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Liu F, Wang L, Ding Y. A case of primary aldosteronism with a negative aldosterone-to-renin ratio. BMC Cardiovasc Disord 2021; 21:350. [PMID: 34294029 PMCID: PMC8299686 DOI: 10.1186/s12872-021-02162-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/08/2021] [Indexed: 11/14/2022] Open
Abstract
Background Primary aldosteronism (PA), as a cause of secondary hypertension, can cause more serious cardiovascular damage than essential hypertension. The aldosterone-to-renin ratio (ARR) is recommended as the most reliable screening method for PA, but ARR screening is often influenced by many factors. PA cannot be easily excluded when negative ARR. Case presentation We report the case of a 45-year-old Chinese man with resistant hypertension. Three years ago, he underwent a comprehensive screening for secondary hypertension, including the ARR, and the result was negative. After that, the patient's blood pressure was still poorly controlled with four kinds of antihypertensive drugs, the target organ damage of hypertension progressed, and hypokalaemia was difficult to correct. When the patient was hospitalized again for comprehensive examination, we found that aldosterone levels had significantly increased, although the ARR was negative. An inhibitory test with saline was further carried out, and the results suggested that aldosterone was not inhibited; therefore, PA was diagnosed. We performed a unilateral adenoma resection for this patient, and spironolactone was continued to control blood pressure. After the operation, blood pressure is well controlled, and hypokalaemia is corrected. Conclusion When the ARR is negative, PA cannot be easily excluded. Comprehensive analysis and diagnosis should be based on the medication and clinical conditions of patients.
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Affiliation(s)
- Fengyi Liu
- Department of Cardiology II, The Second Affiliated Hospital of Dalian Medical University, No.467 Zhongshan Road, Dalian, 116021, Liaoning, People's Republic of China
| | - Liang Wang
- Department of Urology I, The Second Affiliated Hospital of Dalian Medical University, Dalian, 116021, Liaoning, People's Republic of China
| | - Yanchun Ding
- Department of Cardiology II, The Second Affiliated Hospital of Dalian Medical University, No.467 Zhongshan Road, Dalian, 116021, Liaoning, People's Republic of China.
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Satoh F, Morimoto R, Seiji K, Satani N, Ota H, Iwakura Y, Ono Y, Kudo M, Nezu M, Omata K, Tezuka Y, Kawasaki Y, Ishidoya S, Arai Y, Takase K, Nakamura Y, McNamara K, Sasano H, Ito S. Is there a role for segmental adrenal venous sampling and adrenal sparing surgery in patients with primary aldosteronism? Eur J Endocrinol 2015; 173:465-77. [PMID: 26194502 DOI: 10.1530/eje-14-1161] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 07/20/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE AND DESIGN Adrenal venous sampling (AVS) is critical to determine the subtype of primary aldosteronism (PA). Central AVS (C-AVS)--that is, the collection of effluents from bilateral adrenal central veins (CV)--sometimes does not allow differentiation between bilateral aldosterone-producing adenomas (APA) and idiopathic hyperaldosteronism. To establish the best treatment course, we have developed segmental AVS (S-AVS); that is, we collect effluents from the tributaries of CV to determine the intra-adrenal sources of aldosterone overproduction. We then evaluated the clinical utility of this novel approach in the diagnosis and treatment of PA. METHODS We performed C-AVS and/or S-AVS in 297 PA patients and assessed the accuracy of diagnosis based on the results of C-AVS (n=138, 46.5%) and S-AVS (n=159, 53.5%) by comparison with those of clinicopathological evaluation of resected specimens. RESULTS S-AVS demonstrated both elevated and attenuated secretion of aldosterone from APA and non-tumorous segments, respectively, in patients with bilateral APA and recurrent APA. These findings were completely confirmed by detailed histopathological examination after surgery. S-AVS, but not C-AVS, also served to identify APA located distal from the CV. CONCLUSIONS Compared to C-AVS, S-AVS served to identify APA in some patients, and its use should expand the pool of patients eligible for adrenal sparing surgery through the identification of unaffected segments, despite the fact that S-AVS requires more expertise and time. Especially, this new technique could enormously benefit patients with bilateral or recurrent APA because of the preservation of non-tumorous glandular tissue.
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Affiliation(s)
- Fumitoshi Satoh
- Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan
| | - Ryo Morimoto
- Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan
| | - Kazumasa Seiji
- Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan
| | - Nozomi Satani
- Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan
| | - Hideki Ota
- Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan
| | - Yoshitsugu Iwakura
- Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan
| | - Yoshikiyo Ono
- Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan
| | - Masataka Kudo
- Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan
| | - Masahiro Nezu
- Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan
| | - Kei Omata
- Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan
| | - Yuta Tezuka
- Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan
| | - Yoshihide Kawasaki
- Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan
| | - Shigeto Ishidoya
- Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan
| | - Yoichi Arai
- Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan
| | - Kei Takase
- Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan
| | - Yasuhiro Nakamura
- Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan
| | - Keely McNamara
- Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan
| | - Hironobu Sasano
- Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan
| | - Sadayoshi Ito
- Division of Clinical HypertensionEndocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, JapanDivision of NephrologyEndocrinology and Vascular Medicine, Department of MedicineDepartment of Diagnostic RadiologyDepartment of UrologyDepartment of PathologyTohoku University Hospital, Sendai, Miyagi 980-8574, Japan
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Fujimoto K, Honjo S, Tatsuoka H, Hamamoto Y, Kawasaki Y, Matsuoka A, Ikeda H, Wada Y, Sasano H, Koshiyama H. Primary aldosteronism associated with subclinical Cushing syndrome. J Endocrinol Invest 2013; 36:564-7. [PMID: 23385627 DOI: 10.3275/8818] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Recently, it has been reported that the incidence of primary aldosteronism (PA) among patients with hypertension is much more frequent than previously reported. AIM In the present study, we investigated the frequency and features of PA associated with subclinical Cushing syndrome (SCS). MATERIAL AND METHODS Subjects included consecutive patients (no.=39) who were diagnosed as PA and performed adrenal venous sampling between 2003 and 2011 in our institute. RESULTS In 39 subjects who were diagnosed as PA, 29 patients were operated and 5 cases (12.8%) showed no suppression in low-dose dexamethasone suppression test. Four cases of them were demonstrated to be associated with SCS, and one was associated with overt Cushing syndrome (CS). Post-operatively, 3 cases received replacement therapy of hydrocortisone, while others did not. Pathological findings indicated the diagnosis of aldosterone-producing adenoma in 4 cases associated with SCS, and of idiopathic hyperaldosteronismin in one case associated with overt CS. In all 5 cases, immunohistochemical analysis demonstrated the immunoreactivities of both 3βHSD and P450c17 in the adrenocortical tumors, the marked cortical atrophy in the zona fasciculata and reticularis, the decreased dehydroepiandrosterone sulfotransferase expression, and suppression of hypothalamo- pituitary-adrenal axis indicating the autonomous secretion of cortisol from the tumor. CONCLUSIONS The present study suggests that PA is frequently associated with SCS with prevalence of more than 10%, justifying the routine examinations for SCS in PA cases.
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Affiliation(s)
- K Fujimoto
- Center for Diabetes and Endocrinology, Tazuke Kofukai Foundation Medical Research Institute Kitano Hospital, 2-4-20 Ohgimachi Kita-ku, Osaka, 530-8480, Japan
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