYP11B2) genes, giving rise to a chimeric CYP11B1/CYP11B2 gene (CG). We describe a family carrying a CG with high levels of free 18-hydroxycortisol but low prevalence of primary aldosteronism (PA) and an atypical CG inheritance pattern in a family of 4 generations with 16 adults and 13 children, we measured the arterial blood pressure, serum aldosterone, and plasma renin activity and then calculated the serum aldosterone:plasma renin activity ratio and urinary free 18-hydroxycortisol. We identified the CG by long-extension PCR and predicted its inheritance pattern. The CG was found in 24 of 29 subjects (10 children and 14 adults). In CG+ patients, hypertension and high 18-hydroxycortisol were prevalent (83% and 100%, respectively). High serum aldosterone:plasma renin activity ratio was more frequent in pediatric than adult patients (80% versus 36%;
P
<0.001). An inverse association between serum aldosterone:plasma renin activity ratio and age was observed (
r
=−0.48;
P
=0.018). Sequence analysis identified the CYP11B1/CYP11B2 crossover in a 50-bp region spanning intron 3 of CYP11B1 and exon 4 of CYP11B2. The CG segregation differs from an autosomal disease, showing 100% of CG penetrance in generations II and III. Statistical analysis suggests that inheritance pattern was not attributed to random segregation (
P
<0.001). In conclusion, we describe a family with an atypical CYP11B1/CYP11B2 gene inheritance pattern and variable phenotypic expression, where the majority of pediatric patients have primary aldosteronism. Most adults have normal aldosterone and renin levels, which could mask them as essential hypertensives.
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Affiliation(s)
- Cristian A. Carvajal
- From the Department of Endocrinology (C.A.C., C.C., J.E.T., C.V., P.T., R.B., C.F.L., C.E.F.), Division of Pediatrics (A.M.-A., R.B., M.A., C.M., H.G.), Faculty of Medicine, and Department of Pharmacy, Faculty of Chemistry (C.F.L.), Pontificia Universidad Católica de Chile, Santiago, Chile; Millennium Institute of Immunology and Immunotherapy (C.A.C., C.C., R.B., C.E.F.), Santiago, Chile
| | - Carmen Campino
- From the Department of Endocrinology (C.A.C., C.C., J.E.T., C.V., P.T., R.B., C.F.L., C.E.F.), Division of Pediatrics (A.M.-A., R.B., M.A., C.M., H.G.), Faculty of Medicine, and Department of Pharmacy, Faculty of Chemistry (C.F.L.), Pontificia Universidad Católica de Chile, Santiago, Chile; Millennium Institute of Immunology and Immunotherapy (C.A.C., C.C., R.B., C.E.F.), Santiago, Chile
| | - Alejandro Martinez-Aguayo
- From the Department of Endocrinology (C.A.C., C.C., J.E.T., C.V., P.T., R.B., C.F.L., C.E.F.), Division of Pediatrics (A.M.-A., R.B., M.A., C.M., H.G.), Faculty of Medicine, and Department of Pharmacy, Faculty of Chemistry (C.F.L.), Pontificia Universidad Católica de Chile, Santiago, Chile; Millennium Institute of Immunology and Immunotherapy (C.A.C., C.C., R.B., C.E.F.), Santiago, Chile
| | - Juan E. Tichauer
- From the Department of Endocrinology (C.A.C., C.C., J.E.T., C.V., P.T., R.B., C.F.L., C.E.F.), Division of Pediatrics (A.M.-A., R.B., M.A., C.M., H.G.), Faculty of Medicine, and Department of Pharmacy, Faculty of Chemistry (C.F.L.), Pontificia Universidad Católica de Chile, Santiago, Chile; Millennium Institute of Immunology and Immunotherapy (C.A.C., C.C., R.B., C.E.F.), Santiago, Chile
| | - Rodrigo Bancalari
- From the Department of Endocrinology (C.A.C., C.C., J.E.T., C.V., P.T., R.B., C.F.L., C.E.F.), Division of Pediatrics (A.M.-A., R.B., M.A., C.M., H.G.), Faculty of Medicine, and Department of Pharmacy, Faculty of Chemistry (C.F.L.), Pontificia Universidad Católica de Chile, Santiago, Chile; Millennium Institute of Immunology and Immunotherapy (C.A.C., C.C., R.B., C.E.F.), Santiago, Chile
| | - Carolina Valdivia
- From the Department of Endocrinology (C.A.C., C.C., J.E.T., C.V., P.T., R.B., C.F.L., C.E.F.), Division of Pediatrics (A.M.-A., R.B., M.A., C.M., H.G.), Faculty of Medicine, and Department of Pharmacy, Faculty of Chemistry (C.F.L.), Pontificia Universidad Católica de Chile, Santiago, Chile; Millennium Institute of Immunology and Immunotherapy (C.A.C., C.C., R.B., C.E.F.), Santiago, Chile
| | - Pamela Trejo
- From the Department of Endocrinology (C.A.C., C.C., J.E.T., C.V., P.T., R.B., C.F.L., C.E.F.), Division of Pediatrics (A.M.-A., R.B., M.A., C.M., H.G.), Faculty of Medicine, and Department of Pharmacy, Faculty of Chemistry (C.F.L.), Pontificia Universidad Católica de Chile, Santiago, Chile; Millennium Institute of Immunology and Immunotherapy (C.A.C., C.C., R.B., C.E.F.), Santiago, Chile
| | - Marlene Aglony
- From the Department of Endocrinology (C.A.C., C.C., J.E.T., C.V., P.T., R.B., C.F.L., C.E.F.), Division of Pediatrics (A.M.-A., R.B., M.A., C.M., H.G.), Faculty of Medicine, and Department of Pharmacy, Faculty of Chemistry (C.F.L.), Pontificia Universidad Católica de Chile, Santiago, Chile; Millennium Institute of Immunology and Immunotherapy (C.A.C., C.C., R.B., C.E.F.), Santiago, Chile
| | - René Baudrand
- From the Department of Endocrinology (C.A.C., C.C., J.E.T., C.V., P.T., R.B., C.F.L., C.E.F.), Division of Pediatrics (A.M.-A., R.B., M.A., C.M., H.G.), Faculty of Medicine, and Department of Pharmacy, Faculty of Chemistry (C.F.L.), Pontificia Universidad Católica de Chile, Santiago, Chile; Millennium Institute of Immunology and Immunotherapy (C.A.C., C.C., R.B., C.E.F.), Santiago, Chile
| | - Carlos F. Lagos
- From the Department of Endocrinology (C.A.C., C.C., J.E.T., C.V., P.T., R.B., C.F.L., C.E.F.), Division of Pediatrics (A.M.-A., R.B., M.A., C.M., H.G.), Faculty of Medicine, and Department of Pharmacy, Faculty of Chemistry (C.F.L.), Pontificia Universidad Católica de Chile, Santiago, Chile; Millennium Institute of Immunology and Immunotherapy (C.A.C., C.C., R.B., C.E.F.), Santiago, Chile
| | - Cecilia Mellado
- From the Department of Endocrinology (C.A.C., C.C., J.E.T., C.V., P.T., R.B., C.F.L., C.E.F.), Division of Pediatrics (A.M.-A., R.B., M.A., C.M., H.G.), Faculty of Medicine, and Department of Pharmacy, Faculty of Chemistry (C.F.L.), Pontificia Universidad Católica de Chile, Santiago, Chile; Millennium Institute of Immunology and Immunotherapy (C.A.C., C.C., R.B., C.E.F.), Santiago, Chile
| | - Hernán Garcia
- From the Department of Endocrinology (C.A.C., C.C., J.E.T., C.V., P.T., R.B., C.F.L., C.E.F.), Division of Pediatrics (A.M.-A., R.B., M.A., C.M., H.G.), Faculty of Medicine, and Department of Pharmacy, Faculty of Chemistry (C.F.L.), Pontificia Universidad Católica de Chile, Santiago, Chile; Millennium Institute of Immunology and Immunotherapy (C.A.C., C.C., R.B., C.E.F.), Santiago, Chile
| | - Carlos E. Fardella
- From the Department of Endocrinology (C.A.C., C.C., J.E.T., C.V., P.T., R.B., C.F.L., C.E.F.), Division of Pediatrics (A.M.-A., R.B., M.A., C.M., H.G.), Faculty of Medicine, and Department of Pharmacy, Faculty of Chemistry (C.F.L.), Pontificia Universidad Católica de Chile, Santiago, Chile; Millennium Institute of Immunology and Immunotherapy (C.A.C., C.C., R.B., C.E.F.), Santiago, Chile
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Mulatero P, Tizzani D, Viola A, Bertello C, Monticone S, Mengozzi G, Schiavone D, Williams TA, Einaudi S, La Grotta A, Rabbia F, Veglio F. Prevalence and Characteristics of Familial Hyperaldosteronism. Hypertension 2011; 58:797-803. [DOI: 10.1161/hypertensionaha.111.175083] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Primary aldosteronism (PA) is the most frequent cause of secondary hypertension, and patients display an increased prevalence of cardiovascular events compared with essential hypertensives. To date, 3 familial forms of PA have been described and termed familial hyperaldosteronism types I, II, and III (FH-I to -III). The aim of this study was to investigate the prevalence and clinical characteristics of the 3 forms of FH in a large population of PA patients. Three-hundred consecutive PA patients diagnosed in our unit were tested by long-PCR of the
CYP11B1/CYP11B2
hybrid gene that causes FH-I, and all of the available relatives of PA patients were screened to confirm or exclude PA and, thus, FH-II. Urinary 18-hydroxycortisol and 18-oxocortisol were measured in all of the familial PA patients. Two patients were diagnosed with FH-I (prevalence: 0.66%), as well as 21 of their relatives, and clinical phenotypes of the 2 affected families varied markedly. After exclusion of families who refused testing and those who were not informative, 199 families were investigated, of which 12 were diagnosed with FH-II (6%) and an additional 15 individuals had confirmed PA; clinical and biochemical phenotypes of FH-II families were not significantly different from sporadic PA patients. None of the families displayed a phenotype compatible with FH-III diagnosis. Our study demonstrates that familial forms of hyperaldosteronism are more frequent than previously expected and reinforces the recommendation of the Endocrine Society Guidelines to screen all first-degree hypertensive relatives of PA patients.
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Affiliation(s)
- Paolo Mulatero
- From the Department of Medicine and Experimental Oncology, Division of Internal Medicine and Hypertension (P.M., D.T., A.V., C.B., S.M., D.S., T.A.W., F.R., F.V.), and Department of Endocrinology and Diabetology, Regina Margherita Pediatric Hospital (S.E.), University of Torino, Torino, Italy; Clinical Chemistry Laboratory (G.M.), San Giovanni Battista University Hospital, Torino, Italy; Division of Internal Medicine (A.L.G.), Service of Endocrinology and Hypertension, Cardinal Massaia Hospital,
| | - Davide Tizzani
- From the Department of Medicine and Experimental Oncology, Division of Internal Medicine and Hypertension (P.M., D.T., A.V., C.B., S.M., D.S., T.A.W., F.R., F.V.), and Department of Endocrinology and Diabetology, Regina Margherita Pediatric Hospital (S.E.), University of Torino, Torino, Italy; Clinical Chemistry Laboratory (G.M.), San Giovanni Battista University Hospital, Torino, Italy; Division of Internal Medicine (A.L.G.), Service of Endocrinology and Hypertension, Cardinal Massaia Hospital,
| | - Andrea Viola
- From the Department of Medicine and Experimental Oncology, Division of Internal Medicine and Hypertension (P.M., D.T., A.V., C.B., S.M., D.S., T.A.W., F.R., F.V.), and Department of Endocrinology and Diabetology, Regina Margherita Pediatric Hospital (S.E.), University of Torino, Torino, Italy; Clinical Chemistry Laboratory (G.M.), San Giovanni Battista University Hospital, Torino, Italy; Division of Internal Medicine (A.L.G.), Service of Endocrinology and Hypertension, Cardinal Massaia Hospital,
| | - Chiara Bertello
- From the Department of Medicine and Experimental Oncology, Division of Internal Medicine and Hypertension (P.M., D.T., A.V., C.B., S.M., D.S., T.A.W., F.R., F.V.), and Department of Endocrinology and Diabetology, Regina Margherita Pediatric Hospital (S.E.), University of Torino, Torino, Italy; Clinical Chemistry Laboratory (G.M.), San Giovanni Battista University Hospital, Torino, Italy; Division of Internal Medicine (A.L.G.), Service of Endocrinology and Hypertension, Cardinal Massaia Hospital,
| | - Silvia Monticone
- From the Department of Medicine and Experimental Oncology, Division of Internal Medicine and Hypertension (P.M., D.T., A.V., C.B., S.M., D.S., T.A.W., F.R., F.V.), and Department of Endocrinology and Diabetology, Regina Margherita Pediatric Hospital (S.E.), University of Torino, Torino, Italy; Clinical Chemistry Laboratory (G.M.), San Giovanni Battista University Hospital, Torino, Italy; Division of Internal Medicine (A.L.G.), Service of Endocrinology and Hypertension, Cardinal Massaia Hospital,
| | - Giulio Mengozzi
- From the Department of Medicine and Experimental Oncology, Division of Internal Medicine and Hypertension (P.M., D.T., A.V., C.B., S.M., D.S., T.A.W., F.R., F.V.), and Department of Endocrinology and Diabetology, Regina Margherita Pediatric Hospital (S.E.), University of Torino, Torino, Italy; Clinical Chemistry Laboratory (G.M.), San Giovanni Battista University Hospital, Torino, Italy; Division of Internal Medicine (A.L.G.), Service of Endocrinology and Hypertension, Cardinal Massaia Hospital,
| | - Domenica Schiavone
- From the Department of Medicine and Experimental Oncology, Division of Internal Medicine and Hypertension (P.M., D.T., A.V., C.B., S.M., D.S., T.A.W., F.R., F.V.), and Department of Endocrinology and Diabetology, Regina Margherita Pediatric Hospital (S.E.), University of Torino, Torino, Italy; Clinical Chemistry Laboratory (G.M.), San Giovanni Battista University Hospital, Torino, Italy; Division of Internal Medicine (A.L.G.), Service of Endocrinology and Hypertension, Cardinal Massaia Hospital,
| | - Tracy Ann Williams
- From the Department of Medicine and Experimental Oncology, Division of Internal Medicine and Hypertension (P.M., D.T., A.V., C.B., S.M., D.S., T.A.W., F.R., F.V.), and Department of Endocrinology and Diabetology, Regina Margherita Pediatric Hospital (S.E.), University of Torino, Torino, Italy; Clinical Chemistry Laboratory (G.M.), San Giovanni Battista University Hospital, Torino, Italy; Division of Internal Medicine (A.L.G.), Service of Endocrinology and Hypertension, Cardinal Massaia Hospital,
| | - Silvia Einaudi
- From the Department of Medicine and Experimental Oncology, Division of Internal Medicine and Hypertension (P.M., D.T., A.V., C.B., S.M., D.S., T.A.W., F.R., F.V.), and Department of Endocrinology and Diabetology, Regina Margherita Pediatric Hospital (S.E.), University of Torino, Torino, Italy; Clinical Chemistry Laboratory (G.M.), San Giovanni Battista University Hospital, Torino, Italy; Division of Internal Medicine (A.L.G.), Service of Endocrinology and Hypertension, Cardinal Massaia Hospital,
| | - Antonio La Grotta
- From the Department of Medicine and Experimental Oncology, Division of Internal Medicine and Hypertension (P.M., D.T., A.V., C.B., S.M., D.S., T.A.W., F.R., F.V.), and Department of Endocrinology and Diabetology, Regina Margherita Pediatric Hospital (S.E.), University of Torino, Torino, Italy; Clinical Chemistry Laboratory (G.M.), San Giovanni Battista University Hospital, Torino, Italy; Division of Internal Medicine (A.L.G.), Service of Endocrinology and Hypertension, Cardinal Massaia Hospital,
| | - Franco Rabbia
- From the Department of Medicine and Experimental Oncology, Division of Internal Medicine and Hypertension (P.M., D.T., A.V., C.B., S.M., D.S., T.A.W., F.R., F.V.), and Department of Endocrinology and Diabetology, Regina Margherita Pediatric Hospital (S.E.), University of Torino, Torino, Italy; Clinical Chemistry Laboratory (G.M.), San Giovanni Battista University Hospital, Torino, Italy; Division of Internal Medicine (A.L.G.), Service of Endocrinology and Hypertension, Cardinal Massaia Hospital,
| | - Franco Veglio
- From the Department of Medicine and Experimental Oncology, Division of Internal Medicine and Hypertension (P.M., D.T., A.V., C.B., S.M., D.S., T.A.W., F.R., F.V.), and Department of Endocrinology and Diabetology, Regina Margherita Pediatric Hospital (S.E.), University of Torino, Torino, Italy; Clinical Chemistry Laboratory (G.M.), San Giovanni Battista University Hospital, Torino, Italy; Division of Internal Medicine (A.L.G.), Service of Endocrinology and Hypertension, Cardinal Massaia Hospital,
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Raj M. Essential hypertension in adolescents and children: Recent advances in causative mechanisms. Indian J Endocrinol Metab 2011; 15 Suppl 4:S367-S373. [PMID: 22145141 PMCID: PMC3230086 DOI: 10.4103/2230-8210.86981] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Essential hypertension is the most common form of hypertension in adults, and it is recognized more often in adolescents than in younger children. It is well known that the probability of a diagnosis of essential hypertension increases with age from birth onward. The initiation of high blood pressure burden starts in childhood and continues through adolescence to persist in the remaining phases of life. The genesis of essential hypertension is likely to be multifactorial. Obesity, insulin resistance, activation of sympathetic nervous system, sodium homeostasis, renin-angiotensin system, vascular smooth muscle structure and reactivity, serum uric acid levels, genetic factors and fetal programming have been implicated in this disorder. In addition, erythrocyte sodium transport, the free calcium concentration in platelets and leukocytes, urine kallikrein excretion, and sympathetic nervous system receptors have also been investigated as other possible mechanisms. Obesity in children appears to be the lead contributor of essential hypertension prevalence in children and adolescents. Suggested mechanisms of obesity-related hypertension include insulin resistance, sodium retention, increased sympathetic nervous system activity, activation of renin-angiotensin-aldosterone, and altered vascular function. The etiopathogenesis of essential hypertension in children and adolescents appears to closely resemble that of adults. The minor variations seen could probably be due to the evolving nature of this condition. Many of the established mechanisms that are confirmed in adult population need to be replicated in the pediatric age group by means of definitive research for a better understanding of this condition in future.
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Affiliation(s)
- Manu Raj
- Pediatric Cardiovascular Researcher, Population Health Research Institute (PHRI), David Braley Cardiac, Vascular and Stroke Research Institute (DBCVSRI), Hamilton General Hospital, 237 Barton Street East, Hamilton, Ontario, Canada
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36
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Aglony M, Martínez-Aguayo A, Carvajal CA, Campino C, García H, Bancalari R, Bolte L, Avalos C, Loureiro C, Trejo P, Brinkmann K, Giadrosich V, Mericq V, Rocha A, Avila A, Perez V, Inostroza A, Fardella CE. Frequency of Familial Hyperaldosteronism Type 1 in a Hypertensive Pediatric Population. Hypertension 2011; 57:1117-21. [DOI: 10.1161/hypertensionaha.110.168740] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Familial hyperaldosteronism type 1 is an autosomal dominant disorder attributed to a chimeric CYP11B1/CYP11B2 gene (CG). Its prevalence and manifestation in the pediatric population has not been established. We aimed to investigate the prevalence of familial hyperaldosteronism type 1 in Chilean hypertensive children and to describe their clinical and biochemical characteristics. We studied 130 untreated hypertensive children (4 to 16 years old). Blood samples for measuring plasma potassium, serum aldosterone, plasma renin activity, aldosterone/renin ratio, and DNA were collected. The detection of CG was performed using long-extension PCR. We found 4 (3.08%) of 130 children with CG who belonged to 4 unrelated families. The 4 patients with CG had very high aldosterone/renin ratio (49 to 242). In addition, we found 4 children and 5 adults who were affected among 21 first-degree relatives. Of the 8 affected children, 6 presented severe hypertension, 1 presented prehypertension, and 1 presented normotension. High serum aldosterone levels (>17.7 ng/dL) were detected in 6 of 8 subjects (range: 18.6 to 48.4 ng/dL) and suppressed plasma renin activity (≤0.5 ng/mL per hour) and high aldosterone/renin ratio (>10) in 8 of 8 children (range: 49 to 242). Hypokalemia was observed in only 1 of 8 children. We demonstrated that the prevalence of familial hyperaldosteronism type 1 in a pediatric hypertensive pediatric population was surprisingly high. We found a high variability in the clinical and biochemical characteristics of the affected patients, which suggests that familial hyperaldosteronism type 1 is a heterogeneous disease with a wide spectrum of presentations even within the same family group.
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Affiliation(s)
- Marlene Aglony
- From the Division of Pediatrics (M.A., A.M.-A., H.G., R.B., L.B., C.L., V.P.) and Departments of Endocrinology (C.A.C., C.C., P.T., C.E.F.) and Nephrology (A.I.), Pontificia Universidad Católica de Chile, Santiago, Chile; Department of Pediatrics (C.A.), Universidad de Antofagasta, Antofagasta, Chile; Department of Pediatrics (K.B.), Hospital Regional de Punta Arenas, Punta Arenas, Chile; Department of Pediatrics (V.G.), Universidad de Valparaiso, Valparaiso, Chile; Institute of Maternal and Child
| | - Alejandro Martínez-Aguayo
- From the Division of Pediatrics (M.A., A.M.-A., H.G., R.B., L.B., C.L., V.P.) and Departments of Endocrinology (C.A.C., C.C., P.T., C.E.F.) and Nephrology (A.I.), Pontificia Universidad Católica de Chile, Santiago, Chile; Department of Pediatrics (C.A.), Universidad de Antofagasta, Antofagasta, Chile; Department of Pediatrics (K.B.), Hospital Regional de Punta Arenas, Punta Arenas, Chile; Department of Pediatrics (V.G.), Universidad de Valparaiso, Valparaiso, Chile; Institute of Maternal and Child
| | - Cristian A. Carvajal
- From the Division of Pediatrics (M.A., A.M.-A., H.G., R.B., L.B., C.L., V.P.) and Departments of Endocrinology (C.A.C., C.C., P.T., C.E.F.) and Nephrology (A.I.), Pontificia Universidad Católica de Chile, Santiago, Chile; Department of Pediatrics (C.A.), Universidad de Antofagasta, Antofagasta, Chile; Department of Pediatrics (K.B.), Hospital Regional de Punta Arenas, Punta Arenas, Chile; Department of Pediatrics (V.G.), Universidad de Valparaiso, Valparaiso, Chile; Institute of Maternal and Child
| | - Carmen Campino
- From the Division of Pediatrics (M.A., A.M.-A., H.G., R.B., L.B., C.L., V.P.) and Departments of Endocrinology (C.A.C., C.C., P.T., C.E.F.) and Nephrology (A.I.), Pontificia Universidad Católica de Chile, Santiago, Chile; Department of Pediatrics (C.A.), Universidad de Antofagasta, Antofagasta, Chile; Department of Pediatrics (K.B.), Hospital Regional de Punta Arenas, Punta Arenas, Chile; Department of Pediatrics (V.G.), Universidad de Valparaiso, Valparaiso, Chile; Institute of Maternal and Child
| | - Hernán García
- From the Division of Pediatrics (M.A., A.M.-A., H.G., R.B., L.B., C.L., V.P.) and Departments of Endocrinology (C.A.C., C.C., P.T., C.E.F.) and Nephrology (A.I.), Pontificia Universidad Católica de Chile, Santiago, Chile; Department of Pediatrics (C.A.), Universidad de Antofagasta, Antofagasta, Chile; Department of Pediatrics (K.B.), Hospital Regional de Punta Arenas, Punta Arenas, Chile; Department of Pediatrics (V.G.), Universidad de Valparaiso, Valparaiso, Chile; Institute of Maternal and Child
| | - Rodrigo Bancalari
- From the Division of Pediatrics (M.A., A.M.-A., H.G., R.B., L.B., C.L., V.P.) and Departments of Endocrinology (C.A.C., C.C., P.T., C.E.F.) and Nephrology (A.I.), Pontificia Universidad Católica de Chile, Santiago, Chile; Department of Pediatrics (C.A.), Universidad de Antofagasta, Antofagasta, Chile; Department of Pediatrics (K.B.), Hospital Regional de Punta Arenas, Punta Arenas, Chile; Department of Pediatrics (V.G.), Universidad de Valparaiso, Valparaiso, Chile; Institute of Maternal and Child
| | - Lillian Bolte
- From the Division of Pediatrics (M.A., A.M.-A., H.G., R.B., L.B., C.L., V.P.) and Departments of Endocrinology (C.A.C., C.C., P.T., C.E.F.) and Nephrology (A.I.), Pontificia Universidad Católica de Chile, Santiago, Chile; Department of Pediatrics (C.A.), Universidad de Antofagasta, Antofagasta, Chile; Department of Pediatrics (K.B.), Hospital Regional de Punta Arenas, Punta Arenas, Chile; Department of Pediatrics (V.G.), Universidad de Valparaiso, Valparaiso, Chile; Institute of Maternal and Child
| | - Carolina Avalos
- From the Division of Pediatrics (M.A., A.M.-A., H.G., R.B., L.B., C.L., V.P.) and Departments of Endocrinology (C.A.C., C.C., P.T., C.E.F.) and Nephrology (A.I.), Pontificia Universidad Católica de Chile, Santiago, Chile; Department of Pediatrics (C.A.), Universidad de Antofagasta, Antofagasta, Chile; Department of Pediatrics (K.B.), Hospital Regional de Punta Arenas, Punta Arenas, Chile; Department of Pediatrics (V.G.), Universidad de Valparaiso, Valparaiso, Chile; Institute of Maternal and Child
| | - Carolina Loureiro
- From the Division of Pediatrics (M.A., A.M.-A., H.G., R.B., L.B., C.L., V.P.) and Departments of Endocrinology (C.A.C., C.C., P.T., C.E.F.) and Nephrology (A.I.), Pontificia Universidad Católica de Chile, Santiago, Chile; Department of Pediatrics (C.A.), Universidad de Antofagasta, Antofagasta, Chile; Department of Pediatrics (K.B.), Hospital Regional de Punta Arenas, Punta Arenas, Chile; Department of Pediatrics (V.G.), Universidad de Valparaiso, Valparaiso, Chile; Institute of Maternal and Child
| | - Pamela Trejo
- From the Division of Pediatrics (M.A., A.M.-A., H.G., R.B., L.B., C.L., V.P.) and Departments of Endocrinology (C.A.C., C.C., P.T., C.E.F.) and Nephrology (A.I.), Pontificia Universidad Católica de Chile, Santiago, Chile; Department of Pediatrics (C.A.), Universidad de Antofagasta, Antofagasta, Chile; Department of Pediatrics (K.B.), Hospital Regional de Punta Arenas, Punta Arenas, Chile; Department of Pediatrics (V.G.), Universidad de Valparaiso, Valparaiso, Chile; Institute of Maternal and Child
| | - Karin Brinkmann
- From the Division of Pediatrics (M.A., A.M.-A., H.G., R.B., L.B., C.L., V.P.) and Departments of Endocrinology (C.A.C., C.C., P.T., C.E.F.) and Nephrology (A.I.), Pontificia Universidad Católica de Chile, Santiago, Chile; Department of Pediatrics (C.A.), Universidad de Antofagasta, Antofagasta, Chile; Department of Pediatrics (K.B.), Hospital Regional de Punta Arenas, Punta Arenas, Chile; Department of Pediatrics (V.G.), Universidad de Valparaiso, Valparaiso, Chile; Institute of Maternal and Child
| | - Vinka Giadrosich
- From the Division of Pediatrics (M.A., A.M.-A., H.G., R.B., L.B., C.L., V.P.) and Departments of Endocrinology (C.A.C., C.C., P.T., C.E.F.) and Nephrology (A.I.), Pontificia Universidad Católica de Chile, Santiago, Chile; Department of Pediatrics (C.A.), Universidad de Antofagasta, Antofagasta, Chile; Department of Pediatrics (K.B.), Hospital Regional de Punta Arenas, Punta Arenas, Chile; Department of Pediatrics (V.G.), Universidad de Valparaiso, Valparaiso, Chile; Institute of Maternal and Child
| | - Verónica Mericq
- From the Division of Pediatrics (M.A., A.M.-A., H.G., R.B., L.B., C.L., V.P.) and Departments of Endocrinology (C.A.C., C.C., P.T., C.E.F.) and Nephrology (A.I.), Pontificia Universidad Católica de Chile, Santiago, Chile; Department of Pediatrics (C.A.), Universidad de Antofagasta, Antofagasta, Chile; Department of Pediatrics (K.B.), Hospital Regional de Punta Arenas, Punta Arenas, Chile; Department of Pediatrics (V.G.), Universidad de Valparaiso, Valparaiso, Chile; Institute of Maternal and Child
| | - Ana Rocha
- From the Division of Pediatrics (M.A., A.M.-A., H.G., R.B., L.B., C.L., V.P.) and Departments of Endocrinology (C.A.C., C.C., P.T., C.E.F.) and Nephrology (A.I.), Pontificia Universidad Católica de Chile, Santiago, Chile; Department of Pediatrics (C.A.), Universidad de Antofagasta, Antofagasta, Chile; Department of Pediatrics (K.B.), Hospital Regional de Punta Arenas, Punta Arenas, Chile; Department of Pediatrics (V.G.), Universidad de Valparaiso, Valparaiso, Chile; Institute of Maternal and Child
| | - Alejandra Avila
- From the Division of Pediatrics (M.A., A.M.-A., H.G., R.B., L.B., C.L., V.P.) and Departments of Endocrinology (C.A.C., C.C., P.T., C.E.F.) and Nephrology (A.I.), Pontificia Universidad Católica de Chile, Santiago, Chile; Department of Pediatrics (C.A.), Universidad de Antofagasta, Antofagasta, Chile; Department of Pediatrics (K.B.), Hospital Regional de Punta Arenas, Punta Arenas, Chile; Department of Pediatrics (V.G.), Universidad de Valparaiso, Valparaiso, Chile; Institute of Maternal and Child
| | - Viviana Perez
- From the Division of Pediatrics (M.A., A.M.-A., H.G., R.B., L.B., C.L., V.P.) and Departments of Endocrinology (C.A.C., C.C., P.T., C.E.F.) and Nephrology (A.I.), Pontificia Universidad Católica de Chile, Santiago, Chile; Department of Pediatrics (C.A.), Universidad de Antofagasta, Antofagasta, Chile; Department of Pediatrics (K.B.), Hospital Regional de Punta Arenas, Punta Arenas, Chile; Department of Pediatrics (V.G.), Universidad de Valparaiso, Valparaiso, Chile; Institute of Maternal and Child
| | - Andrea Inostroza
- From the Division of Pediatrics (M.A., A.M.-A., H.G., R.B., L.B., C.L., V.P.) and Departments of Endocrinology (C.A.C., C.C., P.T., C.E.F.) and Nephrology (A.I.), Pontificia Universidad Católica de Chile, Santiago, Chile; Department of Pediatrics (C.A.), Universidad de Antofagasta, Antofagasta, Chile; Department of Pediatrics (K.B.), Hospital Regional de Punta Arenas, Punta Arenas, Chile; Department of Pediatrics (V.G.), Universidad de Valparaiso, Valparaiso, Chile; Institute of Maternal and Child
| | - Carlos E. Fardella
- From the Division of Pediatrics (M.A., A.M.-A., H.G., R.B., L.B., C.L., V.P.) and Departments of Endocrinology (C.A.C., C.C., P.T., C.E.F.) and Nephrology (A.I.), Pontificia Universidad Católica de Chile, Santiago, Chile; Department of Pediatrics (C.A.), Universidad de Antofagasta, Antofagasta, Chile; Department of Pediatrics (K.B.), Hospital Regional de Punta Arenas, Punta Arenas, Chile; Department of Pediatrics (V.G.), Universidad de Valparaiso, Valparaiso, Chile; Institute of Maternal and Child
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Mulatero P, Williams TA, Monticone S, Veglio F. Is familial hyperaldosteronism underdiagnosed in hypertensive children? Hypertension 2011; 57:1053-5. [PMID: 21502569 DOI: 10.1161/hypertensionaha.111.172916] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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