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Zhou S, Liu J, Li Z, Yang M, Sha R, Yan R, Wang X, Cao Y. The effect of different treatment strategies on glycolipid metabolism disorders and cardiovascular events in primary aldosteronism. Hypertens Res 2024; 47:1719-1727. [PMID: 38565699 DOI: 10.1038/s41440-024-01648-0] [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: 11/02/2023] [Revised: 02/26/2024] [Accepted: 03/01/2024] [Indexed: 04/04/2024]
Abstract
Recent studies have explored the association between primary aldosteronism and cardiovascular disease incidence. The association between specific primary aldosteronism treatments and differential improvement in cardiovascular event rates is yet to be established. This study was designed to compare the relative effects of spironolactone therapy and surgical intervention on cardiovascular outcomes among primary aldosteronism patients. This retrospective observational study included 853 primary aldosteronism patients from the First Affiliated Hospital of China Medical University between 2014 and 2022. Patients who had completed abdominal computed tomography (CT) examinations with similar metabolic characteristics and 6-month follow-up analyses were included in this study. These patients were separated into a surgical treatment group (n = 33) and a spironolactone treatment group (n = 51). Demographic data, biochemical analysis results, liver/spleen (L/S) X-ray attenuation ratio, hospitalization frequency, and cardiovascular events were compared between the two groups. The spironolactone group demonstrated significantly improved metabolic characteristics compared to the surgical group, shown by lower BMI, blood pressure, total cholesterol (TC), insulin resistance index (IRI), and reduced non-alcoholic fatty liver disease prevalence. Metabolic parameters did not differ significantly within the surgical treatment group when comparing pre- and postoperative values. The incidence of cardiovascular events was lower in the spironolactone group compared to the surgery group (23/33 vs. 20/51, P < 0.001) despite higher hospitalization rates(37/31 vs. 61/53, P < 0.001). In patients with primary aldosteronism, spironolactone treatment is more effective than surgical intervention in remediating abnormal lipid and glucose metabolism while improving cardiovascular outcomes. Chinese clinical trial registry registration number: ChiCTR2300074574.
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Affiliation(s)
- Shiting Zhou
- Department of Endocrinology and Metabolism, Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Affiliated Hospital of China Medical University, Shenyang, PR China
| | - Jing Liu
- Department of Radiology, The First Affiliated Hospital of China Medical University, 110001, Shenyang, China
| | - Zhuo Li
- Department of Endocrinology and Metabolism, Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Affiliated Hospital of China Medical University, Shenyang, PR China
| | - Mingfeng Yang
- Department of Endocrinology and Metabolism, Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Affiliated Hospital of China Medical University, Shenyang, PR China
| | - Ruohe Sha
- Department of Endocrinology and Metabolism, Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Affiliated Hospital of China Medical University, Shenyang, PR China
| | - Ruike Yan
- Department of Endocrinology and Metabolism, Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Affiliated Hospital of China Medical University, Shenyang, PR China
| | - Xinxin Wang
- Department of Endocrinology and Metabolism, Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Affiliated Hospital of China Medical University, Shenyang, PR China
| | - Yanli Cao
- Department of Endocrinology and Metabolism, Institute of Endocrinology, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Affiliated Hospital of China Medical University, Shenyang, PR China.
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Timmerman SA, Mullen N, Taylor AE, Gilligan LC, Pyle M, Shrestha TB, Sebek J, Highland MA, Challapalli R, Arlt W, Bossmann SH, Dennedy MC, Prakash P, Basel MT. Characterization of a Biochemical Mouse Model of Primary Aldosteronism for Thermal Therapies. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.07.592955. [PMID: 38766205 PMCID: PMC11100708 DOI: 10.1101/2024.05.07.592955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Introduction Aldosterone-producing adenoma (APA) is the most common cause of endocrine-related hypertension but surgery is not always feasible. Current medical interventions are associated with significant side effects and poor patient compliance. New APA animal models that replicate basic characteristics of APA and give physical and biochemical feedback are needed to test new non-surgical treatment methods, such as image-guided thermal ablation. Methods A model of APA was developed in nude mice using HAC15 cells, a human adrenal carcinoma cell line. Tumor growth, aldosterone production, and sensitivity to angiotensin II were characterized in the model. The utility of the model was validated via treatment with microwave ablation and characterization of the resulting physical and biochemical changes in the tumor. Results The APA model showed rapid and relatively homogeneous growth. The tumors produced aldosterone and steroid precursors in response to angiotensin II challenge, and plasma aldosterone levels were significantly higher in tumor bearing mice two hours after challenge verses non-tumor bearing mice. The model was useful for testing microwave ablation therapy, reducing aldosterone production by 80% in treated mice. Conclusion The HAC15 model is a useful tumor model to study and develop localized treatment methods for APA.
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Primary aldosteronism: It's time to become reacquainted with this familiar stranger. J Formos Med Assoc 2024; 123 Suppl 2:S77-S78. [PMID: 38350830 DOI: 10.1016/j.jfma.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
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Yu D, Zhang J, Li X, Xiao S, Xing J, Li J. Developing the novel diagnostic model and potential drugs by integrating bioinformatics and machine learning for aldosterone-producing adenomas. Front Mol Biosci 2024; 10:1308754. [PMID: 38239411 PMCID: PMC10794617 DOI: 10.3389/fmolb.2023.1308754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 12/08/2023] [Indexed: 01/22/2024] Open
Abstract
Background: Aldosterone-producing adenomas (APA) are a common cause of primary aldosteronism (PA), a clinical syndrome characterized by hypertension and electrolyte disturbances. If untreated, it may lead to serious cardiovascular complications. Therefore, there is an urgent need for potential biomarkers and targeted drugs for the diagnosis and treatment of aldosteronism. Methods: We downloaded two datasets (GSE156931 and GSE60042) from the GEO database and merged them by de-batch effect, then screened the top50 of differential genes using PPI and enriched them, followed by screening the Aldosterone adenoma-related genes (ARGs) in the top50 using three machine learning algorithms. We performed GSEA analysis on the ARGs separately and constructed artificial neural networks based on the ARGs. Finally, the Enrich platform was utilized to identify drugs with potential therapeutic effects on APA by tARGseting the ARGs. Results: We identified 190 differential genes by differential analysis, and then identified the top50 genes by PPI, and the enrichment analysis showed that they were mainly enriched in amino acid metabolic pathways. Then three machine learning algorithms identified five ARGs, namely, SST, RAB3C, PPY, CYP3A4, CDH10, and the ANN constructed on the basis of these five ARGs had better diagnostic effect on APA, in which the AUC of the training set is 1 and the AUC of the validation set is 0.755. And then the Enrich platform identified drugs tARGseting the ARGs with potential therapeutic effects on APA. Conclusion: We identified five ARGs for APA through bioinformatic analysis and constructed Artificial neural network (ANN) based on them with better diagnostic effects, and identified drugs with potential therapeutic effects on APA by tARGseting these ARGs. Our study provides more options for the diagnosis and treatment of APA.
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Affiliation(s)
- Deshui Yu
- Department of Urology, Air Force Medical Center, Beijing, China
- China Medical University, Shenyang, China
| | - Jinxuan Zhang
- Department of Urology, Air Force Medical Center, Beijing, China
- China Medical University, Shenyang, China
| | - Xintao Li
- Department of Urology, Air Force Medical Center, Beijing, China
| | - Shuwei Xiao
- Department of Urology, Air Force Medical Center, Beijing, China
| | - Jizhang Xing
- Department of Urology, Air Force Medical Center, Beijing, China
| | - Jianye Li
- Department of Urology, Air Force Medical Center, Beijing, China
- China Medical University, Shenyang, China
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Nethathe GD, Lipman J, Anderson R, Fuller PJ, Feldman C. Glucocorticoids with or without fludrocortisone in septic shock: a narrative review from a biochemical and molecular perspective. Br J Anaesth 2024; 132:53-65. [PMID: 38030548 PMCID: PMC10797514 DOI: 10.1016/j.bja.2023.10.034] [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: 08/07/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Two randomised controlled trials have reported a reduction in mortality when adjunctive hydrocortisone is administered in combination with fludrocortisone compared with placebo in septic shock. A third trial did not support this finding when hydrocortisone administered in combination with fludrocortisone was compared with hydrocortisone alone. The underlying mechanisms for this mortality benefit remain poorly understood. We review the clinical implications and potential mechanisms derived from laboratory and clinical data underlying the beneficial role of adjunctive fludrocortisone with hydrocortisone supplementation in septic shock. Factors including distinct biological effects of glucocorticoids and mineralocorticoids, tissue-specific and mineralocorticoid receptor-independent effects of mineralocorticoids, and differences in downstream signalling pathways between mineralocorticoid and glucocorticoid binding at the mineralocorticoid receptor could contribute to this interaction. Furthermore, pharmacokinetic and pharmacodynamic disparities exist between aldosterone and its synthetic counterpart fludrocortisone, potentially influencing their effects. Pending publication of well-designed, randomised controlled trials, a molecular perspective offers valuable insights and guidance to help inform clinical strategies.
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Affiliation(s)
- Gladness D Nethathe
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia; Academy of Critical Care, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
| | - Jeffrey Lipman
- Academy of Critical Care, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; Jamieson Trauma Institute and Intensive Care Services, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Brisbane, 4029, QLD, Australia; Nimes University Hospital, University of Montpellier, Nimes, France
| | - Ronald Anderson
- Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Peter J Fuller
- Endocrinology Unit, Monash Health, Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Melbourne, VIC, Australia
| | - Charles Feldman
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Abstract
The adrenal glands drive physiologic homeostasis, with dysregulation in any direction causing multisystem dysfunction. Adrenal excess states include hyperaldosteronism which manifests with refractory hypertension and electrolyte abnormalities including hypernatremia and hypokalemia. Paragangliomas including pheochromocytoma can cause multisystem end-organ dysfunction due to catecholaminergic storm, which require rapid blood pressure control with phentolamine and identification of lesions amenable to surgical resection. Adrenal insufficiency states in contrast can result in hypotension and decompensation refractory to vasopressor administration, requiring adrenal supplementation via hydrocortisone.
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Affiliation(s)
- Rachel E Bridwell
- Department of Emergency Medicine, Madigan Army Medical Center, 9040A Jackson Avenue, JBLM, WA 98433, USA.
| | - Michael D April
- Department of Emergency and Military Medicine, USUHS, 2233 Gulick Avenue, Building 816A, Fort Stewart, GA 31314, USA
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Yuan H, Kang B, Sun K, Qin S, Ji C, Wang X. CT-based radiomics nomogram for differentiation of adrenal hyperplasia from lipid-poor adenoma: an exploratory study. BMC Med Imaging 2023; 23:4. [PMID: 36611159 PMCID: PMC9826591 DOI: 10.1186/s12880-022-00951-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/14/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND To establish and verify a radiomics nomogram for differentiating isolated micronodular adrenal hyperplasia (iMAD) from lipid-poor adenoma (LPA) based on computed tomography (CT)-extracted radiomic features. METHODS A total of 148 patients with iMAD or LPA were divided into three cohorts: a training cohort (n = 72; 37 iMAD and 35 LPA), a validation cohort (n = 36; 22 iMAD and 14 LPA), and an external validation cohort (n = 40; 20 iMAD and 20 LPA). Radiomics features were extracted from contrast-enhanced and non-contrast CT images. The least absolute shrinkage and selection operator (LASSO) method was applied to develop a triphasic radiomics model and unenhanced radiomics model using reproducible radiomics features. A clinical model was constructed using certain laboratory variables and CT findings. Radiomics nomogram was established by selected radiomics signature and clinical factors. Nomogram performance was assessed by calibration curve, the areas under receiver operating characteristic curves (AUC), and decision curve analysis (DCA). RESULTS Eleven and eight extracted features were finally selected to construct an unenhanced radiomics model and a triphasic radiomics model, respectively. There was no significant difference in AUC between the two models in the external validation cohort (0.838 vs. 0.843, p = 0.949). The radiomics nomogram inclusive of the unenhanced model, maximum diameter, and aldosterone showed the AUC of 0.951, 0.938, and 0.893 for the training, validation, and external validation cohorts, respectively. The nomogram showed good calibration, and the DCA demonstrated the superiority of the nomogram compared with the clinical factors model alone in terms of clinical usefulness. CONCLUSIONS A radiomics nomogram based on unenhanced CT images and clinical variables showed favorable performance for distinguishing iMAD from LPA. In addition, an efficient unenhanced model can help avoid extra contrast-enhanced scanning and radiation risk.
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Affiliation(s)
- Hongtao Yuan
- grid.27255.370000 0004 1761 1174Shandong Provincial Hospital, Shandong University, Jinan, Shandong China
| | - Bing Kang
- grid.460018.b0000 0004 1769 9639Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong China
| | - Kui Sun
- grid.460018.b0000 0004 1769 9639Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong China ,grid.410638.80000 0000 8910 6733School of Medicine, Shandong First Medical University, Jinan, Shandong China
| | - Songnan Qin
- grid.27255.370000 0004 1761 1174Shandong Provincial Hospital, Shandong University, Jinan, Shandong China
| | - Congshan Ji
- grid.460018.b0000 0004 1769 9639Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong China
| | - Ximing Wang
- grid.460018.b0000 0004 1769 9639Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong China
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Zhang J, Yang J, Libianto R, Shen J, Fuller PJ, Grodski S, Lee JC. Impact of dedicated multidisciplinary service on patient selection and outcomes for surgical treatment of primary aldosteronism. Surgery 2022; 172:1682-1688. [PMID: 36123178 DOI: 10.1016/j.surg.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/22/2022] [Accepted: 08/04/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Primary aldosteronism is the most common surgically curable cause of endocrine hypertension. Management of the unilateral subtype of primary aldosteronism with adrenalectomy requires multidisciplinary input. It is unclear if a dedicated endocrine hypertension service confers better outcomes compared to standard care offered by individual clinicians. METHODS In this retrospective study, patients from the Monash University Endocrine Surgery Database were divided into either the endocrine hypertension service group, where patients were managed by a dedicated multidisciplinary team, or the standard group, where patients were managed by individual clinicians. The comparisons included patient selection for surgery, perioperative blood pressure control, and surgical cure rate. RESULTS Despite similar perioperative blood pressure, patients in the endocrine hypertension service group (n = 41) were on fewer antihypertensive medications (1 vs 2, P = .011) compared to the standard group (n = 55). A larger proportion of patients in the endocrine hypertension service group had either bilateral adrenal nodules or no adrenal lesions on computed tomography (41% vs 18%, P = .013). Patients in the standard group had larger adrenal lesions on computed tomography (median 15 mm vs 10 mm, P = .032). Postoperatively, the biochemical cure rate was higher in the endocrine hypertension service group at 6 to 12 months (97% vs 76%, P = .021). CONCLUSION Patients managed by endocrine hypertension service were more likely to be diagnosed with surgically curable primary aldosteronism without a unilateral adrenal adenoma on imaging, required fewer medications for perioperative blood pressure control, and experienced superior postoperative outcomes. Referral to a dedicated endocrine hypertension service is recommended for patients with primary aldosteronism who wish to pursue a surgical cure.
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Affiliation(s)
- Jinghong Zhang
- Department of Endocrinology, Monash Health, Victoria, Australia. https://twitter.com/zhang_jinghong
| | - Jun Yang
- Department of Endocrinology, Monash Health, Victoria, Australia; Department of Medicine, Monash University, Victoria, Australia; Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Victoria, Australia. https://twitter.com/drlouisesegan
| | - Renata Libianto
- Department of Endocrinology, Monash Health, Victoria, Australia; Department of Medicine, Monash University, Victoria, Australia; Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Victoria, Australia
| | - Jimmy Shen
- Department of Endocrinology, Monash Health, Victoria, Australia; Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Victoria, Australia
| | - Peter J Fuller
- Department of Endocrinology, Monash Health, Victoria, Australia; Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Victoria, Australia
| | - Simon Grodski
- Monash University Endocrine Surgery Unit, Monash University, Victoria, Australia; Department of Surgery, Monash Health, Victoria, Australia; Department of Surgery, Central Clinical School, Monash University, Victoria, Australia
| | - James C Lee
- Monash University Endocrine Surgery Unit, Monash University, Victoria, Australia; Department of Surgery, Monash Health, Victoria, Australia; Department of Surgery, Central Clinical School, Monash University, Victoria, Australia.
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Viukari M, Kokko E, Pörsti I, Leijon H, Vesterinen T, Hinkka T, Soinio M, Schalin‐Jäntti C, Matikainen N, Nevalainen PI. Adrenal androgens versus cortisol for primary aldosteronism subtype determination in adrenal venous sampling. Clin Endocrinol (Oxf) 2022; 97:241-249. [PMID: 35167715 PMCID: PMC9544970 DOI: 10.1111/cen.14691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/14/2021] [Accepted: 12/19/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We examined if measurement of adrenal androgens adds to subtype diagnostics of primary aldosteronism (PA) under cosyntropin-stimulated adrenal venous sampling (AVS). DESIGN A prospective pre-specified secondary endpoint analysis of 49 patients with confirmed PA, of whom 29 underwent unilateral adrenalectomy with long-term follow-up. METHODS Concentrations of androstenedione, dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulphate (DHEAS) were measured during AVS in addition to aldosterone and cortisol. Subjects with lateralisation index (LI) of ≥4 were treated with unilateral adrenalectomy, and the immunohistochemical subtype was determined with CYP11B2 and CYP11B1 stains. The performance of adrenal androgens was evaluated by receiver operating characteristics (ROC) curve analyses in adrenalectomy and medical therapy groups. RESULTS During AVS, the correlations between cortisol and androstenedione, DHEA and DHEAS for LI and selectivity index (SI) were highly significant. The right and left side SIs for androstenedione and DHEA were higher (p < .001) than for cortisol. In ROC analysis, the optimal LI cut-off values for androstenedione, DHEA and DHEAS were 4.2, 4.5 and 4.6, respectively. The performance of these LIs for adrenal androgens did not differ from that of cortisol. CONCLUSIONS Under cosyntropin-stimulated AVS, the measurement of androstenedione and DHEA did not improve the cannulation selectivity. The performance of cortisol and adrenal androgens are confirmatory but not superior to cortisol-based results in lateralisation diagnostics of PA.
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Affiliation(s)
- Marianna Viukari
- EndocrinologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Eeva Kokko
- Faculty of Medicine and Health TechnologyTampere UniversityTampereFinland
| | - Ilkka Pörsti
- Faculty of Medicine and Health TechnologyTampere UniversityTampereFinland
- Department of Internal MedicineTampere University HospitalTampereFinland
| | - Helena Leijon
- Department of Pathology, University of Helsinki and HUSLABHelsinki University HospitalHelsinkiFinland
| | - Tiina Vesterinen
- Department of Pathology, University of Helsinki and HUSLABHelsinki University HospitalHelsinkiFinland
| | - Tero Hinkka
- Department of Radiology, Centre for Vascular Surgery and Interventional RadiologyTampere University HospitalTampereFinland
| | - Minna Soinio
- Department of EndocrinologyTurku University HospitalTurkuFinland
| | | | - Niina Matikainen
- EndocrinologyHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Pasi I. Nevalainen
- Department of Internal MedicineTampere University HospitalTampereFinland
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Wang TD, Chiang CE, Chao TH, Cheng HM, Wu YW, Wu YJ, Lin YH, Chen MYC, Ueng KC, Chang WT, Lee YH, Wang YC, Chu PH, Chao TF, Kao HL, Hou CJY, Lin TH. 2022 Guidelines of the Taiwan Society of Cardiology and the Taiwan Hypertension Society for the Management of Hypertension. ACTA CARDIOLOGICA SINICA 2022; 38:225-325. [PMID: 35673334 PMCID: PMC9121756 DOI: 10.6515/acs.202205_38(3).20220321a] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/22/2022] [Indexed: 11/23/2022]
Abstract
Hypertension is the most important modifiable cause of cardiovascular (CV) disease and all-cause mortality worldwide. Despite the positive correlations between blood pressure (BP) levels and later CV events since BP levels as low as 100/60 mmHg have been reported in numerous epidemiological studies, the diagnostic criteria of hypertension and BP thresholds and targets of antihypertensive therapy have largely remained at the level of 140/90 mmHg in the past 30 years. The publication of both the SPRINT and STEP trials (comprising > 8,500 Caucasian/African and Chinese participants, respectively) provided evidence to shake this 140/90 mmHg dogma. Another dogma regarding hypertension management is the dependence on office (or clinic) BP measurements. Although standardized office BP measurements have been widely recommended and adopted in large-scale CV outcome trials, the practice of office BP measurements has never been ideal in real-world practice. Home BP monitoring (HBPM) is easy to perform, more likely to be free of environmental and/or emotional stress, feasible to document long-term BP variations, of good reproducibility and reliability, and more correlated with hypertension-mediated organ damage (HMOD) and CV events, compared to routine office BP measurements. In the 2022 Taiwan Hypertension Guidelines of the Taiwan Society of Cardiology (TSOC) and the Taiwan Hypertension Society (THS), we break these two dogmas by recommending the definition of hypertension as ≥ 130/80 mmHg and a universal BP target of < 130/80 mmHg, based on standardized HBPM obtained according to the 722 protocol. The 722 protocol refers to duplicate BP readings taken per occasion ("2"), twice daily ("2"), over seven consecutive days ("7"). To facilitate implementation of the guidelines, a series of flowcharts encompassing assessment, adjustment, and HBPM-guided hypertension management are provided. Other key messages include that: 1) lifestyle modification, summarized as the mnemonic S-ABCDE, should be applied to people with elevated BP and hypertensive patients to reduce life-time BP burden; 2) all 5 major antihypertensive drugs (angiotensin-converting enzyme inhibitors [A], angiotensin receptor blockers [A], β-blockers [B], calcium-channel blockers [C], and thiazide diuretics [D]) are recommended as first-line antihypertensive drugs; 3) initial combination therapy, preferably in a single-pill combination, is recommended for patients with BP ≥ 20/10 mmHg above targets; 4) a target hierarchy (HBPM-HMOD- ambulatory BP monitoring [ABPM]) should be considered to optimize hypertension management, which indicates reaching the HBPM target first and then keeping HMOD stable or regressed, otherwise ABPM can be arranged to guide treatment adjustment; and 5) renal denervation can be considered as an alternative BP-lowering strategy after careful clinical and imaging evaluation.
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Affiliation(s)
- Tzung-Dau Wang
- Cardiovascular Center and Divisions of Cardiology and Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital
- Department of Internal Medicine, School of Medicine, National Taiwan University College of Medicine
| | - Chern-En Chiang
- General Clinical Research Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Ting-Hsing Chao
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Hao-Min Cheng
- School of Medicine, Institute of Public Health and Community Medicine Research Center, and Institute of Health and Welfare Policy, National Yang Ming Chiao Tung University
- Center for Evidence-based Medicine, Department of Medical Education, Taipei Veterans General Hospital, Taipei
| | - Yen-Wen Wu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei
- Division of Cardiology, Cardiovascular Medical Center, and Department of Nuclear Medicine, Far Eastern Memorial Hospital
| | - Yih-Jer Wu
- Department of Medicine, Mackay Medical College, New Taipei City
- Cardiovascular Center, Department of Internal Medicine, MacKay Memorial Hospital
| | - Yen-Hung Lin
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei
| | - Michael Yu-Chih Chen
- Division of Cardiology, Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Hualien
| | - Kwo-Chang Ueng
- Department of Internal Medicine, Chung-Shan Medical University Hospital, Taichung
| | - Wei-Ting Chang
- Division of Cardiology, Department of Internal Medicine, Chi-Mei Medical Center, Tainan
| | - Ying-Hsiang Lee
- Department of Medicine, Mackay Medical College, New Taipei City
- Cardiovascular Center, Department of Internal Medicine, MacKay Memorial Hospital
| | - Yu-Chen Wang
- Division of Cardiology, Department of Medicine, Asia University Hospital
- Department of Medical Laboratory Science and Biotechnology, Asia University
- Division of Cardiology, Department of Internal Medicine, China Medical University College of Medicine and Hospital, Taichung
| | - Pao-Hsien Chu
- Department of Cardiology, Chang Gung Memorial Hospital
- School of Medicine, Chang Gung University, Taoyuan
| | - Tzu-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
- Institute of Clinical Medicine and Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei
| | - Hsien-Li Kao
- Department of Internal Medicine, School of Medicine, National Taiwan University College of Medicine
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei
| | - Charles Jia-Yin Hou
- Department of Medicine, Mackay Medical College, New Taipei City
- Cardiovascular Center, Department of Internal Medicine, MacKay Memorial Hospital
| | - Tsung-Hsien Lin
- Division of Cardiology, Department of Internal Medicine Kaohsiung Medical University Hospital
- Faculty of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Chikhladze NM. Primary hyperaldosteronism: indications for screening. TERAPEVT ARKH 2022; 94:107-113. [DOI: 10.26442/00403660.2022.01.201324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/14/2022] [Indexed: 11/22/2022]
Abstract
The review discusses the current state of the problem of screening patients for early detection of primary hyperaldosteronism (PHA) as a potential cause of arterial hypertension (AH). The features of screening, methodological errors that make it difficult to interpret the results of the study are considered. The screening criteria are analyzed, based on which it is possible to assess the probability of diagnosis of PHA and judge its prevalence in various populations of patients with AH categories of high risk for the development of PHA. Attention is drawn to the low level of screening in patients with AH in order to detect PHA , and to the need for wider familiarization of doctors with the methods of screening and diagnosis of PHA as the cause of uncontrolled AH. The importance of timely diagnosis of PHA and its targeted treatment to reduce the risk of cardiovascular complications associated with hypersecretion of aldosterone is emphasized.
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Laparoscopic Adrenalectomy Versus Percutaneous Ablation for Aldosterone‑Producing Adenoma: a Meta-analysis. Indian J Surg 2022. [DOI: 10.1007/s12262-021-03217-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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13
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Lee BC, Kang VJW, Pan CT, Huang JZ, Lin YL, Chang YY, Tsai CH, Chou CH, Chen ZW, Liao CW, Chiu YW, Wu VC, Hung CS, Chang CC, Lin YH. KCNJ5 Somatic Mutation Is Associated With Higher Aortic Wall Thickness and Less Calcification in Patients With Aldosterone-Producing Adenoma. Front Endocrinol (Lausanne) 2022; 13:830130. [PMID: 35311227 PMCID: PMC8924484 DOI: 10.3389/fendo.2022.830130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/07/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Primary aldosteronism (PA) is the most common type of secondary hypertension, and it is associated with a higher rate of cardiovascular complications. KCNJ5 somatic mutations have recently been identified in aldosterone-producing adenoma (APA), however their influence on vascular remodeling and injury is still unclear. The aim of this study was to investigate the association between KCNJ5 somatic mutation status and vascular status. METHODS We enrolled 179 APA patients who had undergone adrenalectomy from a prospectively maintained database, of whom 99 had KCNJ5 somatic mutations. Preoperative clinical, biochemical and imaging data of abdominal CT, including abdominal aortic calcification (AAC) score, aortic diameter and wall thickness at levels of superior (SMA) and inferior (IMA) mesenteric arteries were analyzed. RESULTS After propensity score matching for age, sex, body mass index, triglycerides and low-density lipoprotein, there were 48 patients in each KCNJ5 (+) and KCNJ5 (-) group. Mutation carriers had a lower AAC score (217.3 ± 562.2 vs. 605.6 ± 1359.1, P=0.018), higher aortic wall thickness (SMA level: 2.2 ± 0.6 mm vs. 1.8 ± 0.6 mm, P=0.006; IMA level: 2.4 ± 0.6 mm vs. 1.8 ± 0.7 mm, P<0.001) than non-carriers. In multivariate analysis, KCNJ5 mutations were independently associated with AAC score (P=0.014) and aortic wall thickness (SMA level: P<0.001; IMA level: P=0.004). After adrenalectomy, mutation carriers had less aortic wall thickness progression than non-carriers (Δthickness SMA: -0.1 ± 0.8 mm vs. 0.9 ± 0.6 mm, P=0.024; IMA: -0.1 ± 0.6 mm vs. 0.8 ± 0.7 mm, P=0.04). CONCLUSION KCNJ5 mutation carriers had less calcification burden of the aorta, thickened aortic wall, and less wall thickness progression than non-carriers.
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Affiliation(s)
- Bo-Ching Lee
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Departments of Medical Imaging, National Taiwan University Hospital Yun-lin Branch, Douliu, Taiwan
| | - Victor Jing-Wei Kang
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Chien-Ting Pan
- Departments of Internal Medicine, National Taiwan University Hospital Yun-lin Branch, Douliu, Taiwan
| | - Jia-Zheng Huang
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Li Lin
- Department of Business Administration and Graduate School of Service Management, Chihlee University of Technology, New Taipei City, Taiwan
| | - Yi-Yao Chang
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Cardiovascular Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Cheng-Hsuan Tsai
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Hung Chou
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Zheng-Wei Chen
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Departments of Internal Medicine, National Taiwan University Hospital Yun-lin Branch, Douliu, Taiwan
| | - Che-Wei Liao
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, HsinChu, Taiwan
| | - Yu-Wei Chiu
- Department of Cardiovascular Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Computer Science and Engineering, Yuan Ze University, Taoyuan City, Taiwan
| | - Vin-Cent Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Sheng Hung
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Chin-Chen Chang
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
- *Correspondence: Chin-Chen Chang,
| | - Yen-Hung Lin
- Department of Business Administration and Graduate School of Service Management, Chihlee University of Technology, New Taipei City, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
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KCNJ5 Somatic Mutations in Aldosterone-Producing Adenoma Are Associated with a Greater Recovery of Arterial Stiffness. Cancers (Basel) 2021; 13:cancers13174313. [PMID: 34503121 PMCID: PMC8431463 DOI: 10.3390/cancers13174313] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/22/2021] [Accepted: 08/22/2021] [Indexed: 11/25/2022] Open
Abstract
Simple Summary Primary aldosteronism (PA) is the most common form of secondary hypertension and induces various cardiovascular injuries. Aldosterone-producing adenoma (APA) is one of the major forms of PA. The occurrence of APA is closely correlated with somatic mutations, including KCNJ5. We described here the impact of KCNJ5 somatic mutations on arterial stiffness excluding the influence of age, sex, and blood pressure status. We found KCNJ5 mutation carriers had similar arterial stiffness before surgery, but greater improvement of arterial stiffness after adrenalectomy compared with non-carriers. Hence, APA patients with KCNJ5 mutations had a greater improvement in arterial stiffness after adrenalectomy than those without mutations. Abstract Primary aldosteronism is the most common form of secondary hypertension and induces various cardiovascular injuries. In aldosterone-producing adenoma (APA), the impact of KCNJ5 somatic mutations on arterial stiffness excluding the influence of confounding factors is uncertain. We enrolled 213 APA patients who were scheduled to undergo adrenalectomy. KCNJ5 gene sequencing of APA was performed. After propensity score matching (PSM) for age, sex, body mass index, blood pressure, number of hypertensive medications, and hypertension duration, there were 66 patients in each group with and without KCNJ5 mutations. The mutation carriers had a higher aldosterone level and lower log transformed brachial–ankle pulse wave velocity (baPWV) than the non-carriers before PSM, but no difference in log baPWV after PSM. One year after adrenalectomy, the mutation carriers had greater decreases in log plasma aldosterone concentration, log aldosterone–renin activity ratio, and log baPWV than the non-carriers after PSM. Only the mutation carriers had a significant decrease in log baPWV after surgery both before and after PSM. KCNJ5 mutations were not correlated with baseline baPWV after PSM but were significantly correlated with ∆baPWV after surgery both before and after PSM. Conclusively, APA patients with KCNJ5 mutations had a greater regression in arterial stiffness after adrenalectomy than those without mutations.
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15
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Chen CW, Tsai CH, Hung CS, Tsai IJ, Chiu YW, Chang CC, Liu KL, Liao SC, Wu VC, Lin YH. Comparison of cystatin C-based and creatinine-based glomerular filtration rate in the prediction of postoperative residual hypertension in aldosterone-producing adenoma patients after adrenalectomy. Clin Chim Acta 2021; 520:147-153. [PMID: 34116005 DOI: 10.1016/j.cca.2021.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 04/12/2021] [Accepted: 06/03/2021] [Indexed: 12/14/2022]
Abstract
Renal function is associated with postoperative residual hypertension in aldosterone-producing adenoma(APA) patients. Cystatin C-based glomerular filtration rate (GFR) can more accurately estimate renal function than creatinine-based methods. However, which renal function estimation method can more accurately predict postoperative hypertension in APA patients is still unknown. We recruited 180 APA patients who underwent adrenalectomy. Preoperative creatinine and cystatin C-based GFRs were calculated. Residual hypertension was defined as persistent hypertension > 140/90 mmHg or requiring anti-hypertensive medications 1 year after surgery. Sixty-five(36.1%) of the 180 APA patients had residual hypertension. Multivariate logistic regression and receiver operating characteristic (ROC) curve analysis showed a combination of creatinine and cystatin method CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) creatinine-cystatin GFR was significantly associated with residual postoperative hypertension and had the largest area under the ROC curve, which was statistically larger than that of Cockcroft-Gault creatinine-based GFR. In both net reclassification index and integrated discrimination index models, CKD-EPI creatinine-cystatin GFR significantly improved the discriminatory power of CG-GFR. Among these renal function estimations used in the presented study, creatinine-cystatin combined GFR was a precise method to predict residual postoperative hypertension in APA patients received adrenalectomy. These finding may help identify those patients with higher risk of residual hypertension after operation.
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Affiliation(s)
- Ching-Way Chen
- Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
| | - Cheng-Hsuan Tsai
- Department of Internal Medicine, National Taiwan University Hospital JinShen Branch, JinShen, Taiwan
| | - Chi-Sheng Hung
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - I-Jung Tsai
- Division of Nephrology, Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Yu-Wei Chiu
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Department of Computer Science and Engineering, Yuan Ze University, Taoyuan City, Taiwan
| | - Chin-Cheng Chang
- Department of Medical Imagine, National Taiwan University Hospital, Taipei, Taiwan
| | - Kao-Lang Liu
- Department of Medical Imagine, National Taiwan University Hospital, Taipei, Taiwan
| | - Shih-Cheng Liao
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Vin-Cent Wu
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yen-Hung Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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16
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The Management of Primary Hyperaldosteronism in a Poor Technology Environment. Case Rep Urol 2021; 2021:6672052. [PMID: 34055447 PMCID: PMC8131141 DOI: 10.1155/2021/6672052] [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: 11/20/2020] [Accepted: 05/04/2021] [Indexed: 11/18/2022] Open
Abstract
We report a case of Conn's adenoma in a 35-year-old female successfully managed in a poor hospital technology environment.
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17
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Chang YY, Tsai CH, Peng SY, Chen ZW, Chang CC, Lee BC, Liao CW, Pan CT, Chen YL, Lin LC, Chang YR, Peng KY, Chou CH, Wu VC, Hung CS, Lin YH. KCNJ5 Somatic Mutations in Aldosterone-Producing Adenoma Are Associated With a Worse Baseline Status and Better Recovery of Left Ventricular Remodeling and Diastolic Function. Hypertension 2020; 77:114-125. [PMID: 33249859 DOI: 10.1161/hypertensionaha.120.15679] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Primary aldosteronism is the most common secondary endocrine form of hypertension and causes many cardiovascular injuries. KCNJ5 somatic mutations have recently been identified in aldosterone-producing adenoma. However, their impacts on left ventricular remodeling precluding the interference of age, sex, and blood pressure are still uncertain. We enrolled 184 aldosterone-producing adenoma patients who received adrenalectomy. Clinical, biochemical, and echocardiographic data were analyzed preoperatively and 1 year postoperatively. KCNJ5 gene sequencing of aldosterone-producing adenoma was performed. After propensity score matching for age, sex, body mass index, blood pressure, hypertension duration, and number of hypertensive medications, there were 60 patients in each group with and without KCNJ5 mutations. The mutation carriers had higher left ventricular mass index (LVMI) and inappropriately excessive LVMI (ieLVMI) and lower e' than the noncarriers. After adrenalectomy, the mutation carriers had greater decreases in LVMI and ieLVMI than the noncarriers. In addition, only mutation carriers had a significant decrease in E/e' after surgery. In multivariate analysis, baseline LVMI correlated with KCNJ5 mutations, the number of hypertensive medications, and systolic blood pressure. Baseline ieLVMI correlated with KCNJ5 mutations and the number of hypertensive medications. The regression of both LVMI and ieLVMI after surgery was mainly correlated with KCNJ5 mutations and changes in systolic blood pressure. Aldosterone-producing adenoma patients with KCNJ5 mutations had higher LVMI and ieLVMI and a greater regression of LVMI and ieLVMI after adrenalectomy than those without mutations. The patients with KCNJ5 mutations also benefited from adrenalectomy with regard to left ventricular diastolic function, whereas noncarriers did not.
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Affiliation(s)
- Yi-Yao Chang
- From the National Taiwan University College of Medicine, Graduate Institute of Clinical Medicine, Taipei (Y.-Y.C.).,Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan (Y.-Y.C.).,Division of Cardiology, Department of Internal Medicine (Y.-Y.C., C.-H.T., S.-Y.P., Y.-L.C., L.-C.L., Y.-R.C., K.-Y.P., C.-S.H., Y.-H.L.).,Center of General Education, Chihlee University of Technology, New Taipei City, Taiwan (Y.-Y.C.)
| | - Cheng-Hsuan Tsai
- Division of Cardiology, Department of Internal Medicine (Y.-Y.C., C.-H.T., S.-Y.P., Y.-L.C., L.-C.L., Y.-R.C., K.-Y.P., C.-S.H., Y.-H.L.).,Department of Obstetrics and Gynecology (C.-H.C.), National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei.,Department of Internal Medicine, National Taiwan University Hospital, JinShan Branch (C.-H.T.)
| | - Shih-Yuan Peng
- Division of Cardiology, Department of Internal Medicine (Y.-Y.C., C.-H.T., S.-Y.P., Y.-L.C., L.-C.L., Y.-R.C., K.-Y.P., C.-S.H., Y.-H.L.)
| | - Zheng-Wei Chen
- Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch (Z.-W.C., C.-T.P.)
| | - Chin-Chen Chang
- Department of Medical Imaging (C.-C.C., B.-C.L.), National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei
| | - Bo-Ching Lee
- Department of Medical Imaging (C.-C.C., B.-C.L.), National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei
| | - Che-Wei Liao
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch (C.-W.L.)
| | - Chien-Ting Pan
- Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch (Z.-W.C., C.-T.P.)
| | - Ya-Li Chen
- Division of Cardiology, Department of Internal Medicine (Y.-Y.C., C.-H.T., S.-Y.P., Y.-L.C., L.-C.L., Y.-R.C., K.-Y.P., C.-S.H., Y.-H.L.)
| | - Lung-Chun Lin
- Division of Cardiology, Department of Internal Medicine (Y.-Y.C., C.-H.T., S.-Y.P., Y.-L.C., L.-C.L., Y.-R.C., K.-Y.P., C.-S.H., Y.-H.L.).,Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan. (L.-C.L., Y.-R.C., C.-S.H., Y.-H.L.)
| | - Yi-Ru Chang
- Division of Cardiology, Department of Internal Medicine (Y.-Y.C., C.-H.T., S.-Y.P., Y.-L.C., L.-C.L., Y.-R.C., K.-Y.P., C.-S.H., Y.-H.L.).,Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan. (L.-C.L., Y.-R.C., C.-S.H., Y.-H.L.)
| | - Kang-Yung Peng
- Division of Cardiology, Department of Internal Medicine (Y.-Y.C., C.-H.T., S.-Y.P., Y.-L.C., L.-C.L., Y.-R.C., K.-Y.P., C.-S.H., Y.-H.L.)
| | - Chia-Hung Chou
- Division of Cardiology, Department of Internal Medicine (Y.-Y.C., C.-H.T., S.-Y.P., Y.-L.C., L.-C.L., Y.-R.C., K.-Y.P., C.-S.H., Y.-H.L.)
| | - Vin-Cent Wu
- Division of Nephrology, Department of Internal Medicine (V.-C.W.), National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei
| | - Chi-Sheng Hung
- Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan. (L.-C.L., Y.-R.C., C.-S.H., Y.-H.L.)
| | - Yen-Hung Lin
- Division of Cardiology, Department of Internal Medicine (Y.-Y.C., C.-H.T., S.-Y.P., Y.-L.C., L.-C.L., Y.-R.C., K.-Y.P., C.-S.H., Y.-H.L.).,Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan. (L.-C.L., Y.-R.C., C.-S.H., Y.-H.L.)
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18
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De Sousa K, Boulkroun S, Baron S, Nanba K, Wack M, Rainey WE, Rocha A, Giscos-Douriez I, Meatchi T, Amar L, Travers S, Fernandes-Rosa FL, Zennaro MC. Genetic, Cellular, and Molecular Heterogeneity in Adrenals With Aldosterone-Producing Adenoma. Hypertension 2020; 75:1034-1044. [PMID: 32114847 PMCID: PMC7098445 DOI: 10.1161/hypertensionaha.119.14177] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Supplemental Digital Content is available in the text. Aldosterone-producing adenoma (APA) cause primary aldosteronism—the most frequent form of secondary hypertension. Somatic mutations in genes coding for ion channels and ATPases are found in APA and in aldosterone-producing cell clusters. We investigated the genetic, cellular, and molecular heterogeneity of different aldosterone-producing structures in adrenals with APA, to get insight into the mechanisms driving their development and to investigate their clinical and biochemical correlates. Genetic analysis of APA, aldosterone-producing cell clusters, and secondary nodules was performed in adrenal tissues from 49 patients by next-generation sequencing following CYP11B2 immunohistochemistry. Results were correlated with clinical and biochemical characteristics of patients, steroid profiles, and histological features of the tumor and adjacent adrenal cortex. Somatic mutations were identified in 93.75% of APAs. Adenoma carrying KCNJ5 mutations had more clear cells and cells expressing CYP11B1, and fewer cells expressing CYP11B2 or activated β-catenin, compared with other mutational groups. 18-hydroxycortisol and 18-oxocortisol were higher in patients carrying KCNJ5 mutations and correlated with histological features of adenoma; however, mutational status could not be predicted using steroid profiling. Heterogeneous CYP11B2 expression in KCNJ5-mutated adenoma was not associated with genetic heterogeneity. Different mutations were identified in secondary nodules expressing aldosterone synthase and in independent aldosterone-producing cell clusters from adrenals with adenoma; known KCNJ5 mutations were identified in 5 aldosterone-producing cell clusters. Genetic heterogeneity in different aldosterone-producing structures in the same adrenal suggests complex mechanisms underlying APA development.
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Affiliation(s)
- Kelly De Sousa
- From the PARCC, INSERM, Université de Paris, France (K.D.S., S. Boulkroun, A.R., I.G.-D., L.A., F.L.F.-R., M.-C.Z.)
| | - Sheerazed Boulkroun
- From the PARCC, INSERM, Université de Paris, France (K.D.S., S. Boulkroun, A.R., I.G.-D., L.A., F.L.F.-R., M.-C.Z.)
| | - Stéphanie Baron
- Université de Paris, France (S. Baron, M.W., T.M.).,Service de Physiologie (S. Baron, S.T.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, France
| | - Kazutaka Nanba
- Department of Molecular and Integrative Physiology (K.N., W.E.R.), University of Michigan, Ann Arbor, MI, USA.,Department of Endocrinology and Metabolism, National Hospital Organization, Kyoto Medical Center, Japan (K.N.)
| | - Maxime Wack
- Université de Paris, France (S. Baron, M.W., T.M.).,Service d'informatique médicale (M.W.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, France
| | - William E Rainey
- Department of Molecular and Integrative Physiology (K.N., W.E.R.), University of Michigan, Ann Arbor, MI, USA.,Division of Metabolism, Endocrine, and Diabetes, Department of Internal Medicine (W.E.R.), University of Michigan, Ann Arbor, MI, USA
| | - Angélique Rocha
- From the PARCC, INSERM, Université de Paris, France (K.D.S., S. Boulkroun, A.R., I.G.-D., L.A., F.L.F.-R., M.-C.Z.)
| | - Isabelle Giscos-Douriez
- From the PARCC, INSERM, Université de Paris, France (K.D.S., S. Boulkroun, A.R., I.G.-D., L.A., F.L.F.-R., M.-C.Z.)
| | - Tchao Meatchi
- Université de Paris, France (S. Baron, M.W., T.M.).,Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, France
| | - Laurence Amar
- From the PARCC, INSERM, Université de Paris, France (K.D.S., S. Boulkroun, A.R., I.G.-D., L.A., F.L.F.-R., M.-C.Z.).,Unité Hypertension artérielle (L.A.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, France
| | - Simon Travers
- Service de Physiologie (S. Baron, S.T.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, France
| | - Fabio L Fernandes-Rosa
- From the PARCC, INSERM, Université de Paris, France (K.D.S., S. Boulkroun, A.R., I.G.-D., L.A., F.L.F.-R., M.-C.Z.)
| | - Maria-Christina Zennaro
- From the PARCC, INSERM, Université de Paris, France (K.D.S., S. Boulkroun, A.R., I.G.-D., L.A., F.L.F.-R., M.-C.Z.).,Service de Génétique (M.-C.Z.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, France
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19
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Liao MT, Liao CW, Tsai CH, Chang YY, Chen ZW, Pan CT, Lin LC, Wu VC, Kuo SF, Wu XM, Hung CS, Lin YH. U-shaped relationship between left ventricular mass index and estimated glomerular filtration rate in patients with primary aldosteronism. J Investig Med 2019; 68:371-377. [PMID: 31630138 DOI: 10.1136/jim-2019-001057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2019] [Indexed: 11/03/2022]
Abstract
Estimated glomerular filtration rate (eGFR) is an important topic in patients with primary aldosteronism (PA). However, the relationship between left ventricular structure and eGFR is unclear. We conducted a prospective, observational, and cross-sectional study to analyze 168 patients with PA and 168 propensity score-matched patients with essential hypertension (EH) as the control group, matched by age, gender, and systolic blood pressure. In the patients with PA, the eGFR was not correlated with left ventricular mass index (LVMI; r=-0.065, p=0.404), while in the patients with EH, the eGFR was negatively correlated with LVMI (r=-0.309, p<0.001). To test whether eGFR had a non-linear relationship with LVMI among the patients with PA, we stratified the patients with PA according to the tertile of eGFR (low, medium, and high tertile). The medium tertile of patients had a significantly lower LVMI than those in the other two tertiles (LVMI: 143.5±41.6, 120.5±40.5, and 133.1±34.3 g/m2, from the lowest to highest tertile of eGFR; analysis of covariance p=0.032). The medium tertile of eGFR is associated with lowest LVMI. Patients with PA with high and low eGFR were associated with higher LVMI. The findings implied that the reasons for an increased LVMI in patients with PA may be different to those in patients with EH.
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Affiliation(s)
- Min-Tsun Liao
- Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Che-Wei Liao
- Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Cheng-Hsuan Tsai
- Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Yao Chang
- Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Zheng-Wei Chen
- Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Douliou, Taiwan
| | - Chien-Ting Pan
- Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Lung-Chun Lin
- Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Vin-Cent Wu
- Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Shu-Fen Kuo
- Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Xue-Ming Wu
- Internal Medicine, Taoyuan General Hospital, Taoyuan, Taiwan
| | - Chi-Sheng Hung
- Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yen-Hung Lin
- Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Retinoic acid receptor α as a novel contributor to adrenal cortex structure and function through interactions with Wnt and Vegfa signalling. Sci Rep 2019; 9:14677. [PMID: 31605007 PMCID: PMC6789122 DOI: 10.1038/s41598-019-50988-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 09/17/2019] [Indexed: 01/09/2023] Open
Abstract
Primary aldosteronism (PA) is the most frequent form of secondary arterial hypertension. Mutations in different genes increase aldosterone production in PA, but additional mechanisms may contribute to increased cell proliferation and aldosterone producing adenoma (APA) development. We performed transcriptome analysis in APA and identified retinoic acid receptor alpha (RARα) signaling as a central molecular network involved in nodule formation. To understand how RARα modulates adrenal structure and function, we explored the adrenal phenotype of male and female Rarα knockout mice. Inactivation of Rarα in mice led to significant structural disorganization of the adrenal cortex in both sexes, with increased adrenal cortex size in female mice and increased cell proliferation in males. Abnormalities of vessel architecture and extracellular matrix were due to decreased Vegfa expression and modifications in extracellular matrix components. On the molecular level, Rarα inactivation leads to inhibition of non-canonical Wnt signaling, without affecting the canonical Wnt pathway nor PKA signaling. Our study suggests that Rarα contributes to the maintenance of normal adrenal cortex structure and cell proliferation, by modulating Wnt signaling. Dysregulation of this interaction may contribute to abnormal cell proliferation, creating a propitious environment for the emergence of specific driver mutations in PA.
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Mohideen SK, Mustangin M, Kamaruddin NA, Muhammad R, Jamal ARA, Sukor N, Tan GC, Azizan EA. Prevalence and Histopathological Characteristics of KCNJ5 Mutant Aldosterone-Producing Adenomas in a Multi-Ethnic Malaysian Cohort. Front Endocrinol (Lausanne) 2019; 10:666. [PMID: 31636604 PMCID: PMC6787170 DOI: 10.3389/fendo.2019.00666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 09/13/2019] [Indexed: 11/16/2022] Open
Abstract
Studies on excised adrenals from primary aldosteronism patients have found that somatic mutations in KCNJ5 frequently cause excess aldosterone production in the culprit aldosterone-producing adenoma (APA). KCNJ5 mutant APAs were reported to be peculiarly overrepresented among young females and in Oriental cohorts, compared to their older male, or Caucasian counterparts. These larger APAs were also reported to have similarities with the zona fasciculata (ZF) in the adrenal both from the steroid production profile and the morphology of the cell. We therefore aimed to corroborate these findings by characterizing the APAs from a multi-ethnic Malaysian cohort. The prevalence of KCNJ5 mutations was estimated through targeted DNA sequencing of KCNJ5 in 54 APAs. Confirmation of APA sample acquisition was performed by CYP11B2 immunohistochemistry (IHC) staining. The ZF steroid production profile was based on the ZF enzyme CYP17A1 IHC staining, and ZF cell morphology was based on a high cytoplasm to nucleus ratio. Seventeen (31.5%) APAs studied, harbored a KCNJ5 mutation. No female over-representation was seen in this cohort though females were found to have a higher expression of CYP11B2 than males (p = 0.009; Mann-Whitney U test). Age at adrenalectomy correlated negatively with the percentage of ZF-like cells in the APA (p = 0.01; Spearman's rho) but not with the KCNJ5 genotype. KCNJ5 mutant APAs had a high percentage of ZF-like cells (and high CYP17A1 expression) but so did the wild-type APAs. In summary, prevalence of KCNJ5 mutant APAs in this cohort was similar to other Caucasian cohorts, however, over-representation of females did not occur, which is similar to some studies in Oriental cohorts.
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Affiliation(s)
- Syahirah Kaja Mohideen
- Department of Medicine, The National University of Malaysia (UKM) Medical Centre, Kuala Lumpur, Malaysia
| | | | - Nor Azmi Kamaruddin
- Department of Medicine, The National University of Malaysia (UKM) Medical Centre, Kuala Lumpur, Malaysia
| | | | - A. Rahman A. Jamal
- UKM Medical Molecular Biology Institute, UKM Medical Centre, Kuala Lumpur, Malaysia
| | - Norlela Sukor
- Department of Medicine, The National University of Malaysia (UKM) Medical Centre, Kuala Lumpur, Malaysia
| | - Geok Chin Tan
- Department of Pathology, UKM Medical Centre, Kuala Lumpur, Malaysia
| | - Elena Aisha Azizan
- Department of Medicine, The National University of Malaysia (UKM) Medical Centre, Kuala Lumpur, Malaysia
- *Correspondence: Elena Aisha Azizan
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Loh HH, Yee A, Loh HS. Bone health among patients with primary aldosteronism: a systematic review and meta-analysis. MINERVA ENDOCRINOL 2018; 44:387-396. [PMID: 30482008 DOI: 10.23736/s0391-1977.18.02867-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Recent studies showed a possible association between hyperaldosteronism and secondary hyperparathyroidism leading to reduced bone health, however results are conflicting. EVIDENCE ACQUISITION We conducted a meta-analysis to evaluate the relationship between primary aldosteronism (PA) with bone biochemical markers and to assess bone mineral density in patients with primary aldosteronism. EVIDENCE SYNTHESIS A total of 939 subjects were examined (37.5% with PA). Patients with PA had significantly higher serum parathyroid hormone, lower serum calcium, higher urine calcium excretion and higher serum alkaline phosphatase compared to patients without PA, with no significant difference in serum vitamin D between both groups. Bone mineral density of lumbar spine, femoral neck and total neck of femur were similar between two groups. With PA treatment, there was a significant increment in serum calcium and reduction in serum parathyroid hormone. CONCLUSIONS PA is associated with hypercalciuria with subsequent secondary hyperparathyroidism. This potentially affects bone health. We recommend this to be part of complication screening among patients with PA.
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Affiliation(s)
- Huai H Loh
- Faculty of Medicine and Health Sciences, University of Malaysia, Sarawak, Malaysia -
| | - Anne Yee
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Huai S Loh
- Clinical Academic Unit, Newcastle University Medicine Malaysia, Johor, Malaysia
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Is laparoscopic left adrenalectomy with the anterior submesocolic approach for Conn’s or Cushing’s syndrome equally safe and effective as the lateral and anterior ones? Surg Endosc 2018; 33:3026-3033. [DOI: 10.1007/s00464-018-6601-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 11/13/2018] [Indexed: 10/27/2022]
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Swearingen AJ, Kahramangil B, Monteiro R, Krishnamurthy V, Jin J, Shin J, Siperstein A, Berber E. Analysis of postoperative biochemical values and clinical outcomes after adrenalectomy for primary aldosteronism. Surgery 2017; 163:807-810. [PMID: 29249599 DOI: 10.1016/j.surg.2017.10.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 10/21/2017] [Accepted: 10/24/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Primary aldosteronism causes hypertension and hypokalemia and is often surgically treatable. Diagnosis includes elevated plasma aldosterone, suppressed plasma renin activity, and elevated aldosterone renin ratio. Adrenalectomy improves hypertension and hypokalemia. Postoperative plasma aldosterone and plasma renin activity may be useful in documenting cure or failure. METHOD A retrospective analysis of patients who underwent adrenalectomy for primary aldosteronism from 2010 to 2016 was performed, analyzing preoperative and postoperative plasma aldosterone, plasma renin activity, hypertension, and hypokalemia. The utility of postoperative testing was assessed. Clinical cure was defined as improved hypertension control and resolution of potassium loss. Biochemical cure was defined as aldosterone renin ratio reduction to <23.6. RESULTS Forty-four patients were included; 20 had plasma aldosterone and plasma renin activity checked on postoperative day 1. In the study, 40/44 (91%) were clinically cured. All clinical failures had of biochemical failure at follow-up. Postoperative day 1aldosterone renin ratio <23.6 had PPV of 95% for clinical cure. Cured patients had mean plasma aldosterone drop of 33.1 ng/dL on postoperative day 1; noncured patient experienced 3.9 ng/dL increase. A cutoff of plasma aldosterone decrease of 10 ng/dL had high positive predictive value for clinical cure. CONCLUSION Changes in plasma aldosterone and plasma renin activity after adrenalectomy correlate with improved hypertension and hypokalemia. The biochemical impact of adrenalectomy manifests as early as postoperative day 1. We propose a plasma aldosterone decrease of 10 ng/dL as a criterion to predict clinical cure.
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25
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Daniil G, Fernandes-Rosa FL, Chemin J, Blesneac I, Beltrand J, Polak M, Jeunemaitre X, Boulkroun S, Amar L, Strom TM, Lory P, Zennaro MC. CACNA1H Mutations Are Associated With Different Forms of Primary Aldosteronism. EBioMedicine 2016; 13:225-236. [PMID: 27729216 PMCID: PMC5264314 DOI: 10.1016/j.ebiom.2016.10.002] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 09/22/2016] [Accepted: 10/03/2016] [Indexed: 01/10/2023] Open
Abstract
Primary aldosteronism (PA) is the most common form of secondary hypertension. Mutations in KCNJ5, ATP1A1, ATP2B3 and CACNA1D are found in aldosterone producing adenoma (APA) and familial hyperaldosteronism (FH). A recurrent mutation in CACNA1H (coding for Cav3.2) was identified in a familial form of early onset PA. Here we performed whole exome sequencing (WES) in patients with different types of PA to identify new susceptibility genes. Four different heterozygous germline CACNA1H variants were identified. A de novo Cav3.2 p.Met1549Ile variant was found in early onset PA and multiplex developmental disorder. Cav3.2 p.Ser196Leu and p.Pro2083Leu were found in two patients with FH, and p.Val1951Glu was identified in one patient with APA. Electrophysiological analysis of mutant Cav3.2 channels revealed significant changes in the Ca2+ current properties for all mutants, suggesting a gain of function phenotype. Transfections of mutant Cav3.2 in H295R-S2 cells led to increased aldosterone production and/or expression of genes coding for steroidogenic enzymes after K+ stimulation. Identification of CACNA1H mutations associated with early onset PA, FH, and APA suggests that CACNA1H might be a susceptibility gene predisposing to PA with different phenotypic presentations, opening new perspectives for genetic diagnosis and management of patients with PA.
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Affiliation(s)
- Georgios Daniil
- INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Fabio L Fernandes-Rosa
- INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Génétique, Paris, France.
| | - Jean Chemin
- Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS UMR 5203, INSERM U 1191, Montpellier F-34094, France; LabEx Ion Channel Science and Therapeutics, Montpellier F-34094, France
| | - Iulia Blesneac
- Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS UMR 5203, INSERM U 1191, Montpellier F-34094, France; LabEx Ion Channel Science and Therapeutics, Montpellier F-34094, France
| | - Jacques Beltrand
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants Malades, Service d'Endocrinologie, Paris, France; Inserm UMR_1016, Institut Cochin, Paris, France; Institut Imagine, Paris Descartes - Université Sorbonne Paris Cité, Paris, France
| | - Michel Polak
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants Malades, Service d'Endocrinologie, Paris, France; Inserm UMR_1016, Institut Cochin, Paris, France; Institut Imagine, Paris Descartes - Université Sorbonne Paris Cité, Paris, France
| | - Xavier Jeunemaitre
- INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Génétique, Paris, France
| | - Sheerazed Boulkroun
- INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Laurence Amar
- INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Unité Hypertension artérielle, Paris, France
| | - Tim M Strom
- Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany; Institute of Human Genetics, Technische Universität München, Munich, Germany
| | - Philippe Lory
- Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS UMR 5203, INSERM U 1191, Montpellier F-34094, France; LabEx Ion Channel Science and Therapeutics, Montpellier F-34094, France
| | - Maria-Christina Zennaro
- INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Génétique, Paris, France.
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26
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Steichen O, Amar L, Chaffanjon P, Kraimps JL, Ménégaux F, Zinzindohoue F. SFE/SFHTA/AFCE consensus on primary aldosteronism, part 6: Adrenal surgery. ANNALES D'ENDOCRINOLOGIE 2016; 77:220-5. [PMID: 27297451 DOI: 10.1016/j.ando.2016.01.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 01/16/2016] [Accepted: 01/25/2016] [Indexed: 11/28/2022]
Abstract
Treatment of primary aldosteronism (PA) aims at preventing or correcting hypertension, hypokalemia and target organ damage. Patients with lateralized PA and candidates for surgery may be managed by laparoscopic adrenalectomy. Partial adrenalectomy and non-surgical ablation have no proven advantage over total adrenalectomy. Intraoperative morbidity and mortality are low in reference centers, and day-surgery is warranted in selected cases. Spironolactone administered during the weeks preceding surgery controls hypertension and hypokalemia and may prevent postoperative hypoaldosteronism. In most cases, surgery corrects hypokalemia, improves control of hypertension and reduces the burden of pharmacologic treatment; in about 40% of cases, it resolves hypertension. However, success in controlling hypertension and reversing target organ damage is comparable with mineralocorticoid receptor antagonists. Informed patient preference with regard to surgery is thus an important factor in therapeutic decision-making.
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Affiliation(s)
- Olivier Steichen
- Service de médecine interne, hôpital Tenon, AP-HP, 75020 Paris, France; Sorbonne universités, UPMC université Paris 06, faculté de médecine, 75006 Paris, France.
| | - Laurence Amar
- Unité d'hypertension artérielle, AP-HP, HEGP, 75015 Paris, France; Sorbonne Paris Cité, université Paris Descartes, faculté de médecine, 75006 Paris, France
| | - Philippe Chaffanjon
- CHU Grenoble, département de chirurgie thoracique, vasculaire et endocrinienne, 38700 La Tronche, France; Laboratoire d'anatomie des Alpes françaises (LADAF), université Grenoble Alpes, UFR de médecine, 38700 La Tronche, France
| | - Jean-Louis Kraimps
- Chirurgie générale et endocrinienne, hôpital Jean-Bernard, CHU de Poitiers, 86000 Poitiers, France; Faculté de médecine, université de Poitiers, 86000 Poitiers, France
| | - Fabrice Ménégaux
- Sorbonne universités, UPMC université Paris 06, faculté de médecine, 75006 Paris, France; Service de chirurgie digestive et viscérale, AP-HP, Pitié-Salpétrière, 75013 Paris, France
| | - Franck Zinzindohoue
- Sorbonne Paris Cité, université Paris Descartes, faculté de médecine, 75006 Paris, France; Service de chirurgie digestive, générale et cancérologique, AP-HP, HEGP, 75015 Paris, France
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27
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Douillard C, Houillier P, Nussberger J, Girerd X. SFE/SFHTA/AFCE Consensus on Primary Aldosteronism, part 2: First diagnostic steps. ANNALES D'ENDOCRINOLOGIE 2016; 77:192-201. [PMID: 27177498 DOI: 10.1016/j.ando.2016.02.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 02/01/2016] [Accepted: 02/01/2016] [Indexed: 12/09/2022]
Abstract
In patients with suspected primary aldosteronism (PA), the first diagnostic step, screening, must have high sensitivity and negative predictive value. The aldosterone-to-renin ratio (ARR) is used because it has higher sensitivity and lower variability than other measures (serum potassium, plasma aldosterone, urinary aldosterone). ARR is calculated from the plasma aldosterone (PA) and plasma renin activity (PRA) or direct plasma renin (DR) values. These measurements must be taken under standard conditions: in the morning, more than 2hours after awakening, in sitting position after 5 to 15minutes, with normal dietary salt intake, normal serum potassium level and without antihypertensive drugs significantly interfering with the renin-angiotensin-aldosterone system. To rule out ARR elevation due to very low renin values, ARR screening is applied only if aldosterone is>240pmol/l (90pg/ml); DR values<5mIU/l are assimilated to 5mIU/l and PRA values<0.2ng/ml/h to 0.2ng/ml/h. We propose threshold ARR values depending on the units used and a conversion factor (pg to mIU) for DR. If ARR exceeds threshold, PA should be suspected and exploration continued. If ARR is below threshold or if plasma aldosterone is<240pmol/l (90pg/ml) on two measurements, diagnosis of PA is excluded.
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Affiliation(s)
- Claire Douillard
- Service d'endocrinologie et des maladies métaboliques, centre hospitalier régional universitaire de Lille, 59037 Lille, France.
| | - Pascal Houillier
- Département des maladies rénales et métaboliques, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 75015 Paris, France.
| | - Juerg Nussberger
- Service de médecine interne, unité vasculaire et d'hypertension, centre hospitalier universitaire de Lausanne, CH-1011 Lausanne, Switzerland.
| | - Xavier Girerd
- Pôle cœur métabolisme, unité de prévention cardiovasculaire, groupe hospitalier universitaire Pitié-Salpêtrière, 83, boulevard de l'Hôpital, 75013 Paris, France
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28
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Daniel G, Mahony OM, Markovich JE, Appleman E, Monaghan KN, Lawrence YA, Fiocchi EH, Weaver K, Johnston A, Barton B. Clinical findings, diagnostics and outcome in 33 cats with adrenal neoplasia (2002-2013). J Feline Med Surg 2016; 18:77-84. [PMID: 25714105 PMCID: PMC11149020 DOI: 10.1177/1098612x15572035] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
OBJECTIVES The objective of this retrospective study was to describe the clinical signs and diagnostic findings in cats with histopathologically confirmed adrenal neoplasms, and to assess correlations with survival data. METHODS Study data were acquired by reviewing medical records for all cats diagnosed with adrenal neoplasms at seven referral institutions between 2002 and 2013. Inclusion criteria required a histopathologic diagnosis of an adrenal neoplasm (ante-mortem or on necropsy). RESULTS Thirty-three cats met the inclusion criteria for the study. The most common presenting complaints included weakness (n = 12), respiratory signs (n = 4), blindness (n = 4) or gastrointestinal signs (n = 3). Laboratory abnormalities included hypokalemia (n = 18), alkalemia (n = 12), elevated creatine kinase (>3000, n = 5) and azotemia (n = 4). In addition, hypertension was noted in 13 cats. Thirty cats were diagnosed with cortical tumors (17 carcinomas, 13 adenomas) and three cats were diagnosed with pheochromocytomas. Twenty-five cats underwent tests to evaluate the function of the adrenal tumors; 19/25 cats had functional tumors (hyperaldosteronism [n = 16], hypercortisolemia [n = 1], high estradiol [n = 1], and hypersecretion of aldosterone, estradiol and progesterone [n = 1]). Twenty-six cats underwent adrenalectomy, one cat was medically managed and six were euthanized without treatment. Long-term survival postoperatively ranged from 4-540 weeks, with 20 (77%) cats surviving the perioperative period of 2 weeks. The only variable that was found to be negatively associated with survival was female sex. The most common complications noted during the perioperative period were hemorrhage and progressive lethargy and anorexia. CONCLUSIONS AND RELEVANCE Surgical treatment for feline adrenal tumors (regardless of tumor type) resulted in good long-term survival. Given that pre- and postoperative hypocortisolemia was identified in this study, and, in addition, hypersecretion of more than one adrenal hormone occurred in one cat, adrenal panels prior to surgery may be beneficial as part of the preoperative work-up.
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Affiliation(s)
- Gideon Daniel
- Department of Clinical Sciences, Tufts Cummings School of Veterinary Medicine, North Grafton, MA, USA
| | - Orla M Mahony
- Department of Clinical Sciences, Tufts Cummings School of Veterinary Medicine, North Grafton, MA, USA
| | - Jessica E Markovich
- Department of Clinical Sciences, Tufts Cummings School of Veterinary Medicine, North Grafton, MA, USA
| | - Elizabeth Appleman
- Department of Internal Medicine, Animal Medical Center, USA; VCA Fifth Avenue Veterinary Specialists, USA
| | - Kelly N Monaghan
- Department of Medical Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Yuri A Lawrence
- Department of Clinical Sciences, Oregon State University, Corvallis, OR, USA
| | | | - Kelli Weaver
- Tampa Bay Veterinary Specialists, Largo, FL, USA
| | - Andrea Johnston
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine Companion Animal Hospital, NY, USA
| | - Bruce Barton
- Department of Quantitative Health Sciences, University of Massachusetts, Worcester, MA, USA
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29
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Geng X, Yan L, Dong J, Liang Y, Deng Y, Li T, Luo T, Lin H, Zhang S. Role of Nox2 and p22phox in Persistent Postoperative Hypertension in Aldosterone-Producing Adenoma Patients after Adrenalectomy. Int J Endocrinol 2016; 2016:2395634. [PMID: 27057164 PMCID: PMC4771902 DOI: 10.1155/2016/2395634] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 01/05/2016] [Indexed: 12/17/2022] Open
Abstract
Adrenal aldosterone-producing adenoma (APA), producing the salt-retaining hormone aldosterone, commonly causes secondary hypertension, which often persists after unilateral adrenalectomy. Although persistent hypertension was correlated with residual hormone aldosterone, the in vivo mechanism remains unclear. NADPH oxidase is the critical cause of aldosterone synthesis in vitro. Nox2 and p22phox comprise the NADPH oxidase catalytic core, serving to initiate a reactive oxygen species (ROS) cascade that may participate in the pathology. mRNAs of seven NADPH oxidase isoforms in APA were evaluated by RT-PCR and Q-PCR and their proteins by immunohistochemistry and Western blotting. NADPH oxidase activity was also detected. Nox2 and p22phox were especially abundant in APA. Particularly higher Nox2 and p22phox gene and protein levels were seen in APA than controls. Significant correlations between Nox2 mRNA and aldosterone synthase (CYP11B2) mRNA (R = 0.66, P < 0.01) and Nox2 protein and baseline plasma aldosterone concentration (PAC) (R = 0.503, P < 0.01) were detected in APA; however, none were found between p22phox mRNA, CYP11B2 mRNA, p22phox protein, and baseline PAC. Importantly, we found that Nox2 localized specifically in hyperplastic zona glomerulosa cells. In conclusion, our results highlight that Nox2 and p22phox may be directly involved in pathological aldosterone production and zona glomerulosa cell proliferation after APA resection.
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Affiliation(s)
- Xiaojing Geng
- Department of Endocrinology Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
- Department of Endocrinology Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China
| | - Li Yan
- Department of Endocrinology Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Jun Dong
- Department of General Internal Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Ying Liang
- Department of Endocrinology Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Yajuan Deng
- Department of Endocrinology Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Ting Li
- Department of Endocrinology Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Tongfeng Luo
- Department of Endocrinology Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
- Department of Endocrinology Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China
| | - Hailun Lin
- Department of Endocrinology Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Shaoling Zhang
- Department of Endocrinology Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
- *Shaoling Zhang:
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30
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Fernandes-Rosa FL, Giscos-Douriez I, Amar L, Gomez-Sanchez CE, Meatchi T, Boulkroun S, Zennaro MC. Different Somatic Mutations in Multinodular Adrenals With Aldosterone-Producing Adenoma. Hypertension 2015; 66:1014-22. [PMID: 26351028 PMCID: PMC4600038 DOI: 10.1161/hypertensionaha.115.05993] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 08/15/2015] [Indexed: 11/16/2022]
Abstract
Primary aldosteronism is the most common form of secondary hypertension. Somatic mutations in KCNJ5, ATP1A1, ATP2B3, and CACNA1D are found in aldosterone-producing adenoma. In addition, adrenals with aldosterone-producing adenomas show cortical remodeling and frequently multiple secondary nodules. Our aim was to investigate whether different aldosterone-producing nodules from the same adrenal share the same mutational status. Aldosterone synthase expression was assessed in multinodular adrenals from 27 patients. DNA of 37 aldosterone-producing secondary nodules was extracted from formalin-fixed paraffin-embedded tissues and genotyped for KCNJ5, ATP1A1, ATP2B3, and CACNA1D mutations. Among 17 adrenals with a somatic mutation in the principal nodule, 4 showed the same mutation in a secondary nodule, whereas 10 had no mutation in any of the known genes. In 1 adrenal harboring the KCNJ5 p.Gly151Arg mutation in the principal nodule, the same mutation was present in 2 secondary nodules, but no mutation was found in a third nodule. Finally, in 2 adrenals with a CACNA1D mutation in the principal nodule, a KCNJ5 mutation was identified in the secondary nodule. Among 10 adrenals without mutations in the principal nodule, 1 carried a KCNJ5 mutation in the secondary nodule. No mutations were detected in 7 aldosterone-producing cell clusters from 6 adrenals. No association was observed between the presence of mutations in secondary nodules and clinical parameters. In conclusion, different mutations are found in different aldosterone-producing nodules from the same adrenal, suggesting that somatic mutations are independent events triggered by mechanisms that remain to be identified.
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Affiliation(s)
- Fabio Luiz Fernandes-Rosa
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., I.G.-D., L.A., T.M., S.B., M.-C.Z.); Université Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., I.G.-D., L.A., T.M., S.B., M.-C.Z.); Service de Génétique (F.L.F.-R., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; and Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center and University of Mississippi Medical Center, Jackson, MS (C.E.G.-S.)
| | - Isabelle Giscos-Douriez
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., I.G.-D., L.A., T.M., S.B., M.-C.Z.); Université Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., I.G.-D., L.A., T.M., S.B., M.-C.Z.); Service de Génétique (F.L.F.-R., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; and Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center and University of Mississippi Medical Center, Jackson, MS (C.E.G.-S.)
| | - Laurence Amar
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., I.G.-D., L.A., T.M., S.B., M.-C.Z.); Université Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., I.G.-D., L.A., T.M., S.B., M.-C.Z.); Service de Génétique (F.L.F.-R., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; and Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center and University of Mississippi Medical Center, Jackson, MS (C.E.G.-S.)
| | - Celso E Gomez-Sanchez
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., I.G.-D., L.A., T.M., S.B., M.-C.Z.); Université Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., I.G.-D., L.A., T.M., S.B., M.-C.Z.); Service de Génétique (F.L.F.-R., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; and Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center and University of Mississippi Medical Center, Jackson, MS (C.E.G.-S.)
| | - Tchao Meatchi
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., I.G.-D., L.A., T.M., S.B., M.-C.Z.); Université Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., I.G.-D., L.A., T.M., S.B., M.-C.Z.); Service de Génétique (F.L.F.-R., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; and Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center and University of Mississippi Medical Center, Jackson, MS (C.E.G.-S.)
| | - Sheerazed Boulkroun
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., I.G.-D., L.A., T.M., S.B., M.-C.Z.); Université Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., I.G.-D., L.A., T.M., S.B., M.-C.Z.); Service de Génétique (F.L.F.-R., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; and Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center and University of Mississippi Medical Center, Jackson, MS (C.E.G.-S.)
| | - Maria-Christina Zennaro
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., I.G.-D., L.A., T.M., S.B., M.-C.Z.); Université Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., I.G.-D., L.A., T.M., S.B., M.-C.Z.); Service de Génétique (F.L.F.-R., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; and Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center and University of Mississippi Medical Center, Jackson, MS (C.E.G.-S.).
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Fernandes-Rosa FL, Amar L, Tissier F, Bertherat J, Meatchi T, Zennaro MC, Boulkroun S. Functional histopathological markers of aldosterone producing adenoma and somatic KCNJ5 mutations. Mol Cell Endocrinol 2015; 408:220-6. [PMID: 25617716 DOI: 10.1016/j.mce.2015.01.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 01/14/2015] [Accepted: 01/15/2015] [Indexed: 11/22/2022]
Abstract
The current pathological diagnosis of Aldosterone Producing Adenoma (APA) is limited to the description of nodules and/or hyperplasia in the resected adrenal gland, independent of their functional characteristics. The aim of our study was to characterize histopathological markers to confirm the presence and identify the sites of aldosterone production and to discriminate KCNJ5-related APA. We investigated 18 adrenals with APA and 15 with non-functioning adrenal incidentaloma (NFAI) for expression of Disabled-2 and GIRK4, two markers of zona glomerulosa (ZG), and 77 adrenals with APA with known mutational status for GIRK4 expression. Two-thirds of APA and only one NFAI exhibited both GIRK4 and Disabled-2 membrane staining, allowing to correctly classify 79% of adenomas. Remarkably, 28/32 APA with KCNJ5 mutations exhibited lower GIRK4 expression in APA relative to peritumoral ZG. This was highly specific for KCNJ5 mutations, indicating that GIRK4 immunohistochemistry might be used for initial screening of the somatic mutation status.
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Affiliation(s)
- Fabio Luiz Fernandes-Rosa
- INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France; University Paris Descartes, Sorbonne Paris Cité, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Génétique, Paris, France
| | - Laurence Amar
- INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France; University Paris Descartes, Sorbonne Paris Cité, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Génétique, Paris, France
| | - Frédérique Tissier
- Institut Cochin, Université Paris Descartes, CNRS (UMR 8104), Paris, France; Inserm, U1016, Paris, France; Assistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, France; Université Pierre et Marie Curie, Paris, France
| | - Jérôme Bertherat
- Institut Cochin, Université Paris Descartes, CNRS (UMR 8104), Paris, France; Inserm, U1016, Paris, France; Assistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, France
| | - Tchao Meatchi
- INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France; University Paris Descartes, Sorbonne Paris Cité, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Génétique, Paris, France
| | - Maria-Christina Zennaro
- INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France; University Paris Descartes, Sorbonne Paris Cité, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Génétique, Paris, France
| | - Sheerazed Boulkroun
- INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France; University Paris Descartes, Sorbonne Paris Cité, Paris, France.
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Steichen O, Lorthioir A, Zinzindohoue F, Plouin PF, Amar L. Outcomes of drug-based and surgical treatments for primary aldosteronism. Adv Chronic Kidney Dis 2015; 22:196-203. [PMID: 25908468 DOI: 10.1053/j.ackd.2014.10.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 10/08/2014] [Accepted: 10/08/2014] [Indexed: 12/16/2022]
Abstract
Treatments for primary aldosteronism (PA) aim to correct or prevent the deleterious consequences of hyperaldosteronism: hypertension, hypokalemia, and direct target organ damage. Patients with unilateral PA considered fit for surgery can undergo laparoscopic adrenalectomy, which significantly decreases blood pressure (BP) and medications in most cases and cures hypertension in about 40%. Mineralocorticoid receptor antagonists (MRA) are used to treat patients with bilateral PA and those with unilateral PA if surgery is not possible or not desired. Spironolactone is more potent than eplerenone, but high doses are poorly tolerated in men. MRA can be replaced or complemented with epithelial sodium channel blockers, such as amiloride. Thiazide diuretics and calcium channel blockers are used when the first-line drugs are insufficient to control BP. Dietary sodium restriction should be implemented in all cases because the deleterious consequences of hyperaldosteronism are dependent on salt loading. Several studies comparing the results of surgery and MRA have reported no differences in terms of BP, serum potassium concentration, or cardiovascular and kidney outcomes, although the benefits of treatment tend to be observed sooner with surgery. Patients with PA display relative glomerular hyperfiltration, which is reversed by specific treatment, revealing CKD in 30% of patients. However, further kidney damage is lessened by the treatment of PA.
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Ardhanari S, Kannuswamy R, Chaudhary K, Lockette W, Whaley-Connell A. Mineralocorticoid and apparent mineralocorticoid syndromes of secondary hypertension. Adv Chronic Kidney Dis 2015; 22:185-95. [PMID: 25908467 DOI: 10.1053/j.ackd.2015.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 03/02/2015] [Accepted: 03/04/2015] [Indexed: 11/11/2022]
Abstract
The mineralocorticoid aldosterone is a key hormone in the regulation of plasma volume and blood pressure in man. Excessive levels of this mineralocorticoid have been shown to mediate metabolic disorders and end-organ damage more than what can be attributed to its effects on blood pressure alone. Inappropriate excess levels of aldosterone contribute significantly to the cardiorenal metabolic syndrome and target organ injury that include atherosclerosis, myocardial hypertrophy, fibrosis, heart failure, and kidney disease. The importance of understanding the role of excess mineralocorticoid hormones such as aldosterone in resistant hypertension and in those with secondary hypertension should be visited. Primary aldosteronism is one of the commonly identified causes of hypertension and is treatable and/or potentially curable. We intend to review the management of mineralocorticoid-induced hypertension in the adult population along with other disease entities that mimic primary aldosteronism.
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Lethielleux G, Amar L, Raynaud A, Plouin PF, Steichen O. Influence of Diagnostic Criteria on the Interpretation of Adrenal Vein Sampling. Hypertension 2015; 65:849-54. [DOI: 10.1161/hypertensionaha.114.04812] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Guidelines promote the use of adrenal vein sampling (AVS) to document lateralized aldosterone hypersecretion in primary aldosteronism. However, there are large discrepancies between institutions in the criteria used to interpret its results. This study evaluates the consequences of these differences on the classification and management of patients. The results of all 537 AVS procedures performed between January 2001 and July 2010 in our institution were interpreted with 4 diagnostic criteria used in experienced institutions where AVS is performed without cosyntropin (Brisbane, Padua, Paris, and Turin) and with criteria proposed by a recent consensus statement. AVS procedures were classified as unsuccessful, lateralized, or not lateralized according to each set of criteria. Almost 5× more AVS procedures were classified as unsuccessful with the strictest criteria than with the least strict criteria (18% versus 4%, respectively). Similarly, over 2× more AVS procedures were classified as lateralized with the least stringent criteria than with the most stringent criteria (60% versus 26%, respectively). Multiple samples were available from ≥1 side for 155 AVS procedures. These procedures were classified differently by ≥2 right–left sample pairs in 12% to 20% of cases. Thus, different sets of criteria used to interpret AVS in experienced institutions translate into heterogeneous classifications and hence management decisions, for patients with primary aldosteronism. Defining the most appropriate procedures and diagnostic criteria is needed for AVS to achieve optimal performance and fully justify its status as a gold standard.
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Affiliation(s)
- Gaëlle Lethielleux
- From the Hypertension Department (G.L., L.A., P.-F.P.), Cardiovascular Imaging Department (A.R.), Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Faculty of Medicine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (L.A., P.-F.P.); Internal Medicine Department, Tenon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France (O.S.); Faculty of Medicine, UPMC Univ Paris 06, Sorbonne Universités, Paris, France (O.S.); and
| | - Laurence Amar
- From the Hypertension Department (G.L., L.A., P.-F.P.), Cardiovascular Imaging Department (A.R.), Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Faculty of Medicine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (L.A., P.-F.P.); Internal Medicine Department, Tenon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France (O.S.); Faculty of Medicine, UPMC Univ Paris 06, Sorbonne Universités, Paris, France (O.S.); and
| | - Alain Raynaud
- From the Hypertension Department (G.L., L.A., P.-F.P.), Cardiovascular Imaging Department (A.R.), Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Faculty of Medicine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (L.A., P.-F.P.); Internal Medicine Department, Tenon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France (O.S.); Faculty of Medicine, UPMC Univ Paris 06, Sorbonne Universités, Paris, France (O.S.); and
| | - Pierre-François Plouin
- From the Hypertension Department (G.L., L.A., P.-F.P.), Cardiovascular Imaging Department (A.R.), Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Faculty of Medicine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (L.A., P.-F.P.); Internal Medicine Department, Tenon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France (O.S.); Faculty of Medicine, UPMC Univ Paris 06, Sorbonne Universités, Paris, France (O.S.); and
| | - Olivier Steichen
- From the Hypertension Department (G.L., L.A., P.-F.P.), Cardiovascular Imaging Department (A.R.), Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Faculty of Medicine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (L.A., P.-F.P.); Internal Medicine Department, Tenon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France (O.S.); Faculty of Medicine, UPMC Univ Paris 06, Sorbonne Universités, Paris, France (O.S.); and
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Montes-Osorio ZE, Aguilar-Priego JM, Soriano-Ramírez L, García-Salazar JM. Aldosteronoma. Reporte de un caso y revisión bibliográfica. GACETA MEXICANA DE ONCOLOGÍA 2015. [DOI: 10.1016/j.gamo.2015.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Yang B, Yang Y, Tu W, Shen Y, Dong Q. A rare case of unilateral adrenal hyperplasia accompanied by hypokalaemic periodic paralysis caused by a novel dominant mutation in CACNA1S: features and prognosis after adrenalectomy. BMC Urol 2014; 14:96. [PMID: 25430699 PMCID: PMC4259161 DOI: 10.1186/1471-2490-14-96] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 11/20/2014] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Acute hypokalaemic paralysis is characterised by acute flaccid muscle weakness and has a complex aetiological spectrum. Herein we report, for the first time, a case of unilateral adrenal hyperplasia accompanied by hypokalaemic periodic paralysis type I resulting from a novel dominant mutation in CACNA1S. We present the clinical features and prognosis after adrenalectomy in this case. CASE PRESENTATION A 43-year-old Han Chinese male presented with severe hypokalaemic paralysis that remitted after taking oral potassium. The patient had suffered from periodic attacks of hypokalaemic paralysis for more than 20 years. A computed tomography (CT) scan of the abdomen showed a nodular mass on the left adrenal gland, although laboratory examination revealed the patient had not developed primary aldosteronism. The patient underwent a left adrenalectomy 4 days after admission, and the pathological examination further confirmed a 1.1 cm benign nodule at the periphery of the adrenal gland. Three months after the adrenalectomy, a paralytic attack recurred and the patient asked for assistance from the Department of Medical Genetics. His family history showed that two uncles, one brother, and a nephew also had a history of periodic paralysis, although their symptoms were milder. The patient's CACNA1S and SCN4A genes were sequenced, and a novel missense mutation, c.1582C > T (p.Arg528Cys), in CACNA1S was detected. Detection of the mutation in five adult male family members, including three with periodic paralysis and two with no history of the disease, indicated that this mutation caused hypokalaemic periodic paralysis type I in his family. Follow-up 2 years after adrenalectomy showed that the serum potassium concentration was increased between paralyses and the number and severity of paralytic attacks were significantly decreased. CONCLUSION We identified a novel dominant mutation, c.1582C > T (p.Arg528Cys), in CACNA1S that causes hypokalaemic periodic paralysis. The therapeutic effect of adrenalectomy indicated that unilateral adrenal hyperplasia might make paralytic attacks more serious and more frequent by decreasing serum potassium. This finding suggests that the surgical removal of hyperplastic tissues might relieve the symptoms of patients with severe hypokalaemic paralysis caused by other incurable diseases, even if the adrenal lesion does not cause primary aldosteronism.
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Affiliation(s)
| | | | | | | | - Qiang Dong
- Department of Urology, West China Hospital, Sichuan University, Chengdu 610041, China.
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Adrenal reserve function after unilateral adrenalectomy in patients with primary aldosteronism. J Hypertens 2014; 31:2010-7. [PMID: 23846863 DOI: 10.1097/hjh.0b013e3283635789] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE After unilateral adrenalectomy (uADX) in patients with a unilateral aldosterone-producing adenoma (APA), the remaining contralateral adrenal gland is generally considered sufficient to support life. However, few studies have compared adrenal reserve function before and after uADX. Therefore, we closely evaluated adrenal cortisol secretory function before and after uADX in patients with unilateral APA. METHODS Patients who were diagnosed with APA and underwent uADX for unilateral APA were initially included in this study. Patients with subclinical Cushing's syndrome (SCS) or Cushing's syndrome were excluded on suspicion of autonomous cortisol secretion. Fourteen patients were finally evaluated. Morning basal serum cortisol and plasma adrenocorticotropin hormone (ACTH) levels were measured, and ACTH stimulation tests under 1-mg dexamethasone suppression (dex-ACTH test) were performed before and after uADX. RESULTS No patient developed clinical adrenal insufficiency. Basal cortisol levels were not significantly different before and after uADX. However, basal ACTH levels were significantly elevated after uADX. In addition, peak cortisol levels on the dex-ACTH test decreased in all patients after uADX. The peak cortisol level after uADX was 86.6 (81.4-92.4)% of the level before uADX. CONCLUSION The adrenal cortisol secretory response to ACTH stimulation is mildly reduced after uADX in patients with unilateral APA without SCS or Cushing's syndrome, although their basal cortisol level is sustained by elevated ACTH. These data will be important as a point of discussion when patients with unilateral APA consider either uADX or specific pharmacotherapy as treatment options.
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Fernandes-Rosa FL, Williams TA, Riester A, Steichen O, Beuschlein F, Boulkroun S, Strom TM, Monticone S, Amar L, Meatchi T, Mantero F, Cicala MV, Quinkler M, Fallo F, Allolio B, Bernini G, Maccario M, Giacchetti G, Jeunemaitre X, Mulatero P, Reincke M, Zennaro MC. Genetic spectrum and clinical correlates of somatic mutations in aldosterone-producing adenoma. Hypertension 2014; 64:354-61. [PMID: 24866132 DOI: 10.1161/hypertensionaha.114.03419] [Citation(s) in RCA: 204] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Primary aldosteronism is the most common form of secondary hypertension. Somatic mutations in KCNJ5, ATP1A1, ATP2B3, and CACNA1D have been described in aldosterone-producing adenomas (APAs). Our aim was to investigate the prevalence of somatic mutations in these genes in unselected patients with APA (n=474), collected through the European Network for the Study of Adrenal Tumors. Correlations with clinical and biochemical parameters were first analyzed in a subset of 199 patients from a single center and then replicated in 2 additional centers. Somatic heterozygous KCNJ5 mutations were present in 38% (180/474) of APAs, whereas ATP1A1 mutations were found in 5.3% (25/474) and ATP2B3 mutations in 1.7% (8/474) of APAs. Previously reported somatic CACNA1D mutations as well as 10 novel CACNA1D mutations were identified in 44 of 474 (9.3%) APAs. There was no difference in the cellular composition of APAs or in CYP11B2, CYP11B1, KCNJ5, CACNA1D, or ATP1A1 gene expression in APAs across genotypes. Patients with KCNJ5 mutations were more frequently female, diagnosed younger, and with higher minimal plasma potassium concentrations compared with CACNA1D mutation carriers or noncarriers. CACNA1D mutations were associated with smaller adenomas. These associations were largely dependent on the population structure of the different centers. In conclusion, recurrent somatic mutations were identified in 54% of APAs. Young women with APAs are more likely to be KCNJ5 mutation carriers; identification of specific characteristics or surrogate biomarkers of mutation status may lead to targeted treatment options.
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Affiliation(s)
- Fabio Luiz Fernandes-Rosa
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); Service de Génétique (F.L.F.-R., X.J., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Divisions of Internal Medicine and Hypertension, Department of Medical Sciences (T.A.W., S.M., P.M.) and Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences (M.M.), University of Torino, Torino, Italy; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany (A.R., F.B., M.R.); Faculty of Medicine, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Paris, France (O.S.); Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany (T.M.S.); Institute of Human Genetics, Technische Universität München, Munich, Germany (T.M.S.); Endocrine Unit, Department of Medicine (F.M., M.-V.C.) and Department of Medicine (F.F.), University of Padova, Padova, Italy; Clinical Endocrinology, Campus Mitte, University Hospital Charité, Berlin, Germany (M.Q.); Department of Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany (B.A.); Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy (G.B.); and Division of Endocrinology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Università Politecnica delle Marche, Ancona, Italy (G.G.)
| | - Tracy Ann Williams
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); Service de Génétique (F.L.F.-R., X.J., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Divisions of Internal Medicine and Hypertension, Department of Medical Sciences (T.A.W., S.M., P.M.) and Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences (M.M.), University of Torino, Torino, Italy; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany (A.R., F.B., M.R.); Faculty of Medicine, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Paris, France (O.S.); Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany (T.M.S.); Institute of Human Genetics, Technische Universität München, Munich, Germany (T.M.S.); Endocrine Unit, Department of Medicine (F.M., M.-V.C.) and Department of Medicine (F.F.), University of Padova, Padova, Italy; Clinical Endocrinology, Campus Mitte, University Hospital Charité, Berlin, Germany (M.Q.); Department of Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany (B.A.); Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy (G.B.); and Division of Endocrinology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Università Politecnica delle Marche, Ancona, Italy (G.G.)
| | - Anna Riester
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); Service de Génétique (F.L.F.-R., X.J., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Divisions of Internal Medicine and Hypertension, Department of Medical Sciences (T.A.W., S.M., P.M.) and Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences (M.M.), University of Torino, Torino, Italy; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany (A.R., F.B., M.R.); Faculty of Medicine, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Paris, France (O.S.); Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany (T.M.S.); Institute of Human Genetics, Technische Universität München, Munich, Germany (T.M.S.); Endocrine Unit, Department of Medicine (F.M., M.-V.C.) and Department of Medicine (F.F.), University of Padova, Padova, Italy; Clinical Endocrinology, Campus Mitte, University Hospital Charité, Berlin, Germany (M.Q.); Department of Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany (B.A.); Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy (G.B.); and Division of Endocrinology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Università Politecnica delle Marche, Ancona, Italy (G.G.)
| | - Olivier Steichen
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); Service de Génétique (F.L.F.-R., X.J., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Divisions of Internal Medicine and Hypertension, Department of Medical Sciences (T.A.W., S.M., P.M.) and Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences (M.M.), University of Torino, Torino, Italy; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany (A.R., F.B., M.R.); Faculty of Medicine, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Paris, France (O.S.); Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany (T.M.S.); Institute of Human Genetics, Technische Universität München, Munich, Germany (T.M.S.); Endocrine Unit, Department of Medicine (F.M., M.-V.C.) and Department of Medicine (F.F.), University of Padova, Padova, Italy; Clinical Endocrinology, Campus Mitte, University Hospital Charité, Berlin, Germany (M.Q.); Department of Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany (B.A.); Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy (G.B.); and Division of Endocrinology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Università Politecnica delle Marche, Ancona, Italy (G.G.)
| | - Felix Beuschlein
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); Service de Génétique (F.L.F.-R., X.J., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Divisions of Internal Medicine and Hypertension, Department of Medical Sciences (T.A.W., S.M., P.M.) and Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences (M.M.), University of Torino, Torino, Italy; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany (A.R., F.B., M.R.); Faculty of Medicine, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Paris, France (O.S.); Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany (T.M.S.); Institute of Human Genetics, Technische Universität München, Munich, Germany (T.M.S.); Endocrine Unit, Department of Medicine (F.M., M.-V.C.) and Department of Medicine (F.F.), University of Padova, Padova, Italy; Clinical Endocrinology, Campus Mitte, University Hospital Charité, Berlin, Germany (M.Q.); Department of Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany (B.A.); Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy (G.B.); and Division of Endocrinology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Università Politecnica delle Marche, Ancona, Italy (G.G.)
| | - Sheerazed Boulkroun
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); Service de Génétique (F.L.F.-R., X.J., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Divisions of Internal Medicine and Hypertension, Department of Medical Sciences (T.A.W., S.M., P.M.) and Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences (M.M.), University of Torino, Torino, Italy; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany (A.R., F.B., M.R.); Faculty of Medicine, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Paris, France (O.S.); Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany (T.M.S.); Institute of Human Genetics, Technische Universität München, Munich, Germany (T.M.S.); Endocrine Unit, Department of Medicine (F.M., M.-V.C.) and Department of Medicine (F.F.), University of Padova, Padova, Italy; Clinical Endocrinology, Campus Mitte, University Hospital Charité, Berlin, Germany (M.Q.); Department of Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany (B.A.); Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy (G.B.); and Division of Endocrinology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Università Politecnica delle Marche, Ancona, Italy (G.G.)
| | - Tim M Strom
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); Service de Génétique (F.L.F.-R., X.J., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Divisions of Internal Medicine and Hypertension, Department of Medical Sciences (T.A.W., S.M., P.M.) and Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences (M.M.), University of Torino, Torino, Italy; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany (A.R., F.B., M.R.); Faculty of Medicine, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Paris, France (O.S.); Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany (T.M.S.); Institute of Human Genetics, Technische Universität München, Munich, Germany (T.M.S.); Endocrine Unit, Department of Medicine (F.M., M.-V.C.) and Department of Medicine (F.F.), University of Padova, Padova, Italy; Clinical Endocrinology, Campus Mitte, University Hospital Charité, Berlin, Germany (M.Q.); Department of Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany (B.A.); Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy (G.B.); and Division of Endocrinology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Università Politecnica delle Marche, Ancona, Italy (G.G.)
| | - Silvia Monticone
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); Service de Génétique (F.L.F.-R., X.J., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Divisions of Internal Medicine and Hypertension, Department of Medical Sciences (T.A.W., S.M., P.M.) and Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences (M.M.), University of Torino, Torino, Italy; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany (A.R., F.B., M.R.); Faculty of Medicine, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Paris, France (O.S.); Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany (T.M.S.); Institute of Human Genetics, Technische Universität München, Munich, Germany (T.M.S.); Endocrine Unit, Department of Medicine (F.M., M.-V.C.) and Department of Medicine (F.F.), University of Padova, Padova, Italy; Clinical Endocrinology, Campus Mitte, University Hospital Charité, Berlin, Germany (M.Q.); Department of Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany (B.A.); Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy (G.B.); and Division of Endocrinology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Università Politecnica delle Marche, Ancona, Italy (G.G.)
| | - Laurence Amar
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); Service de Génétique (F.L.F.-R., X.J., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Divisions of Internal Medicine and Hypertension, Department of Medical Sciences (T.A.W., S.M., P.M.) and Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences (M.M.), University of Torino, Torino, Italy; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany (A.R., F.B., M.R.); Faculty of Medicine, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Paris, France (O.S.); Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany (T.M.S.); Institute of Human Genetics, Technische Universität München, Munich, Germany (T.M.S.); Endocrine Unit, Department of Medicine (F.M., M.-V.C.) and Department of Medicine (F.F.), University of Padova, Padova, Italy; Clinical Endocrinology, Campus Mitte, University Hospital Charité, Berlin, Germany (M.Q.); Department of Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany (B.A.); Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy (G.B.); and Division of Endocrinology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Università Politecnica delle Marche, Ancona, Italy (G.G.)
| | - Tchao Meatchi
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); Service de Génétique (F.L.F.-R., X.J., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Divisions of Internal Medicine and Hypertension, Department of Medical Sciences (T.A.W., S.M., P.M.) and Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences (M.M.), University of Torino, Torino, Italy; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany (A.R., F.B., M.R.); Faculty of Medicine, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Paris, France (O.S.); Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany (T.M.S.); Institute of Human Genetics, Technische Universität München, Munich, Germany (T.M.S.); Endocrine Unit, Department of Medicine (F.M., M.-V.C.) and Department of Medicine (F.F.), University of Padova, Padova, Italy; Clinical Endocrinology, Campus Mitte, University Hospital Charité, Berlin, Germany (M.Q.); Department of Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany (B.A.); Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy (G.B.); and Division of Endocrinology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Università Politecnica delle Marche, Ancona, Italy (G.G.)
| | - Franco Mantero
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); Service de Génétique (F.L.F.-R., X.J., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Divisions of Internal Medicine and Hypertension, Department of Medical Sciences (T.A.W., S.M., P.M.) and Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences (M.M.), University of Torino, Torino, Italy; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany (A.R., F.B., M.R.); Faculty of Medicine, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Paris, France (O.S.); Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany (T.M.S.); Institute of Human Genetics, Technische Universität München, Munich, Germany (T.M.S.); Endocrine Unit, Department of Medicine (F.M., M.-V.C.) and Department of Medicine (F.F.), University of Padova, Padova, Italy; Clinical Endocrinology, Campus Mitte, University Hospital Charité, Berlin, Germany (M.Q.); Department of Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany (B.A.); Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy (G.B.); and Division of Endocrinology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Università Politecnica delle Marche, Ancona, Italy (G.G.)
| | - Maria-Verena Cicala
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); Service de Génétique (F.L.F.-R., X.J., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Divisions of Internal Medicine and Hypertension, Department of Medical Sciences (T.A.W., S.M., P.M.) and Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences (M.M.), University of Torino, Torino, Italy; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany (A.R., F.B., M.R.); Faculty of Medicine, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Paris, France (O.S.); Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany (T.M.S.); Institute of Human Genetics, Technische Universität München, Munich, Germany (T.M.S.); Endocrine Unit, Department of Medicine (F.M., M.-V.C.) and Department of Medicine (F.F.), University of Padova, Padova, Italy; Clinical Endocrinology, Campus Mitte, University Hospital Charité, Berlin, Germany (M.Q.); Department of Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany (B.A.); Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy (G.B.); and Division of Endocrinology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Università Politecnica delle Marche, Ancona, Italy (G.G.)
| | - Marcus Quinkler
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); Service de Génétique (F.L.F.-R., X.J., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Divisions of Internal Medicine and Hypertension, Department of Medical Sciences (T.A.W., S.M., P.M.) and Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences (M.M.), University of Torino, Torino, Italy; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany (A.R., F.B., M.R.); Faculty of Medicine, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Paris, France (O.S.); Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany (T.M.S.); Institute of Human Genetics, Technische Universität München, Munich, Germany (T.M.S.); Endocrine Unit, Department of Medicine (F.M., M.-V.C.) and Department of Medicine (F.F.), University of Padova, Padova, Italy; Clinical Endocrinology, Campus Mitte, University Hospital Charité, Berlin, Germany (M.Q.); Department of Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany (B.A.); Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy (G.B.); and Division of Endocrinology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Università Politecnica delle Marche, Ancona, Italy (G.G.)
| | - Francesco Fallo
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); Service de Génétique (F.L.F.-R., X.J., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Divisions of Internal Medicine and Hypertension, Department of Medical Sciences (T.A.W., S.M., P.M.) and Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences (M.M.), University of Torino, Torino, Italy; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany (A.R., F.B., M.R.); Faculty of Medicine, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Paris, France (O.S.); Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany (T.M.S.); Institute of Human Genetics, Technische Universität München, Munich, Germany (T.M.S.); Endocrine Unit, Department of Medicine (F.M., M.-V.C.) and Department of Medicine (F.F.), University of Padova, Padova, Italy; Clinical Endocrinology, Campus Mitte, University Hospital Charité, Berlin, Germany (M.Q.); Department of Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany (B.A.); Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy (G.B.); and Division of Endocrinology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Università Politecnica delle Marche, Ancona, Italy (G.G.)
| | - Bruno Allolio
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); Service de Génétique (F.L.F.-R., X.J., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Divisions of Internal Medicine and Hypertension, Department of Medical Sciences (T.A.W., S.M., P.M.) and Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences (M.M.), University of Torino, Torino, Italy; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany (A.R., F.B., M.R.); Faculty of Medicine, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Paris, France (O.S.); Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany (T.M.S.); Institute of Human Genetics, Technische Universität München, Munich, Germany (T.M.S.); Endocrine Unit, Department of Medicine (F.M., M.-V.C.) and Department of Medicine (F.F.), University of Padova, Padova, Italy; Clinical Endocrinology, Campus Mitte, University Hospital Charité, Berlin, Germany (M.Q.); Department of Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany (B.A.); Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy (G.B.); and Division of Endocrinology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Università Politecnica delle Marche, Ancona, Italy (G.G.)
| | - Giampaolo Bernini
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); Service de Génétique (F.L.F.-R., X.J., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Divisions of Internal Medicine and Hypertension, Department of Medical Sciences (T.A.W., S.M., P.M.) and Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences (M.M.), University of Torino, Torino, Italy; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany (A.R., F.B., M.R.); Faculty of Medicine, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Paris, France (O.S.); Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany (T.M.S.); Institute of Human Genetics, Technische Universität München, Munich, Germany (T.M.S.); Endocrine Unit, Department of Medicine (F.M., M.-V.C.) and Department of Medicine (F.F.), University of Padova, Padova, Italy; Clinical Endocrinology, Campus Mitte, University Hospital Charité, Berlin, Germany (M.Q.); Department of Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany (B.A.); Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy (G.B.); and Division of Endocrinology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Università Politecnica delle Marche, Ancona, Italy (G.G.)
| | - Mauro Maccario
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); Service de Génétique (F.L.F.-R., X.J., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Divisions of Internal Medicine and Hypertension, Department of Medical Sciences (T.A.W., S.M., P.M.) and Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences (M.M.), University of Torino, Torino, Italy; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany (A.R., F.B., M.R.); Faculty of Medicine, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Paris, France (O.S.); Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany (T.M.S.); Institute of Human Genetics, Technische Universität München, Munich, Germany (T.M.S.); Endocrine Unit, Department of Medicine (F.M., M.-V.C.) and Department of Medicine (F.F.), University of Padova, Padova, Italy; Clinical Endocrinology, Campus Mitte, University Hospital Charité, Berlin, Germany (M.Q.); Department of Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany (B.A.); Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy (G.B.); and Division of Endocrinology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Università Politecnica delle Marche, Ancona, Italy (G.G.)
| | - Gilberta Giacchetti
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); Service de Génétique (F.L.F.-R., X.J., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Divisions of Internal Medicine and Hypertension, Department of Medical Sciences (T.A.W., S.M., P.M.) and Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences (M.M.), University of Torino, Torino, Italy; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany (A.R., F.B., M.R.); Faculty of Medicine, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Paris, France (O.S.); Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany (T.M.S.); Institute of Human Genetics, Technische Universität München, Munich, Germany (T.M.S.); Endocrine Unit, Department of Medicine (F.M., M.-V.C.) and Department of Medicine (F.F.), University of Padova, Padova, Italy; Clinical Endocrinology, Campus Mitte, University Hospital Charité, Berlin, Germany (M.Q.); Department of Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany (B.A.); Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy (G.B.); and Division of Endocrinology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Università Politecnica delle Marche, Ancona, Italy (G.G.)
| | - Xavier Jeunemaitre
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); Service de Génétique (F.L.F.-R., X.J., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Divisions of Internal Medicine and Hypertension, Department of Medical Sciences (T.A.W., S.M., P.M.) and Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences (M.M.), University of Torino, Torino, Italy; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany (A.R., F.B., M.R.); Faculty of Medicine, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Paris, France (O.S.); Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany (T.M.S.); Institute of Human Genetics, Technische Universität München, Munich, Germany (T.M.S.); Endocrine Unit, Department of Medicine (F.M., M.-V.C.) and Department of Medicine (F.F.), University of Padova, Padova, Italy; Clinical Endocrinology, Campus Mitte, University Hospital Charité, Berlin, Germany (M.Q.); Department of Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany (B.A.); Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy (G.B.); and Division of Endocrinology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Università Politecnica delle Marche, Ancona, Italy (G.G.)
| | - Paolo Mulatero
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); Service de Génétique (F.L.F.-R., X.J., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Divisions of Internal Medicine and Hypertension, Department of Medical Sciences (T.A.W., S.M., P.M.) and Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences (M.M.), University of Torino, Torino, Italy; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany (A.R., F.B., M.R.); Faculty of Medicine, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Paris, France (O.S.); Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany (T.M.S.); Institute of Human Genetics, Technische Universität München, Munich, Germany (T.M.S.); Endocrine Unit, Department of Medicine (F.M., M.-V.C.) and Department of Medicine (F.F.), University of Padova, Padova, Italy; Clinical Endocrinology, Campus Mitte, University Hospital Charité, Berlin, Germany (M.Q.); Department of Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany (B.A.); Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy (G.B.); and Division of Endocrinology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Università Politecnica delle Marche, Ancona, Italy (G.G.)
| | - Martin Reincke
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); Service de Génétique (F.L.F.-R., X.J., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Divisions of Internal Medicine and Hypertension, Department of Medical Sciences (T.A.W., S.M., P.M.) and Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences (M.M.), University of Torino, Torino, Italy; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany (A.R., F.B., M.R.); Faculty of Medicine, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Paris, France (O.S.); Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany (T.M.S.); Institute of Human Genetics, Technische Universität München, Munich, Germany (T.M.S.); Endocrine Unit, Department of Medicine (F.M., M.-V.C.) and Department of Medicine (F.F.), University of Padova, Padova, Italy; Clinical Endocrinology, Campus Mitte, University Hospital Charité, Berlin, Germany (M.Q.); Department of Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany (B.A.); Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy (G.B.); and Division of Endocrinology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Università Politecnica delle Marche, Ancona, Italy (G.G.)
| | - Maria-Christina Zennaro
- From the INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); University Paris Descartes, Sorbonne Paris Cité, Paris, France (F.L.F.-R., S.B., L.A., T.M., X.J., M.-C.Z.); Service de Génétique (F.L.F.-R., X.J., M.-C.Z.), Unité Hypertension artérielle (L.A.), and Service d'Anatomie Pathologique (T.M.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Divisions of Internal Medicine and Hypertension, Department of Medical Sciences (T.A.W., S.M., P.M.) and Endocrinology, Diabetes, and Metabolism, Department of Medical Sciences (M.M.), University of Torino, Torino, Italy; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany (A.R., F.B., M.R.); Faculty of Medicine, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Paris, France (O.S.); Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany (T.M.S.); Institute of Human Genetics, Technische Universität München, Munich, Germany (T.M.S.); Endocrine Unit, Department of Medicine (F.M., M.-V.C.) and Department of Medicine (F.F.), University of Padova, Padova, Italy; Clinical Endocrinology, Campus Mitte, University Hospital Charité, Berlin, Germany (M.Q.); Department of Medicine I, Endocrine and Diabetes Unit, University Hospital Würzburg, Würzburg, Germany (B.A.); Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy (G.B.); and Division of Endocrinology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi, Università Politecnica delle Marche, Ancona, Italy (G.G.).
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Al-Salameh A, Cohen R, Desailloud R. Overview of the genetic determinants of primary aldosteronism. APPLICATION OF CLINICAL GENETICS 2014; 7:67-79. [PMID: 24817817 PMCID: PMC4012345 DOI: 10.2147/tacg.s45620] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Primary aldosteronism is the most common cause of secondary hypertension. The syndrome accounts for 10% of all cases of hypertension and is primarily caused by bilateral adrenal hyperplasia or aldosterone-producing adenoma. Over the last few years, the use of exome sequencing has significantly improved our understanding of this syndrome. Somatic mutations in the KCNJ5, ATP1A1, ATP2B3 or CACNA1D genes are present in more than half of all cases of aldosterone-producing adenoma (~40%, ~6%, ~1% and ~8%, respectively). Germline gain-of-function mutations in KCNJ5 are now known to cause familial hyperaldosteronism type III, and an additional form of genetic hyperaldosteronism has been reported in patients with germline mutations in CACNA1D. These genes code for channels that control ion homeostasis across the plasma membrane of zona glomerulosa cells. Moreover, all these mutations modulate the same pathway, in which elevated intracellular calcium levels lead to aldosterone hyperproduction and (in some cases) adrenal cell proliferation. From a clinical standpoint, the discovery of these mutations has potential implications for patient management. The mutated channels could be targeted by drugs, in order to control hormonal and overgrowth-related manifestations. Furthermore, some of these mutations are associated with high cell turnover and may be amenable to diagnosis via the sequencing of cell-free (circulating) DNA. However, genotype-phenotype correlations in patients harboring these mutations have yet to be characterized. Despite this recent progress, much remains to be done to elucidate the yet unknown mechanisms underlying sporadic bilateral adrenal hyperplasia.
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Affiliation(s)
- Abdallah Al-Salameh
- Service de Diabétologie, Endocrinologie et Maladies Métaboliques, Centre Hospitalier de Creil, Creil, France
| | - Régis Cohen
- Service d'Endocrinologie, Centre Hospitalier de Saint-Denis, Saint-Denis, France
| | - Rachel Desailloud
- Service d'Endocrinologie, Diabétologie et Nutrition, Centre Hospitalier Universitaire d'Amiens, Amiens, France
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Steichen O, Plouin PF. Prise en charge actuelle de l’hypertension artérielle. Rev Med Interne 2014; 35:235-42. [DOI: 10.1016/j.revmed.2013.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 06/20/2013] [Indexed: 10/26/2022]
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Amar L, Lorthioir A, Giavarini A, Plouin PF, Azizi M. [Presentations and management of adrenal hypertension]. Presse Med 2014; 43:420-7. [PMID: 24569318 DOI: 10.1016/j.lpm.2013.06.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 06/06/2013] [Accepted: 06/17/2013] [Indexed: 11/26/2022] Open
Abstract
The frequency of the diagnosed causes of secondary hypertension is only known from hospital-based records, which probably overestimate the true prevalence. Excluding oral contraceptive users and cases with renal failure, their overall frequency was estimated at 1 percent in the eighties, 5 percent in the nineties, and 9 percent in recent years. This increase in frequency was mostly due to an increased number of diagnosed cases of endocrine hypertension. The diagnosis of endocrine hypertension is not synonymous with the diagnosis of a surgically correctable form of hypertension. Indeed, hypertension is surgically curable in a minority of patients, mostly in patients with aldosterone-secreting adenomas or with pheochromocytomas or functional paragangliomas. The presentation, screening, diagnosis and therapeutic management of endocrine hypertension are discussed in the present issue.
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Affiliation(s)
- Laurence Amar
- Université Paris Descartes, Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, hôpital européen Georges-Pompidou, unité d'hypertension artérielle, 75908 Paris cedex 15, France
| | - Aurélien Lorthioir
- Université Paris Descartes, Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, hôpital européen Georges-Pompidou, unité d'hypertension artérielle, 75908 Paris cedex 15, France
| | - Alessandra Giavarini
- Université Paris Descartes, Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, hôpital européen Georges-Pompidou, unité d'hypertension artérielle, 75908 Paris cedex 15, France
| | - Pierre-François Plouin
- Université Paris Descartes, Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, hôpital européen Georges-Pompidou, unité d'hypertension artérielle, 75908 Paris cedex 15, France.
| | - Michel Azizi
- Université Paris Descartes, Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris, hôpital européen Georges-Pompidou, unité d'hypertension artérielle, 75908 Paris cedex 15, France
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Lu CC, Wu VC, Wu KD, Liu KL, Lin WC, Cheng MF, Tzen KY, Yen RF. Prognostic value of semiquantification NP-59 SPECT/CT in primary aldosteronism patients after adrenalectomy. Eur J Nucl Med Mol Imaging 2014; 41:1375-84. [PMID: 24525587 DOI: 10.1007/s00259-014-2692-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 01/02/2014] [Indexed: 01/02/2023]
Abstract
PURPOSE Primary aldosteronism (PA), characterized by an excessive production of aldosterone, affects 5-13 % of patients with hypertension. Accurate strategies are needed for the timely diagnosis of PA to allow curability and prevention of excessive cardiovascular events and related damage. This study aimed to evaluate the usefulness of semiquantification of (131)I-6β-iodomethyl-norcholesterol (NP-59) single photon emission computed tomography (SPECT)/CT in differentiating aldosterone-producing adenoma (APA) from idiopathic adrenal hyperplasia (IAH) and in predicting clinical outcomes after adrenalectomy. METHODS We retrospectively reviewed 49 PA patients who had undergone adrenalectomy after NP-59 SPECT/CT within 1 year. A conventional visual scale (VS) and two semiquantitative parameters generated from SPECT/CT, adrenal to liver ratio (ALR) and lesion to contralateral ratio of bilateral adrenal glands (CON), with cutoff values calculated by receiver-operating characteristic (ROC) analysis, were compared with pathology results and postsurgical outcomes to determine the accuracy. RESULTS An ALR cutoff of 1.84 and a CON cutoff of 1.15 showed an ability to distinguish adenoma from hyperplasia similar to VS (p = 0.2592 and 0.1908, respectively). An ALR cutoff of 2.28 and a CON cutoff of 1.11 yielded the highest sensitivity and specificity to predict postsurgical outcomes, and an ALR of 2.28 had an ability superior to VS (p = 0.0215), while a CON of 1.11 did not (p = 0.1015). Patients with either ALR or CON greater than the cutoff had a high probability of positive postsurgical outcomes (n = 36/38), while patients with both ALR and CON less than the cutoff had a low probability of positive postsurgical outcomes (n = 2/11). CONCLUSION Semiquantification of NP-59 scintigraphy has an ability similar to VS in differentiating APA from IAH, but an excellent ability to predict postsurgical outcomes of adrenalectomy. An ALR or CON greater than the cutoff strongly suggests benefits from adrenalectomy, and both ALR and CON less than the cutoff implies a reduced chance of improvement in postsurgical outcome.
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Affiliation(s)
- Ching-Chu Lu
- Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan, 7 Chung-Shan South Road, Taipei, Taiwan, 100,
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A retrospective study of laparoscopic unilateral adrenalectomy for primary hyperaldosteronism caused by unilateral adrenal hyperplasia. Int Urol Nephrol 2014; 46:1283-8. [DOI: 10.1007/s11255-013-0614-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 11/17/2013] [Indexed: 10/25/2022]
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Bi C, Li B, Du L, Wang L, Zhang Y, Cheng Z, Zhai A. Vitamin D receptor, an important transcription factor associated with aldosterone-producing adenoma. PLoS One 2013; 8:e82309. [PMID: 24376526 PMCID: PMC3869669 DOI: 10.1371/journal.pone.0082309] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 10/22/2013] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To explore the endocrine mechanisms of aldosterone-producing adenoma (APA) by using the microarray expression profiles of normal and APA samples. METHODS The gene expression profile GSE8514 was downloaded from Gene Expression Omnibus database, including samples from normal adrenals (n = 5) and APAs (n = 10). The differentially expressed genes (DEGs) were identified by samr package and endocrine DEGs were obtained according to Clinical Genome Database. Then, functional enrichment analysis of screened DEGs was performed by DAVID (Database for Annotation, Visualization and Integrated Discovery). Finally, a regulatory network was constructed to screen endocrine genes related with adrenal dysfunction and pathway enrichment analysis for the constructed network was performed. RESULTS A total of 2149 DEGs were identified including 379 up- and 1770 down-regulated genes. And 26 endocrine genes were filtered from the DEGs. Furthermore, the down-regulated DEGs are mainly related to protein kinase cascade, response to molecule of bacterial origin, response to lipopolysaccharide, cellular macromolecule catabolic process and macromolecule catabolic process, while the up-regulated DEGs are related with regulation of ion transport. The target genes of VDR (vitamin D receptor), one of the three endocrine genes differentially expressed in the regulatory network, were endocrine genes including CYP24A1 (25-hydroxyvitamin D-24-hydroxylase) and PTH (parathyroid hormone). Three pathways may be associated with APA pathogenesis including cytokine-cytokine receptor interaction, pathways in cancer and autoimmune thyroid disease. CONCLUSION The VDR is the most significant transcription factor and related endocrine genes might play important roles in the endocrine mechanisms of APA.
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Affiliation(s)
- Changlong Bi
- Department of Endocrinology, Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Bo Li
- Department of Endocrinology, Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Lili Du
- Department of Endocrinology, Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Lishan Wang
- FengHe (ShangHai) Information Technology Co., Ltd., Shanghai, China
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai Jiao Tong University, Shanghai ,China
| | - Yingqi Zhang
- Department of Endocrinology, Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhifeng Cheng
- Department of Endocrinology, Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Aixia Zhai
- Department of Microbiology, Harbin Medical University, Harbin, China
- Heilongjiang Provincial Science and Technology Innovation Team in Higher Education Institutes for Infection and Immunity, Harbin Medical University, Harbin , China
- Heilongjiang Provincial Key Laboratory for Infection and Immunity, Harbin Medical University, Harbin, China
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Berthon A, Drelon C, Ragazzon B, Boulkroun S, Tissier F, Amar L, Samson-Couterie B, Zennaro MC, Plouin PF, Skah S, Plateroti M, Lefèbvre H, Sahut-Barnola I, Batisse-Lignier M, Assié G, Lefrançois-Martinez AM, Bertherat J, Martinez A, Val P. WNT/β-catenin signalling is activated in aldosterone-producing adenomas and controls aldosterone production. Hum Mol Genet 2013; 23:889-905. [PMID: 24087794 DOI: 10.1093/hmg/ddt484] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Primary aldosteronism (PA) is the main cause of secondary hypertension, resulting from adrenal aldosterone-producing adenomas (APA) or bilateral hyperplasia. Here, we show that constitutive activation of WNT/β-catenin signalling is the most frequent molecular alteration found in 70% of APA. We provide evidence that decreased expression of the WNT inhibitor SFRP2 may be contributing to deregulated WNT signalling and APA development in patients. This is supported by the demonstration that mice with genetic ablation of Sfrp2 have increased aldosterone production and ectopic differentiation of zona glomerulosa cells. We further show that β-catenin plays an essential role in the control of basal and Angiotensin II-induced aldosterone secretion, by activating AT1R, CYP21 and CYP11B2 transcription. This relies on both LEF/TCF-dependent activation of AT1R and CYP21 regulatory regions and indirect activation of CYP21 and CYP11B2 promoters, through increased expression of the nuclear receptors NURR1 and NUR77. Altogether, these data show that aberrant WNT/β-catenin activation is associated with APA development and suggest that WNT pathway may be a good therapeutic target in PA.
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Affiliation(s)
- Annabel Berthon
- Clermont Université, Université Blaise Pascal, GReD, BP 10448, F-63000 Clermont-Ferrand, France
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Agha A, Hornung M, Iesalnieks I, Schreyer A, Jung EM, Haneya A, Schlitt HJ. Predictors of malignancy in primary aldosteronism. Langenbecks Arch Surg 2013; 399:93-8. [PMID: 24048685 DOI: 10.1007/s00423-013-1121-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 09/08/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Primary aldosteronism (PA, also Conn syndrome) is a benign disease in majority of cases. However, malignant transformation has been described. Present study reports on three cases of aldosterone producing adrenocortical carcinoma (APAC) in comparison to patients with benign PA. PATIENTS AND METHODS Data of patients undergoing adrenalectomy for benign PA were compared to patients with APAC. Retrospective chart analysis was performed. All patients received spironolactone for 6-8 weeks preoperatively. RESULTS Seventy-four patients underwent adrenalectomy for PA between 1994 and 2011. Three of them revealed an APAC. Patients with APAC presented with a significantly lower serum potassium level (1.7 mmol/l vs. 3.4 mmol/l, p = 0.001) and significant larger tumors (5.2 vs. 1.8 cm, p = 0.002). In addition, aldosterone/renin (A/R) ratio 675 in patients with APAC as compared to 74 in patients with benign PA (p = 0.0001). Sixty-eight of 71 patients with benign PA underwent minimal invasive surgery, whereas all three patients with APAC were operated conventionally. All patients with APAC developed disease recurrence 6-18 months postoperatively. CONCLUSION Tumor size >4 cm and a very high A/R ratio seems to predictors of malignancy in patients with PA. If these criteria are present, open adrenalectomy should be performed instead of endoscopic procedure.
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Affiliation(s)
- Ayman Agha
- Department of Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
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Chao CT, Wu VC, Kuo CC, Lin YH, Chang CC, Chueh SJ, Wu KD, Pimenta E, Stowasser M. Diagnosis and management of primary aldosteronism: an updated review. Ann Med 2013; 45:375-83. [PMID: 23701121 DOI: 10.3109/07853890.2013.785234] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Primary aldosteronism (PA) is the most common secondary form of arterial hypertension, with a particularly high prevalence among patients with resistant hypertension. Aldosterone has been found to be associated with cardiovascular toxicity. Prolonged aldosteronism leads to higher incidence of cardiac events, glomerular hyperfiltration, and potentially bone/metabolic sequels. The wider application of aldosterone/renin ratio as screening test has substantially contributed to increasing diagnosis of PA. Diagnosis of PA consists of two phases: screening and confirmatory testing. Adrenal imaging is often inaccurate for differentiation between an adenoma and hyperplasia, and adrenal venous sampling is essential for selecting the appropriate treatment modality. The etiologies of PA have two main subtypes: unilateral (aldosterone-producing adenoma) and bilateral (micro- or macronodular hyperplasia). Aldosterone-producing adenoma is typically managed with unilateral adrenalectomy, while bilateral adrenal hyperplasia is amenable to pharmacological approaches using mineralocorticoid antagonists. Short-term treatment outcome following surgery is determined by factors such as preoperative blood pressure level and hypertension duration, but evidence regarding long-term treatment outcome is still lacking. However, directed treatments comprising of unilateral adrenalectomy or mineralocorticoid antagonists still potentially reduce the toxicities of aldosterone. Utilizing a physician-centered approach, we intend to provide up-dated information on the etiology, diagnosis, and the management of PA.
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Sigurjonsdottir HA, Gronowitz M, Andersson O, Eggertsen R, Herlitz H, Sakinis A, Wangberg B, Johannsson G. Unilateral adrenal hyperplasia is a usual cause of primary hyperaldosteronism. Results from a Swedish screening study. BMC Endocr Disord 2012; 12:17. [PMID: 22958674 PMCID: PMC3515501 DOI: 10.1186/1472-6823-12-17] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 08/31/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The existence of unilateral adrenal hyperplasia (AH) has been considered a rare cause of primary hyperaldosteronism (PA). METHODS In a prospective study we screened for PA in a non-selected (NSP) and selected hypertensive population (SP), to define the cause of PA. We included 353 consecutive patients with hypertension; age 20 to 88 years, 165 women and 188 men, from a university-based Hypertension and Nephrology Outpatient clinics (123 SP) and two primary care centres, (230 NSP) from the same catch-up area. Serum aldosterone and plasma renin activity (PRA) were measured and the ARR calculated. Verifying diagnostic procedure was performed in patients with both elevated aldosterone and ARR. Patients diagnosed with PA were invited for adrenal venous sampling (AVS) and offered laparoscopic adrenalectomy when AVS found the disease to be unilateral. RESULTS After screening, 46 patients, 13% of the whole population (22.8% SP and 7.8% NSP) had aldosterone and ARR above the locally defined cut-off limits (0.43 nmol/l and 1.28 respectively). After diagnostic verification, 20 patients (6%) had PA, (14.5% SP and 1.4% NSP). Imaging diagnostic procedures with CT-scans and scintigraphy were inconclusive. AVS, performed in 15 patients verified bilateral disease in 4 and unilateral in 10 patients. One AVS failed. After laparoscopic adrenalectomy, 4 patients were found to have adenoma and 5 unilateral AH. One patient denied operation. CONCLUSION The prevalence of PA was in agreement with previous studies. The study finds unilateral PA common and unilateral AH as half of those cases. As may be suspected PA is found in much higher frequency in specialised hypertensive units compared to primary care centers. AVS was mandatory in diagnosis of unilateral PA.
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Affiliation(s)
- Helga Agusta Sigurjonsdottir
- Department of Medicine, Centrum of Endocrinology and Metabolism, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | | | - Ove Andersson
- Department of Medicine, Hypertension Outpatient Clinic, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Robert Eggertsen
- Department of Medicine Primary Health Care, Mölnlycke Primary Health Care and Research Centre, University of Gothenburg, Gothenburg, Sweden
| | - Hans Herlitz
- Department of Medicine, Nephrology Outpatient Clinic, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Augustinas Sakinis
- Dept of Radiology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Bo Wangberg
- Dept of Surgery, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Gudmundur Johannsson
- Department of Medicine, Centrum of Endocrinology and Metabolism, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
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Reincke M, Fischer E, Gerum S, Merkle K, Schulz S, Pallauf A, Quinkler M, Hanslik G, Lang K, Hahner S, Allolio B, Meisinger C, Holle R, Beuschlein F, Bidlingmaier M, Endres S. Observational Study Mortality in Treated Primary Aldosteronism. Hypertension 2012; 60:618-24. [DOI: 10.1161/hypertensionaha.112.197111] [Citation(s) in RCA: 188] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In comparison with essential hypertension, primary aldosteronism (PA) is associated with an increased risk of cardiovascular morbidity. To date, no data on mortality have been published. We assessed mortality of patients treated for PA within the German Conn's registry and identified risk factors for adverse outcome in a case-control study. Patients with confirmed PA treated in 3 university centers in Germany since 1994 were included in the analysis. All of the patients were contacted in 2009 and 2010 to verify life status. Subjects from the population-based F3 survey of the Cooperative Health Research in the Region of Augsburg served as controls. Final analyses were based on 600 normotensive controls, 600 hypertensive controls, and 300 patients with PA. Kaplan-Meyer survival curves were calculated for both cohorts. Ten-year overall survival was 95% in normotensive controls, 90% in hypertensive controls, and 90% in patients with PA (
P
value not significant). In multivariate analysis, age (hazard ratio, 1.09 per year [95% CI, 1.03–1.14]), angina pectoris (hazard ratio, 3.6 [95% CI, 1.04–12.04]), and diabetes mellitus (hazard ratio, 2.55 [95% CI, 1.07–6.09]) were associated with an increase in all-cause mortality, whereas hypokalemia (hazard ratio, 0.41 per mmol/L [95% CI, 0.17–0.99]) was associated with reduced mortality. Cardiovascular mortality was the main cause of death in PA (50% versus 34% in hypertensive controls;
P
<0.05). These data indicate that cardiovascular mortality is increased in patients treated for PA, whereas all-cause mortality is not different from matched hypertensive controls.
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Affiliation(s)
- Martin Reincke
- From the Medizinische Klinik und Poliklinik IV (M.R., E.F., S.G., K.M., S.S., A.P., F.B., M.B., S.E.) and Klinik und Poliklinik für Strahlentherapie (S.G.), Klinikum der Ludwig-Maximilians-Universität München, München, Germany; Klinische Endokrinologie (S.G., M.Q., G.H.), Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany; Medizinische Klinik und Poliklinik I (K.L., S.H., B.A.), Julius-Maximilians-Universität, Würzburg, Germany; Institute of Epidemiology II (C.M.), Helmholtz
| | - Evelyn Fischer
- From the Medizinische Klinik und Poliklinik IV (M.R., E.F., S.G., K.M., S.S., A.P., F.B., M.B., S.E.) and Klinik und Poliklinik für Strahlentherapie (S.G.), Klinikum der Ludwig-Maximilians-Universität München, München, Germany; Klinische Endokrinologie (S.G., M.Q., G.H.), Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany; Medizinische Klinik und Poliklinik I (K.L., S.H., B.A.), Julius-Maximilians-Universität, Würzburg, Germany; Institute of Epidemiology II (C.M.), Helmholtz
| | - Sabine Gerum
- From the Medizinische Klinik und Poliklinik IV (M.R., E.F., S.G., K.M., S.S., A.P., F.B., M.B., S.E.) and Klinik und Poliklinik für Strahlentherapie (S.G.), Klinikum der Ludwig-Maximilians-Universität München, München, Germany; Klinische Endokrinologie (S.G., M.Q., G.H.), Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany; Medizinische Klinik und Poliklinik I (K.L., S.H., B.A.), Julius-Maximilians-Universität, Würzburg, Germany; Institute of Epidemiology II (C.M.), Helmholtz
| | - Katrin Merkle
- From the Medizinische Klinik und Poliklinik IV (M.R., E.F., S.G., K.M., S.S., A.P., F.B., M.B., S.E.) and Klinik und Poliklinik für Strahlentherapie (S.G.), Klinikum der Ludwig-Maximilians-Universität München, München, Germany; Klinische Endokrinologie (S.G., M.Q., G.H.), Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany; Medizinische Klinik und Poliklinik I (K.L., S.H., B.A.), Julius-Maximilians-Universität, Würzburg, Germany; Institute of Epidemiology II (C.M.), Helmholtz
| | - Sebastian Schulz
- From the Medizinische Klinik und Poliklinik IV (M.R., E.F., S.G., K.M., S.S., A.P., F.B., M.B., S.E.) and Klinik und Poliklinik für Strahlentherapie (S.G.), Klinikum der Ludwig-Maximilians-Universität München, München, Germany; Klinische Endokrinologie (S.G., M.Q., G.H.), Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany; Medizinische Klinik und Poliklinik I (K.L., S.H., B.A.), Julius-Maximilians-Universität, Würzburg, Germany; Institute of Epidemiology II (C.M.), Helmholtz
| | - Anna Pallauf
- From the Medizinische Klinik und Poliklinik IV (M.R., E.F., S.G., K.M., S.S., A.P., F.B., M.B., S.E.) and Klinik und Poliklinik für Strahlentherapie (S.G.), Klinikum der Ludwig-Maximilians-Universität München, München, Germany; Klinische Endokrinologie (S.G., M.Q., G.H.), Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany; Medizinische Klinik und Poliklinik I (K.L., S.H., B.A.), Julius-Maximilians-Universität, Würzburg, Germany; Institute of Epidemiology II (C.M.), Helmholtz
| | - Marcus Quinkler
- From the Medizinische Klinik und Poliklinik IV (M.R., E.F., S.G., K.M., S.S., A.P., F.B., M.B., S.E.) and Klinik und Poliklinik für Strahlentherapie (S.G.), Klinikum der Ludwig-Maximilians-Universität München, München, Germany; Klinische Endokrinologie (S.G., M.Q., G.H.), Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany; Medizinische Klinik und Poliklinik I (K.L., S.H., B.A.), Julius-Maximilians-Universität, Würzburg, Germany; Institute of Epidemiology II (C.M.), Helmholtz
| | - Gregor Hanslik
- From the Medizinische Klinik und Poliklinik IV (M.R., E.F., S.G., K.M., S.S., A.P., F.B., M.B., S.E.) and Klinik und Poliklinik für Strahlentherapie (S.G.), Klinikum der Ludwig-Maximilians-Universität München, München, Germany; Klinische Endokrinologie (S.G., M.Q., G.H.), Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany; Medizinische Klinik und Poliklinik I (K.L., S.H., B.A.), Julius-Maximilians-Universität, Würzburg, Germany; Institute of Epidemiology II (C.M.), Helmholtz
| | - Katharina Lang
- From the Medizinische Klinik und Poliklinik IV (M.R., E.F., S.G., K.M., S.S., A.P., F.B., M.B., S.E.) and Klinik und Poliklinik für Strahlentherapie (S.G.), Klinikum der Ludwig-Maximilians-Universität München, München, Germany; Klinische Endokrinologie (S.G., M.Q., G.H.), Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany; Medizinische Klinik und Poliklinik I (K.L., S.H., B.A.), Julius-Maximilians-Universität, Würzburg, Germany; Institute of Epidemiology II (C.M.), Helmholtz
| | - Stefanie Hahner
- From the Medizinische Klinik und Poliklinik IV (M.R., E.F., S.G., K.M., S.S., A.P., F.B., M.B., S.E.) and Klinik und Poliklinik für Strahlentherapie (S.G.), Klinikum der Ludwig-Maximilians-Universität München, München, Germany; Klinische Endokrinologie (S.G., M.Q., G.H.), Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany; Medizinische Klinik und Poliklinik I (K.L., S.H., B.A.), Julius-Maximilians-Universität, Würzburg, Germany; Institute of Epidemiology II (C.M.), Helmholtz
| | - Bruno Allolio
- From the Medizinische Klinik und Poliklinik IV (M.R., E.F., S.G., K.M., S.S., A.P., F.B., M.B., S.E.) and Klinik und Poliklinik für Strahlentherapie (S.G.), Klinikum der Ludwig-Maximilians-Universität München, München, Germany; Klinische Endokrinologie (S.G., M.Q., G.H.), Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany; Medizinische Klinik und Poliklinik I (K.L., S.H., B.A.), Julius-Maximilians-Universität, Würzburg, Germany; Institute of Epidemiology II (C.M.), Helmholtz
| | - Christa Meisinger
- From the Medizinische Klinik und Poliklinik IV (M.R., E.F., S.G., K.M., S.S., A.P., F.B., M.B., S.E.) and Klinik und Poliklinik für Strahlentherapie (S.G.), Klinikum der Ludwig-Maximilians-Universität München, München, Germany; Klinische Endokrinologie (S.G., M.Q., G.H.), Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany; Medizinische Klinik und Poliklinik I (K.L., S.H., B.A.), Julius-Maximilians-Universität, Würzburg, Germany; Institute of Epidemiology II (C.M.), Helmholtz
| | - Rolf Holle
- From the Medizinische Klinik und Poliklinik IV (M.R., E.F., S.G., K.M., S.S., A.P., F.B., M.B., S.E.) and Klinik und Poliklinik für Strahlentherapie (S.G.), Klinikum der Ludwig-Maximilians-Universität München, München, Germany; Klinische Endokrinologie (S.G., M.Q., G.H.), Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany; Medizinische Klinik und Poliklinik I (K.L., S.H., B.A.), Julius-Maximilians-Universität, Würzburg, Germany; Institute of Epidemiology II (C.M.), Helmholtz
| | - Felix Beuschlein
- From the Medizinische Klinik und Poliklinik IV (M.R., E.F., S.G., K.M., S.S., A.P., F.B., M.B., S.E.) and Klinik und Poliklinik für Strahlentherapie (S.G.), Klinikum der Ludwig-Maximilians-Universität München, München, Germany; Klinische Endokrinologie (S.G., M.Q., G.H.), Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany; Medizinische Klinik und Poliklinik I (K.L., S.H., B.A.), Julius-Maximilians-Universität, Würzburg, Germany; Institute of Epidemiology II (C.M.), Helmholtz
| | - Martin Bidlingmaier
- From the Medizinische Klinik und Poliklinik IV (M.R., E.F., S.G., K.M., S.S., A.P., F.B., M.B., S.E.) and Klinik und Poliklinik für Strahlentherapie (S.G.), Klinikum der Ludwig-Maximilians-Universität München, München, Germany; Klinische Endokrinologie (S.G., M.Q., G.H.), Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany; Medizinische Klinik und Poliklinik I (K.L., S.H., B.A.), Julius-Maximilians-Universität, Würzburg, Germany; Institute of Epidemiology II (C.M.), Helmholtz
| | - Stephan Endres
- From the Medizinische Klinik und Poliklinik IV (M.R., E.F., S.G., K.M., S.S., A.P., F.B., M.B., S.E.) and Klinik und Poliklinik für Strahlentherapie (S.G.), Klinikum der Ludwig-Maximilians-Universität München, München, Germany; Klinische Endokrinologie (S.G., M.Q., G.H.), Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany; Medizinische Klinik und Poliklinik I (K.L., S.H., B.A.), Julius-Maximilians-Universität, Würzburg, Germany; Institute of Epidemiology II (C.M.), Helmholtz
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50
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van der Linden P, Steichen O, Zinzindohoué F, Plouin PF. Blood pressure and medication changes following adrenalectomy for unilateral primary aldosteronism: a follow-up study. J Hypertens 2012; 30:761-9. [PMID: 22252482 DOI: 10.1097/hjh.0b013e328350225d] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Adrenalectomy for unilateral primary aldosteronism cures hypertension in less than 50% of patients, but improvement is observed in most of the remaining ones. Our goal was to quantify the blood pressure (BP) decrease adjusted for medication changes following adrenalectomy and to identify preoperative predictors of this outcome. METHODS We analyzed simultaneous changes in BP and medication by reviewing the records of 156 consecutive patients who had undergone adrenalectomy for unilateral primary aldosteronism in one center between 2001 and 2009 for whom postoperative follow-up data were available. RESULTS Median [interquartile range] baseline SBP was 149 [135-160] mmHg on drugs from two [1-3] different classes. After adrenalectomy, SBP decreased by 21 [5-31] mmHg and the number of drug classes administered, by one [0-2]. The decrease in SBP, adjusted for the change in the number of drug classes, was 26 [14-36] mmHg. Each drug class dropped after surgery was equivalent to a 5 mmHg SBP decrease. Patients with higher preoperative BP or serum sodium levels experienced a greater BP decrease after adrenalectomy. Adrenalectomy cured hypertension in 68 (44%) patients. Hypertension was less likely to be cured in patients with a longer history of hypertension, higher preoperative BP levels, larger number of drug classes, or lower urinary aldosterone levels. CONCLUSION Although patients with severe hypertension are likely to derive considerable benefits from adrenalectomy in terms of BP or treatment reduction, they should be warned that hypertension cure is unlikely.
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