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Araujo-Castro M, Ruiz-Sánchez JG, Ramírez PP, Martín Rojas-Marcos P, Aguilera-Saborido A, Gómez Cerezo JF, López Lazareno N, Torregrosa ME, Gorrín Ramos J, Oriola J, Poch E, Oliveras A, Méndez Monter JV, Gómez Muriel I, Bella-Cueto MR, Mercader Cidoncha E, Runkle I, Hanzu FA. Practical consensus for the treatment and follow-up of primary aldosteronism: a multidisciplinary consensus document. Endocrine 2024:10.1007/s12020-024-03773-9. [PMID: 38507182 DOI: 10.1007/s12020-024-03773-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/07/2024] [Indexed: 03/22/2024]
Abstract
Primary aldosteronism (PA) is the most frequent cause of secondary hypertension and is associated with a higher cardiometabolic risk than essential hypertension. The aim of this consensus is to provide practical clinical recommendations for its surgical and medical treatment, pathology study and biochemical and clinical follow-up, as well as for the approach in special situations like advanced age, pregnancy and chronic kidney disease, from a multidisciplinary perspective, in a nominal group consensus approach of experts from the Spanish Society of Endocrinology and Nutrition (SEEN), Spanish Society of Cardiology (SEC), Spanish Society of Nephrology (SEN), Spanish Society of Internal Medicine (SEMI), Spanish Radiology Society (SERAM), Spanish Society of Vascular and Interventional Radiology (SERVEI), Spanish Society of Laboratory Medicine (SEQC(ML)), Spanish Society of Anatomic-Pathology and Spanish Association of Surgeons (AEC).
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Affiliation(s)
- Marta Araujo-Castro
- Endocrinology & Nutrition Department. Hospital Universitario Ramón y Cajal. Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), University of Alcalá, Madrid, Spain.
| | - Jorge Gabriel Ruiz-Sánchez
- Endocrinology & Nutrition Department. Hospital Universitario Fundación Jiménez Díaz, Health Research Institute-Fundación Jiménez Díaz University Hospital (IIS-FJD, UAM), Madrid, Spain
| | - Paola Parra Ramírez
- Endocrinology & Nutrition Department, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain
| | | | | | | | | | | | - Jorge Gorrín Ramos
- Biochemical department, Laboratori de Referència de Catalunya, Barcelona, Spain
| | - Josep Oriola
- Biochemistry and Molecular Genetics Department. CDB. Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Esteban Poch
- Nephrology Department. Hospital Clinic. IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Anna Oliveras
- Nephrology Department, Hospital del Mar Universitat Pompeu Fabra, Barcelona, Spain
| | | | | | - María Rosa Bella-Cueto
- Pathology Department, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA). Universitat Autònoma de Barcelona. Sabadell. ES, Barcelona, Spain
| | - Enrique Mercader Cidoncha
- General Surgery. Hospital General Universitario Gregorio Marañón, Fellow European Board of Surgery -Endocrine Surgery, Madrid, Spain
| | - Isabelle Runkle
- Endocrinology and Nutrition Department, Hospital Clinico San Carlos Madrid, Madrid, Spain
| | - Felicia A Hanzu
- Endocrinology & Nutrition Department. Hospital Clinic. IDIBAPS, University of Barcelona, Barcelona, Spain.
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Araujo-Castro M, Ruiz-Sánchez JG, Parra Ramírez P, Martín Rojas-Marcos P, Aguilera-Saborido A, Gómez Cerezo JF, López Lazareno N, Torregrosa Quesada ME, Gorrin Ramos J, Oriola J, Poch E, Oliveras A, Méndez Monter JV, Gómez Muriel I, Bella-Cueto MR, Mercader Cidoncha E, Runkle I, Hanzu FA. Screening and diagnosis of primary aldosteronism. Consensus document of all the Spanish Societies involved in the management of primary aldosteronism. Endocrine 2024:10.1007/s12020-024-03751-1. [PMID: 38448679 DOI: 10.1007/s12020-024-03751-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/15/2024] [Indexed: 03/08/2024]
Abstract
Primary aldosteronism (PA) is the most frequent cause of secondary hypertension (HT), and is associated with a higher cardiometabolic risk than essential HT. However, PA remains underdiagnosed, probably due to several difficulties clinicians usually find in performing its diagnosis and subtype classification. The aim of this consensus is to provide practical recommendations focused on the prevalence and the diagnosis of PA and the clinical implications of aldosterone excess, from a multidisciplinary perspective, in a nominal group consensus approach by experts from the Spanish Society of Endocrinology and Nutrition (SEEN), Spanish Society of Cardiology (SEC), Spanish Society of Nephrology (SEN), Spanish Society of Internal Medicine (SEMI), Spanish Radiology Society (SERAM), Spanish Society of Vascular and Interventional Radiology (SERVEI), Spanish Society of Laboratory Medicine (SEQC(ML)), Spanish Society of Anatomic-Pathology, Spanish Association of Surgeons (AEC).
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Affiliation(s)
- Marta Araujo-Castro
- Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal. Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS)., Madrid, Spain.
| | - Jorge Gabriel Ruiz-Sánchez
- Endocrinology & Nutrition Department. Hospital Universitario Fundación Jiménez Díaz, Health Research Institute-Fundación Jiménez Díaz University Hospital (IIS-FJD, UAM), Madrid, Spain
| | - Paola Parra Ramírez
- Endocrinology & Nutrition Department, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain
| | | | | | | | - Nieves López Lazareno
- Biochemical Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Jorge Gorrin Ramos
- Biochemical department, Laboratori de Referència de Catalunya, Barcelona, Spain
| | - Josep Oriola
- Biochemistry and Molecular Genetics Department, CDB. Hospital Clínic. University of Barcelona, Barcelona, Spain
| | - Esteban Poch
- Nephrology Department. Hospital Clinic, IDIBAPS. University of Barcelona, Barcelona, Spain
| | - Anna Oliveras
- Nephrology Department. Hospital del Mar, Universitat Pompeu Fabra, Barcelona, ES, Spain
| | | | | | - María Rosa Bella-Cueto
- Pathology Department, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA). Universitat Autònoma de Barcelona. Sabadell, Barcelona, Spain
| | - Enrique Mercader Cidoncha
- General Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Fellow European Board of Surgery -Endocrine Surgery, Madrid, Spain
| | - Isabelle Runkle
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Felicia A Hanzu
- Endocrinology & Nutrition Department, Hospital Clinic. IDIBAPS. University of Barcelona, Barcelona, Spain.
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Araujo-Castro M, Pascual-Corrales E, Martín Rojas P, Parra Ramírez P. Epidemiology and diagnosis of primary aldosteronism. What have we learned from the SPAIN-ALDO registry? Endocrine 2024; 83:527-536. [PMID: 37884825 DOI: 10.1007/s12020-023-03573-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/14/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE To summarize the available data on the prevalence, clinical repercussion, and diagnosis of primary aldosteronism (PA) and to discuss the SPAIN-ALDO registry's findings, which is the largest PA patient registry in Spain. METHODS A comprehensive review of the literature focused on the prevalence, clinical presentation and diagnosis of PA was performed. RESULTS PA is the most common cause of secondary arterial hypertension. In addition, PA patients have a higher cardio-metabolic risk than patients with essential arterial hypertension matched by age, sex, and blood pressure levels. However, despite its high prevalence and associated metabolic and cardiovascular complications, PA remains largely under-recognized, with less than 2% of people in at-risk populations ever tested. The diagnostic investigation is a multistep process, including screening, confirmatory testing, and subtype differentiation of unilateral from bilateral PA forms. Data from the SPAIN-ALDO registry have shed light on the cardiometabolic impact of PA and about the limitations in the PA diagnosis of these patients in Spain. CONCLUSIONS The most common cause of secondary hypertension is PA. One of the most challenging aspects of the diagnosis is the differentiation between unilateral and bilateral PA because adrenal venous sampling is a difficult procedure that should be performed in experienced centers. Data from the SPAIN-ALDO registry have provided important information on the nationwide management of this pathology.
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Affiliation(s)
- Marta Araujo-Castro
- Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.
- University of Alcalá, Madrid, Spain.
- Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain.
| | - Eider Pascual-Corrales
- Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain
| | - Patricia Martín Rojas
- Endocrinology & Nutrition Department, Hospital Universitario La Paz Madrid, Madrid, Spain
| | - Paola Parra Ramírez
- Endocrinology & Nutrition Department, Hospital Universitario La Paz Madrid, Madrid, Spain.
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Ruiz-García C, Riesco LR, Mateos-Serrano B, Millán RB, Muñoz AJDP, Bouzas JG, Ramírez PP, Marcos PMR, Catalán AL, Lecumberri B, Álvarez-Escolá C, Castro A. Disease-free survival and response to therapy of clinically node- negative Papillary Thyroid Cancer treated without central neck dissection: Retrospective study of 321 patients. Acta Otorrinolaringol Esp (Engl Ed) 2024:S2173-5735(24)00021-8. [PMID: 38346491 DOI: 10.1016/j.otoeng.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/12/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND AND OBJECTIVE Nodal metastases in the central compartment are frequent in papillary thyroid cancer (PTC). However, they are mostly micrometastases with no impact on survival and their relevance on the risk of locoregional relapse is controversial. There is no consensus regarding optimal management of the central neck in patients with PTC cN0. In our center, we do not perform prophylactic central neck dissection (pCND). The objective of this study is to review our long-term results and compare them with the most recent literature. PATIENTS AND METHODS Retrospective review of patients with PTC who underwent total thyroidectomy (TT) without CND between 2005 and 2017. Primary result was disease-free survival in the neck (DFS). RESULTS 321 patients were identified, mostly T1-T2 tumors (94.1%). Median follow-up was 90 months. DFS in the central compartment was excellent (96.1% at 10 year's follow-up). 19 patients had cervical recurrence, of which 15 underwent salvage surgery. On their last visit, including salvage surgery when appropriate, 77% of patients had excellent response, 18.7% had indeterminate response, 3.1% had biochemically incomplete response and 1.2% had morphologically incomplete response. Recurrent laryngeal nerve (RLN) paralysis after TT was transient in 4.7% of patients and permanent in 0.9% of patients. There were no RLN paralysis after salvage surgery. Permanent hypoparathyroidism occurred in 3.4% of patients. Only one patient had hypoparathyroidism after salvage surgery and it was permanent. CONCLUSIONS Based on long-term results and low rate of complications associated with salvage surgery in our experience, we consider routine pCND is not justified.
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Affiliation(s)
- Carmen Ruiz-García
- Otorhinolaryngology Department, Hospital Universitario La Paz, Madrid, Spain
| | | | | | | | | | | | - Paola Parra Ramírez
- Endocrinology and Nutrition Department, Hospital Universitario La Paz, Madrid, Spain
| | | | | | - Beatriz Lecumberri
- Endocrinology and Nutrition Department, Hospital Universitario La Paz, Madrid, Spain
| | | | - Alejandro Castro
- Otorhinolaryngology Department, Hospital Universitario La Paz, Madrid, Spain.
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Herrera-Martínez AD, Román ÁR, Corrales EP, Idrobo C, Ramírez PP, Rojas PM, Lázaro CR, Araujo-Castro M. Adrenal incidentalomas, cortisol secretion and cancer: is there a real crosstalk? Front Endocrinol (Lausanne) 2024; 14:1335202. [PMID: 38264281 PMCID: PMC10804881 DOI: 10.3389/fendo.2023.1335202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 12/11/2023] [Indexed: 01/25/2024] Open
Abstract
Background Cortisol has immunomodulatory effects that increase the risk and evolution of several diseases. Cancer is characterized by a proinflammatory state in which cells exert impaired function and proliferation. The relation between cortisol secretion and increased risk of malignant neoplasm, or their behavior, has not been fully elucidated. Aim To determine the relation between cortisol secretion and the prevalence and clinical outcome of malignant neoplasms in patients with adrenal incidentalomas (AIs). Methods Multicenter retrospective study that included 935 patients with AIs. Cortisol secretion was defined by a cortisol post-dexamethasone suppression test > 1.8 µg/dL, and nonfunctioning AIs (NFAIs) as a value ≤ 1.8 µg/dL. Results Cortisol secretion was evident in 30.8% of the patients and cancer in 23.6% (especially breast, colorectal, prostate and thyroid cancer). No differences in the cancer prevalence were found between patients with cortisol secretion and NFAIs (63.6% vs. 63.4%, p=0.10). After adjusting by age, cortisol secretion was not associated with the presence of cancer (OR 1.29, CI 0.93-1.78). However, cortisol secretion was significantly associated with stage IV of cancer at diagnosis (OR 2.68, CI 1.19- 6.00) and mortality (OR 3.2, CI 1.28- 7.97). Patients with NFAI and breast cancer required treatment with chemo- and radio-therapy more frequently that patients with cortisol secreting AI (90% vs 10% and 92.9% vs 7.1% respectively, p<0.05), similarly patients with prostate cancer required radiotherapy more frequently (90.9% vs 9.1%, p=0.05); also, patients with colorectal cancer and NFAI, tended to require chemotherapy more frequently(76.5% vs 23.5%, p=0.06). Conclusion Cortisol secretion does not increase the risk of malignant neoplasm, but it affects its clinical course, treatment requirements and mortality, leading to a worst prognosis and higher mortality when compared with patients with NFAIs.
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Affiliation(s)
- Aura D. Herrera-Martínez
- Endocrinology & Nutrition Department, Hospital Reina Sofia, Córdoba, Spain
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), Córdoba, Spain
| | - Ángel Rebollo Román
- Endocrinology & Nutrition Department, Hospital Reina Sofia, Córdoba, Spain
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), Córdoba, Spain
| | - Eider Pascual Corrales
- Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain
| | - Cindy Idrobo
- Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain
| | | | | | | | - Marta Araujo-Castro
- Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain
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Vivancos Sánchez C, Navia Álvarez P, Alfonso Carrillo C, Parra Ramírez P, Pérez López C. Carotid pseudoaneurysms after endoscopic transsphenoidal surgery for acromegaly. ENDOCRINOL DIAB NUTR 2024; 71:35-37. [PMID: 38326177 DOI: 10.1016/j.endien.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/26/2023] [Accepted: 11/28/2023] [Indexed: 02/09/2024]
Affiliation(s)
| | - Pedro Navia Álvarez
- Departamento de Neuroradiología Intervencionista, Servicio de Radiología, Hospital Universitario La Paz, Madrid, Spain
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Parra Ramírez P, Martín Rojas-Marcos P, Paja Fano M, González-Boillos M, Pascual-Corrales E, García Cano AM, Ruiz-Sanchez JG, Vicente Delgado A, Gómez Hoyos E, Ferreira R, García Sanz I, Recasens Sala M, Barahona San Millan R, Picón César MJ, Díaz Guardiola P, Perdomo CM, Manjón-Miguélez L, Rebollo Román Á, Robles Lázaro C, Morales-Ruiz M, Calatayud M, Andree Furio Collao S, Meneses D, Sampedro-Nuñez MA, Mena Ribas E, Sanmartín Sánchez A, Gonzalvo Diaz C, Lamas C, Guerrero-Vázquez R, Del Castillo Tous M, Serrano Gotarredona J, Michalopoulou Alevras T, Tenés Rodrigo S, Roa Chamorro R, Jaen Aguila F, Moya Mateo EM, Hanzu FA, Araujo-Castro M. Renin as a Biomarker to Guide Medical Treatment in Primary Aldosteronism Patients. Findings from the SPAIN-ALDO Registry. High Blood Press Cardiovasc Prev 2024; 31:43-53. [PMID: 38225508 DOI: 10.1007/s40292-023-00618-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 12/12/2023] [Indexed: 01/17/2024] Open
Abstract
INTRODUCTION Primary aldosteronism (PA) is associated with several cardiometabolic comorbidities. Specific treatment by mineralocorticoid receptor antagonists (MRA) or adrenalectomy has been reported to reduce the cardiometabolic risk. However, the cardiovascular benefit could depend on plasma renin levels in patients on MRA. AIM To compare the development of cardiovascular, renal and metabolic complications between medically treated patients with PA and those who underwent adrenalectomy, taking the renin status during MRA treatment into account. METHODS A multicenter retrospective study (SPAIN-ALDO Register) of patients with PA treated at 35 Spanish tertiary hospitals. Patients on MRA were divided into two groups based on renin suppression (n = 90) or non-suppression (n = 70). Both groups were also compared to unilateral PA patients (n = 275) who achieved biochemical cure with adrenalectomy. RESULTS Adrenalectomized patients were younger, had higher plasma aldosterone concentration, and lower potassium levels than MRA group. Patients on MRA had similar baseline characteristics when stratified into treatment groups with suppressed and unsuppressed renin. 97 (55.1%) of 176 patients without comorbidities at diagnosis, developed at least one comorbidity during follow-up (median 12 months vs. 12.5 months' follow-up after starting MRA and surgery, respectively). Surgery group had a lower risk of developing new cardiovascular events (HR 0.40 [95% CI 0.18-0.90]) than MRA group. Surgical treatment improved glycemic and blood pressure control, increased serum potassium levels, and required fewer antihypertensive drugs than medical treatment. However, there were no differences in the cardiometabolic profile or the incidence of new comorbidities between the groups with suppressed and unsuppressed renin levels (HR 0.95 [95% CI 0.52-1.73]). CONCLUSION Cardiovascular, renal, and metabolic events were comparable in MRA patients with unsuppressed and suppressed renin. Effective surgical treatment of PA was associated with a decreased incidence of new cardiovascular events when compared to MRA therapy.
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Affiliation(s)
- Paola Parra Ramírez
- Endocrinology and Nutrition Department, Hospital Universitario La Paz, Madrid, Spain
| | | | - Miguel Paja Fano
- Endocrinology and Nutrition Department, OSI Bilbao-Basurto, Hospital Universitario de Basurto, Bilbao, Spain
- University of the Basque Country UPC/EHU, Bilbao, Spain
| | - Margarita González-Boillos
- Endocrinology and Nutrition Department, Hospital Universitario de Castellón, Castelló de la Plana, Castellón, Spain
| | - Eider Pascual-Corrales
- Endocrinology and Nutrition Department, Hospital Universitario Ramón y Cajal, Colmenar Viejo Street km 9, 28034, Madrid, Spain
- Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain
| | | | | | | | - Emilia Gómez Hoyos
- Endocrinology and Nutrition Department, Hospital Universitario de Valladolid, Valladolid, Spain
| | - Rui Ferreira
- Endocrinology and Nutrition Department, Hospital Universitario Rey Juan Carlos, Madrid, Spain
| | - Iñigo García Sanz
- General and Digestive Surgery Department, Hospital Universitario de La Princesa, Madrid, Spain
| | - Mònica Recasens Sala
- Endocrinology and Nutrition Department, Hospital De Girona Doctor Josep Trueta, Girona, Spain
| | | | - María José Picón César
- Endocrinology and Nutrition Department, Hospital Universitario Virgen de la Victoria de Málaga, IBIMA Malaga, Málaga, Spain
- CIBEROBN, Madrid, Spain
| | | | - Carolina M Perdomo
- Endocrinology and Nutrition Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Laura Manjón-Miguélez
- Endocrinology and Nutrition Department, Hospital Universitario Central de Asturias, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Ángel Rebollo Román
- Endocrinology and Nutrition Department, Hospital Reina Sofía, Córdoba, Spain
| | - Cristina Robles Lázaro
- Endocrinology and Nutrition Department, Hospital Clínico Universitario de Salamanca, Salamanca, Spain
| | - Manuel Morales-Ruiz
- Biochemistry and Molecular Genetics Department-CDB, Hospital Clinic, IDIBAPS, CIBERehd, Barcelona, Spain
| | - María Calatayud
- Endocrinology and Nutrition Department, Hospital Doce de Octubre, Madrid, Spain
| | | | - Diego Meneses
- Endocrinology and Nutrition Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | - Elena Mena Ribas
- Endocrinology and Nutrition Department, Hospital Universitario Son Espases, Palma, Islas Baleares, Spain
| | - Alicia Sanmartín Sánchez
- Endocrinology and Nutrition Department, Hospital Universitario Son Espases, Palma, Islas Baleares, Spain
| | - Cesar Gonzalvo Diaz
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Cristina Lamas
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Raquel Guerrero-Vázquez
- Endocrinology and Nutrition Department, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - María Del Castillo Tous
- Endocrinology and Nutrition Department, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | | | | | - Ricardo Roa Chamorro
- Internal Medicine Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Fernando Jaen Aguila
- Internal Medicine Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | - Felicia A Hanzu
- Endocrinology and Nutrition Department, Hospital Clinic, University of Barcelona, IDIPAS, Barcelona, Spain
| | - Marta Araujo-Castro
- Endocrinology and Nutrition Department, Hospital Universitario Ramón y Cajal, Colmenar Viejo Street km 9, 28034, Madrid, Spain.
- Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain.
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Ruiz-Sánchez JG, Paja-Fano M, González Boillos M, Pla Peris B, Pascual-Corrales E, García Cano AM, Parra Ramírez P, Martín Rojas-Marcos P, Vicente Delgado A, Gómez Hoyos E, Ferreira R, García Sanz I, Recasens Sala M, Barahona San Millan R, Picón César MJ, Díaz Guardiola P, García González JJ, Perdomo CM, Manjón Miguélez L, García Centeno R, Percovich JC, Rebollo Román Á, Gracia Gimeno P, Robles Lázaro C, Morales-Ruiz M, Hanzu FA, Araujo-Castro M. Effect of Obesity on Clinical Characteristics of Primary Aldosteronism Patients at Diagnosis and Postsurgical Response. J Clin Endocrinol Metab 2023; 109:e379-e388. [PMID: 37428898 PMCID: PMC10735298 DOI: 10.1210/clinem/dgad400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 06/20/2023] [Accepted: 07/05/2023] [Indexed: 07/12/2023]
Abstract
CONTEXT Patients with obesity have an overactivated renin-angiotensin-aldosterone system (RAAS) that is associated with essential hypertension. However, the influence of obesity in primary aldosteronism (PA) is unknown. OBJECTIVE We analyzed the effect of obesity on the characteristics of PA, and the association between obesity and RAAS components. METHODS A retrospective study was conducted of the Spanish PA Registry (SPAIN-ALDO Registry), which included patients with PA seen at 20 tertiary centers between 2018 and 2022. Differences between patients with and without obesity were analyzed. RESULTS A total of 415 patients were included; 189 (45.5%) with obesity. Median age was 55 years (range, 47.3-65.2 years) and 240 (58.4%) were male. Compared to those without obesity, patients with obesity had higher rates of diabetes mellitus, chronic kidney disease, obstructive apnea syndrome, left ventricular hypertrophy, prior cardiovascular events, higher means of systolic blood pressure, and required more antihypertensive drugs. Patients with PA and obesity also had higher values of serum glucose, glycated hemoglobin A1c, creatinine, uric acid, and triglycerides, and lower levels of high-density lipoprotein cholesterol. Levels of blood aldosterone (PAC) and renin were similar between patients with and without obesity. Body mass index was not correlated with PAC nor renin. The rates of adrenal lesions on imaging studies, as well as the rates of unilateral disease assessed by adrenal vein sampling or I-6β-iodomethyl-19-norcholesterol scintigraphy, were similar between groups. CONCLUSION Obesity in PA patients involves a worse cardiometabolic profile, and need for more antihypertensive drugs but similar PAC and renin levels, and rates of adrenal lesions and lateral disease than patients without obesity. However, obesity implicates a lower rate of hypertension cure after adrenalectomy.
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Affiliation(s)
- Jorge Gabriel Ruiz-Sánchez
- Endocrinology & Nutrition Department, Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS FJD, UAM), Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - Miguel Paja-Fano
- Endocrinology & Nutrition Department, OSI Bilbao-Basurto, Medicine Department, Basque Country University, Hospital Universitario de Basurto, 48013 Bilbao, Spain
| | - Marga González Boillos
- Endocrinology & Nutrition Department, Hospital Universitario de Castellón, 12004 Castellón, Spain
| | - Begoña Pla Peris
- Endocrinology & Nutrition Department, Hospital Universitario de Castellón, 12004 Castellón, Spain
| | - Eider Pascual-Corrales
- Endocrinology & Nutrition Department, Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | | | - Paola Parra Ramírez
- Endocrinology & Nutrition Department, Hospital Universitario La Paz, 28046 Madrid, Spain
| | | | | | - Emilia Gómez Hoyos
- Endocrinology & Nutrition Department, Hospital Universitario de Valladolid, 47003 Valladolid, Spain
| | - Rui Ferreira
- Endocrinology & Nutrition Department, Hospital Universitario de La Princesa, 28006 Madrid, Spain
| | - Iñigo García Sanz
- General & Digestive Surgery Department, Hospital Universitario de La Princesa, 28006 Madrid, Spain
| | - Monica Recasens Sala
- Endocrinology & Nutrition Department, Institut Català de la Salut Girona, 17007 Girona, Spain
| | | | - María José Picón César
- Endocrinology & Nutrition Department, Hospital Universitario Virgen de la Victoria de Málaga, IBIMA, 29010 Málaga, Spain
- CIBEROBN, 28029 Madrid, Spain
| | - Patricia Díaz Guardiola
- Endocrinology & Nutrition Department, Hospital Universitario Infanta Sofía, 28702 Madrid, Spain
| | - Juan Jesús García González
- Endocrinology & Nutrition Department, Hospital Universitario Virgen de la Macarena, 41009 Sevilla, Spain
| | - Carolina M Perdomo
- Endocrinology & Nutrition Department, Clínica Universidad de Navarra, 31008 Pamplona, Spain
| | - Laura Manjón Miguélez
- Endocrinology & Nutrition Department, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Rogelio García Centeno
- Endocrinology & Nutrition Department, Hospital Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Juan Carlos Percovich
- Endocrinology & Nutrition Department, Hospital Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Ángel Rebollo Román
- Endocrinology & Nutrition Department, Hospital Reina Sofía, 14004 Córdoba, Spain
| | - Paola Gracia Gimeno
- Endocrinology & Nutrition Department, Hospital Royo Villanova, 50015 Zaragoza, Spain
| | - Cristina Robles Lázaro
- Endocrinology & Nutrition Department, Complejo Universitario de Salamanca, 37007 Salamanca, Spain
| | - Manuel Morales-Ruiz
- Biochemistry and Molecular Genetics Department-CDB, Hospital Clinic, IDIBAPS, CIBERehd, 08036 Barcelona, Spain
| | - Felicia A Hanzu
- Endocrinology & Nutrition Department, Hospital Clinic, IDIBAPS, CIBERDEM, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Marta Araujo-Castro
- Endocrinology & Nutrition Department, Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
- Department of Medicine, University of Alcalá, 28801 Madrid, Spain
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9
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Parra Ramírez P, Martín Rojas-Marcos P, Paja Fano M, González Boillos M, Peris BP, Pascual-Corrales E, García Cano AM, Ruiz-Sanchez JG, Vicente Delgado A, Gómez Hoyos E, Ferreira R, García Sanz I, Recasens Sala M, Barahona San Millan R, Picón César MJ, Díaz Guardiola P, Perdomo CM, Manjón-Miguélez L, García Centeno R, Percovich JC, Rebollo Román Á, Gracia Gimeno P, Robles Lázaro C, Morales-Ruiz M, Calatayud M, Furio Collao SA, Meneses D, Sampedro Nuñez MA, Escudero Quesada V, Mena Ribas E, Sanmartín Sánchez A, Gonzalvo Diaz C, Lamas C, Guerrero-Vázquez R, Del Castillo Tous M, Serrano Gotarredona J, Michalopoulou Alevras T, Moya Mateo EM, Hanzu FA, Araujo-Castro M. Is adrenal venous sampling always necessary to differentiate between unilateral and bilateral primary aldosteronism? Lesson from the SPAIN-ALDO register. Endocrine 2023:10.1007/s12020-023-03609-y. [PMID: 38008883 DOI: 10.1007/s12020-023-03609-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/10/2023] [Indexed: 11/28/2023]
Abstract
PURPOSE To evaluate whether the clinical, biochemical and radiological features of patients with primary aldosteronism (PA) can predict both main subtypes of PA. METHODS A retrospective multicenter study of PA patients followed in 27 Spanish tertiary hospitals (SPAIN-ALDO Register). Only patients with confirmed unilateral or bilateral PA based on adrenal venous sampling (AVS) and/or postsurgical biochemical cure after adrenalectomy were included. Supervised regression techniques were used for model development. RESULTS 328 patients [270 unilateral PA (UPA), 58 bilateral PA (BPA)] were included. The area under the curve (AUC) for aldosterone/potassium ratio and aldosterone responses following saline infusion test were 0.602 [95%CI 0.520 to 0.684] and 0.574 [95% CI 0.446-0.701], respectively, to differentiate UPA from BPA. The AUC was 0.825 [95% 0.764-0.886] when the prediction model with seven parameters - comorbidities (dyslipidemia, cerebrovascular disease, sleep apnea syndrome [SAS]), systolic blood pressure (SBP), plasma aldosterone levels (PAC), hypokalemia and unilateral adrenal nodule >1 cm and normal contralateral adrenal gland on CT/MRI - was used. In patients without comorbidities, hypokalemia, SBP > 160 mmHg, PAC > 40 ng/dL, and unilateral adrenal lesions were associated with a likelihood of having a UPA of 98.5%. The chance of BPA was higher in individuals with comorbidities, SBP < 140 mmHg, normokalemia, low PAC levels, and no adrenal tumors on the CT/MRI (91.5%). CONCLUSION A combination of high PAC, SBP > 160 mmHg, low serum potassium, a unilateral adrenal nodule>1 cm and no comorbidities could predict a UPA with a 98.5% accuracy.
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Affiliation(s)
- Paola Parra Ramírez
- Endocrinology & Nutrition Department, Hospital Universitario La Paz Madrid, Madrid, Spain
| | | | - Miguel Paja Fano
- Endocrinology & Nutrition Department. OSI Bilbao-Basurto, Hospital Universitario de Basurto, Bilbao, Spain
- Medicine Department, Basque Country University, Bilbao, Spain
| | - Marga González Boillos
- Endocrinology & Nutrition Department, Hospital Universitario de Castellón, Castellón, Spain
| | - Begoña Pla Peris
- Endocrinology & Nutrition Department, Hospital Universitario de Castellón, Castellón, Spain
| | - Eider Pascual-Corrales
- Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain
- Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | | | - Emilia Gómez Hoyos
- Endocrinology & Nutrition Department, Hospital Universitario de Valladolid, Valladolid, Spain
| | - Rui Ferreira
- Endocrinology & Nutrition Department, Hospital Universitario Rey Juan Carlos, Madrid, Spain
| | - Iñigo García Sanz
- General & Digestive Surgery Department, Hospital Universitario de La Princesa, Madrid, Spain
| | - Mònica Recasens Sala
- Endocrinology & Nutrition Department, Hospital De Girona Doctor Josep Trueta, Girona, Spain
| | | | - María José Picón César
- Endocrinology & Nutrition Department, Hospital Universitario Virgen de la Victoria de Málaga. IBIMA Malaga. Spain CIBEROBN, Madrid, Spain
| | | | - Carolina M Perdomo
- Endocrinology & Nutrition Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Laura Manjón-Miguélez
- Endocrinology & Nutrition Department, Hospital Universitario Central de Asturias, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Madrid, Spain
| | - Rogelio García Centeno
- Endocrinology & Nutrition Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Juan Carlos Percovich
- Endocrinology & Nutrition Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | | | - Paola Gracia Gimeno
- Endocrinology & Nutrition Department, Hospital Royo Villanova, Zaragoza, Spain
| | - Cristina Robles Lázaro
- Endocrinology & Nutrition Department, Complejo Universitario de Salamanca, Salamanca, Spain
| | - Manuel Morales-Ruiz
- Biochemistry and Molecular Genetics Department-CDB, Hospital Clinic. IDIBAPS, CIBERehd, Barcelona, Spain
| | - María Calatayud
- Endocrinology & Nutrition Department, Hospital Doce de Octubre, Madrid, Spain
| | | | - Diego Meneses
- Endocrinology & Nutrition Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | | | - Elena Mena Ribas
- Endocrinology & Nutrition Department, Hospital Universitario Son Espases, Islas Baleares, Spain
| | | | - Cesar Gonzalvo Diaz
- Endocrinology & Nutrition Department, Hospital Universitario De Albacete, Albacete, Spain
| | - Cristina Lamas
- Endocrinology & Nutrition Department, Hospital Universitario De Albacete, Albacete, Spain
| | - Raquel Guerrero-Vázquez
- Endocrinology & Nutrition Department, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - María Del Castillo Tous
- Endocrinology & Nutrition Department, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | | | | | - Felicia A Hanzu
- Endocrinology & Nutrition Department, Hospital Clinic. IDIPAS, Barcelona, Spain
| | - Marta Araujo-Castro
- Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain.
- Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.
- University of Alcalá, Madrid, Spain.
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10
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Herrera-Martínez AD, Rebollo Román Á, Pascual Corrales E, Idrobo C, Parra Ramírez P, Martín Rojas-Marcos P, Robles Lázaro C, Marginean DL, Araujo-Castro M. Adrenal Incidentalomas and Other Endocrine-Related Adenomas: How Much Does Cortisol Secretion Matter? Cancers (Basel) 2023; 15:4735. [PMID: 37835429 PMCID: PMC10572012 DOI: 10.3390/cancers15194735] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
Background: Adrenal incidentalomas (AI) are frequent findings in clinical practice. About 40% of AIs are associated with hypercortisolism of variable severity. Although mild autonomous cortisol secretion (MACS) has been associated with the impaired clinical outcome of several diseases, its effect on the development of benign neoplasms is unknown. Aim: To compare the prevalence of adenomas (thyroid, parathyroid, pituitary and other locations) in patients with nonfunctioning AIs (NFAIs) and MACS. Methods: A multicenter, retrospective study of patients with AIs evaluated in four tertiary hospitals was performed. Results: A total of 923 patients were included. Most patients were male (53.6%), with a mean age at diagnosis of 62.4 ± 11.13 years; 21.7% presented with bilateral AIs. MACS was observed in 29.9% (n = 276) of patients, while 69.9% (n = 647) were NFAIs. Adenomas in locations other than the adrenal gland were observed in 36% of the studied population, with a similar distribution in patients with MACS and NFAIs (33% vs. 32%; p > 0.05). There were no statistically significant differences in the prevalence of pituitary, thyroid, parathyroid or other endocrine-related adenomas between both groups, but the prevalence of metabolic comorbidities and mortality was increased in patients with MACS, specifically in patients with thyroid and other endocrine-related adenomas (p < 0.05). Conclusions: Adenomas in locations other than the adrenal glands occur in one third of patients with AIs. Mild autonomous hypercortisolism does not affect the prevalence of other endocrine-related adenomas but is associated with increased metabolic comorbidities and mortality, especially in patients with thyroid adenomas and adenomas in other locations.
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Affiliation(s)
- Aura D. Herrera-Martínez
- Endocrinology & Nutrition Department, Hospital Reina Sofia, 14004 Córdoba, Spain; (Á.R.R.); (D.L.M.)
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), 14004 Córdoba, Spain
| | - Ángel Rebollo Román
- Endocrinology & Nutrition Department, Hospital Reina Sofia, 14004 Córdoba, Spain; (Á.R.R.); (D.L.M.)
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), 14004 Córdoba, Spain
| | - Eider Pascual Corrales
- Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain (C.I.)
- Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), 28034 Madrid, Spain
| | - Cindy Idrobo
- Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain (C.I.)
- Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), 28034 Madrid, Spain
| | - Paola Parra Ramírez
- Endocrinology & Nutrition Department, Hospital La Paz, 28034 Madrid, Spain (P.M.R.-M.)
| | | | | | - Delia Lavinia Marginean
- Endocrinology & Nutrition Department, Hospital Reina Sofia, 14004 Córdoba, Spain; (Á.R.R.); (D.L.M.)
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), 14004 Córdoba, Spain
| | - Marta Araujo-Castro
- Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain (C.I.)
- Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), 28034 Madrid, Spain
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11
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Araujo-Castro M, Paja Fano M, Pla Peris B, González Boillos M, Pascual-Corrales E, García-Cano AM, Parra Ramírez P, Rojas-Marcos PM, Ruiz-Sanchez JG, Vicente A, Gómez-Hoyos E, Ferreira R, García Sanz I, Recasens M, Barahona San Millan R, Picón César MJ, Díaz Guardiola P, Perdomo C, Manjón L, García-Centeno R, Percovich JC, Rebollo Román Á, Gracia Gimeno P, Robles Lázaro C, Morales M, Calatayud M, Collao SAF, Meneses D, Sampedro Nuñez MA, Escudero Quesada V, Ribas EM, Sanmartín Sánchez A, Diaz CG, Lamas C, Guerrero-Vázquez R, del Castillo Tous M, Serrano J, Michalopoulou T, Moya Mateo EM, Hanzu F. Autonomous cortisol secretion in patients with primary aldosteronism: prevalence and implications on cardiometabolic profile and on surgical outcomes. Endocr Connect 2023; 12:e230043. [PMID: 37410097 PMCID: PMC10448600 DOI: 10.1530/ec-23-0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 07/04/2023] [Indexed: 07/07/2023]
Abstract
Purpose The aim of this study was to evaluate the prevalence of autonomous cortisol secretion (ACS) in patients with primary aldosteronism (PA) and its implications on cardiometabolic and surgical outcomes. Methods This is a retrospective multicenter study of PA patients who underwent 1 mg dexamethasone-suppression test (DST) during diagnostic workup in 21 Spanish tertiary hospitals. ACS was defined as a cortisol post-DST >1.8 µg/dL (confirmed ACS if >5 µg/dL and possible ACS if 1.8-5 µg/dL) in the absence of specific clinical features of hypercortisolism. The cardiometabolic profile was compared with a control group with ACS without PA (ACS group) matched for age and DST levels. Results The prevalence of ACS in the global cohort of patients with PA (n = 176) was 29% (ACS-PA; n = 51). Ten patients had confirmed ACS and 41 possible ACS. The cardiometabolic profile of ACS-PA and PA-only patients was similar, except for older age and larger tumor size of the adrenal lesion in the ACS-PA group. When comparing the ACS-PA group (n = 51) and the ACS group (n = 78), the prevalence of hypertension (OR 7.7 (2.64-22.32)) and cardiovascular events (OR 5.0 (2.29-11.07)) was higher in ACS-PA patients than in ACS patients. The coexistence of ACS in patients with PA did not affect the surgical outcomes, the proportion of biochemical cure and clinical cure being similar between ACS-PA and PA-only groups. Conclusion Co-secretion of cortisol and aldosterone affects almost one-third of patients with PA. Its occurrence is more frequent in patients with larger tumors and advanced age. However, the cardiometabolic and surgical outcomes of patients with ACS-PA and PA-only are similar.
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Affiliation(s)
- Marta Araujo-Castro
- Department of Endocrinology & Nutrition, Hospital Universitario Ramón y Cajal & Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain
- University of Alcalá, Madrid, Spain
| | - Miguel Paja Fano
- Department of Endocrinology & Nutrition, OSI Bilbao-Basurto, Hospital Universitario de Basurton & Basque Country University, Medicine Department, Bilbao, Spain
| | - Begoña Pla Peris
- Department of Endocrinology & Nutrition, Hospital Universitario de Castellón, Castellón, Spain
| | - Marga González Boillos
- Department of Endocrinology & Nutrition, Hospital Universitario de Castellón, Castellón, Spain
| | - Eider Pascual-Corrales
- Department of Endocrinology & Nutrition, Hospital Universitario Ramón y Cajal & Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain
| | | | - Paola Parra Ramírez
- Department of Endocrinology & Nutrition, Hospital Universitario La Paz Madrid, Spain
| | | | | | - Almudena Vicente
- Department of Endocrinology & Nutrition, Hospital Universitario de Toledo, Toledo, Spain
| | - Emilia Gómez-Hoyos
- Department of Endocrinology & Nutrition, Hospital Universitario de Valladolid, Valladolid, Spain
| | - Rui Ferreira
- Department of Endocrinology & Nutrition, Hospital Universitario Rey Juan Carlos, Madrid, Spain
| | - Iñigo García Sanz
- Department of General & Digestive Surgery, Hospital Universitario de La Princesa, Madrid, Spain
| | - Mónica Recasens
- Department of Endocrinology & Nutrition, Institut Català de la Salut Girona, Girona, Spain
| | | | - María José Picón César
- Department of Endocrinology & Nutrition, Hospital Universitario Virgen de la Victoria de Málaga, IBIMA Malaga, Spain CIBEROBN, Madrid, Spain
| | - Patricia Díaz Guardiola
- Department of Endocrinology & Nutrition, Hospital Universitario Infanta Sofía, Madrid, Spain
| | - Carolina Perdomo
- Department of Endocrinology & Nutrition, Clínica Universidad de Navarra, Pamplona, Spain
| | - Laura Manjón
- Department of Endocrinology & Nutrition, Hospital Universitario Central de Asturias & Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Rogelio García-Centeno
- Department of Endocrinology & Nutrition, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Juan Carlos Percovich
- Department of Endocrinology & Nutrition, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Ángel Rebollo Román
- Department of Endocrinology & Nutrition, Hospital Reina Sofía, Córdoba, Spain
| | - Paola Gracia Gimeno
- Department of Endocrinology & Nutrition, Hospital Rollo Villanova, Zaragoza, Spain
| | - Cristina Robles Lázaro
- Department of Endocrinology & Nutrition, Complejo Universitario de Salamanca, Salamanca, Spain
| | - Manuel Morales
- Biochemistry and Molecular Genetics Department-CDB, Hospital Clinic, IDIBAPS, CIBERehd, Barcelona, Spain
| | - María Calatayud
- Department of Endocrinology & Nutrition, Hospital Doce de Octubre, Madrid, Spain
| | | | - Diego Meneses
- Department of Endocrinology & Nutrition, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | | | - Elena Mena Ribas
- Department of Endocrinology & Nutrition, Hospital Universitario Son Espases, Islas Baleares, Spain
| | - Alicia Sanmartín Sánchez
- Department of Endocrinology & Nutrition, Hospital Universitario Son Espases, Islas Baleares, Spain
| | - Cesar Gonzalvo Diaz
- Department of Endocrinology & Nutrition, Hospital Universitario De Albacete, Albacete, Spain
| | - Cristina Lamas
- Department of Endocrinology & Nutrition, Hospital Universitario De Albacete, Albacete, Spain
| | | | | | - Joaquín Serrano
- Department of Endocrinology & Nutrition, Hospital General Universitario de Alicante, Alicante, Spain
| | - Theodora Michalopoulou
- Department of Endocrinology and Nutrition, Joan XXIII University Hospital, Tarragona, Spain
| | | | - Felicia Hanzu
- Department of Endocrinology & Nutrition, Hospital Clinic, IDIPAS, Barcelona, Spain
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12
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Araujo-Castro M, Paja Fano M, González Boillos M, Pascual-Corrales E, García Cano AM, Parra Ramírez P, Martín Rojas-Marcos P, Vicente Delgado A, Casteràs A, Puig A, García Sanz I, Díaz Guardiola P, Robles Lázaro C, Núñez MAS, Guerrero-Vázquez R, Del Castillo Tous M, Michalopoulou Alevras T, Tenes Rodrigo S, Hanzu FA. Diagnostic Accuracy of Adrenal Iodine-131 6-Beta-Iodomethyl-19-Norcholesterol Scintigraphy for the Subtyping of Primary Aldosteronism. Biomedicines 2023; 11:1934. [PMID: 37509573 PMCID: PMC10377416 DOI: 10.3390/biomedicines11071934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/05/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
PURPOSE To evaluate the diagnostic accuracy of the 131I-6β-iodomethyl-19-norcholesterol (NP-59) adrenal scintigraphy for the subtyping diagnosis of primary aldosteronism (PA), considering as gold standard for the diagnosis of unilateral PA (UPA), either the results of the adrenal venous sampling (AVS) or the outcome after adrenalectomy. METHODS A retrospective multicenter study was performed on PA patients from 14 Spanish tertiary hospitals who underwent NP-59 scintigraphy with an available subtyping diagnosis. Patients were classified as UPA if biochemical cure was achieved after adrenalectomy or/and if an AVS lateralization index > 4 with ACTH stimulation or >2 without ACTH stimulation was observed. Patients were classified as having bilateral PA (BPA) if the AVS lateralization index was ≤4 with ACTH or ≤2 without ACTH stimulation or if there was evidence of bilateral adrenal nodules >1 cm in each adrenal gland detected by CT/MRI. RESULTS A total of 86 patients with PA were included (70.9% (n = 61) with UPA and 29.1% (n = 25) with BPA). Based on the NP-59 scintigraphy results, 16 patients showed normal suppressed adrenal gland uptake, and in the other 70 cases, PA was considered unilateral in 49 patients (70%) and bilateral in 21 (30%). Based on 59-scintigraphy results, 10.4% of the patients with unilateral uptake had BPA, and 27.3% of the cases with bilateral uptake had UPA. The AUC of the ROC curve of the NP-59 scintigraphy for PA subtyping was 0.812 [0.707-0.916]. Based on the results of the CT/MRI and NP-59 scintigraphy, only 6.7% of the patients with unilateral uptake had BPA, and 24% of the cases with bilateral uptake had UPA. The AUC of the ROC curve of the model combining CT/MRI and 59-scintigraphy results for subtyping PA was 0.869 [0.782-0.957]. CONCLUSION The results of NP-59 scintigraphy in association with the information provided by the CT/MRI may be useful for PA subtyping. However, their diagnostic accuracy is only moderate. Therefore, it should be considered a second-line diagnostic tool when AVS is not an option.
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Affiliation(s)
- Marta Araujo-Castro
- Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
- Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), 28034 Madrid, Spain
- Medicine Department, University of Alcalá, 28801 Madrid, Spain
| | - Miguel Paja Fano
- Endocrinology & Nutrition Department, OSI Bilbao-Basurto, Hospital Universitario de Basurto, 48013 Bilbao, Spain
- Medicine Department, Basque Country University, 48013 Bilbao, Spain
| | - Marga González Boillos
- Endocrinology & Nutrition Department, Hospital Universitario de Castellón, 12004 Castellón, Spain
| | - Eider Pascual-Corrales
- Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
- Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), 28034 Madrid, Spain
| | | | - Paola Parra Ramírez
- Endocrinology & Nutrition Department, Hospital Universitario La Paz, 28046 Madrid, Spain
| | | | | | - Anna Casteràs
- Endocrinology & Nutrition Department, Hospital Universitario de Vall Hebron, 08035 Barcelona, Spain
| | - Albert Puig
- Endocrinology & Nutrition Department, Hospital Universitario de Vall Hebron, 08035 Barcelona, Spain
| | - Iñigo García Sanz
- General & Digestive Surgery Department, Hospital Universitario de La Princesa, 28006 Madrid, Spain
| | - Patricia Díaz Guardiola
- Endocrinology & Nutrition Department, Hospital Universitario Infanta Sofía, 28702 Madrid, Spain
| | - Cristina Robles Lázaro
- Endocrinology & Nutrition Department, Complejo Universitario de Salamanca, 37007 Salamanca, Spain
| | | | | | | | | | | | - Felicia A Hanzu
- Endocrinology & Nutrition Department, Hospital Clinic, IDIPAS, 08007 Barcelona, Spain
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Benítez Valderrama P, Castro Calvo A, Rodrigañez Riesco L, Regojo Zapata R, Parra Ramírez P. Fibrous variant of Hashimoto's thyroiditis as a sign of IgG4-related disease, mimicking thyroid lymphoma: Case report. ENDOCRINOL DIAB NUTR 2023; 70 Suppl 2:60-62. [PMID: 36517386 DOI: 10.1016/j.endien.2022.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/14/2022] [Indexed: 06/04/2023]
Affiliation(s)
| | | | | | - Rita Regojo Zapata
- Servicio de Anatomía Patológica, Hospital Universitario La Paz, Madrid, Spain
| | - Paola Parra Ramírez
- Servicio de Endocrinología y Nutrición, Hospital Universitario La Paz, Madrid, Spain
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14
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Araujo-Castro M, Parra Ramírez P, Martín Rojas-Marcos P, García Centeno R, Gracia Gimeno P, Tomé Fernández-Ladreda M, Sampedro Núñez MA, Higueruela C, Robles Lázaro C. Nonfunctioning adrenal incidentalomas with cortisol post-dexamethasone suppression test >0.9 µg/dL have a higher prevalence of cardiovascular disease than those with values ≤0.9 µg/dL. Endocrine 2023; 79:384-391. [PMID: 36261701 DOI: 10.1007/s12020-022-03228-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 10/05/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE To analyze the differences in the cardiometabolic profile in patients with nonfunctioning adrenal incidentalomas (NFAI) with post-dexamethasone suppression test (DST) cortisol ≤1.4 µg/dL (NFAI ≤ 1.4) and those with post-DST cortisol >1.4 µg/dL (NFAI > 1.4) and between NFAI with post-DST cortisol ≤0.9 µg/dL (NFAI ≤ 0.9) and those with levels >0.9 µg/dL (NFAI > 0.9). METHODS Multicenter retrospective observational study of patients with NFAIs. NFAI was defined as an adrenal incidentaloma with negative hormonal study (including metanephrines, post-DST cortisol ≤1.8 µg/dL and aldosterone/renin ratio when screening was indicated). Autonomous cortisol secretion (ACS) development was defined as an NFAIs in which post-DST serum cortisol >1.8 µg/dL were evidenced during hormonal follow-up evaluation. RESULTS A total of 593 NFAI were included. Based on the 1.4 µg/dL threshold in the DST, most of the NFAI were classified as NFAI ≤ 1.4 (74.5%). Patients in the NFAI > 1.4 group were older than those in the NFAI ≤ 1.4 group, but there was no difference in the cardiometabolic profile after adjusting for age. A total of 69.5% of the patients had DST > 0.9 µg/dl. They were older and had a higher prevalence of cardiovascular disease than NFAI ≤ 0.9, even after adjusting by age (adjusted OR = 2.23 [1.10-4.53]). Patients in the NFAI > 1.4 group developed ACS more commonly than the NFAI ≤ 1.4 group (23.5% vs. 7.44%, P < 0.001). However, when the threshold of 0.9 µg/dL was considered, no difference was found between NFAI ≤ 0.9 and NFAI > 0.9 (P = 0.126). CONCLUSION The threshold of 1.4 µg/dL in the DST is useful to predict which patients with NFAI had a higher risk of ACS development during follow-up; and the threshold of 0.9 µg/dL to identify those patients with NFAI with a higher cardiovascular risk.
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Affiliation(s)
- Marta Araujo-Castro
- Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.
- Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain.
- University of Alcalá, Madrid, Spain.
| | - Paola Parra Ramírez
- Endocrinology & Nutrition Department, Hospital Universitario La Paz Madrid, Madrid, Spain
| | | | - Rogelio García Centeno
- Endocrinology & Nutrition Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Paola Gracia Gimeno
- Endocrinology & Nutrition Department, Hospital Royo Villanueva, Zaragoza, Spain
| | | | | | - Cecilia Higueruela
- Endocrinology & Nutrition Department, Complejo Universitario de Salamanca, Salamanca, Spain
| | - Cristina Robles Lázaro
- Endocrinology & Nutrition Department, Complejo Universitario de Salamanca, Salamanca, Spain
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Araujo-Castro M, Mínguez Ojeda C, García Sanz I, Calatayud M, Hanzu F, Mora M, Vicente A, Blanco Carrera C, De Miguel Novoa P, López García MDC, Lamas C, Manjón-Miguélez L, Del Castillo Tous M, Rodríguez de Vera P, Barahona San Millán R, Recasens M, Tomé Fernández-Ladreda M, Valdés N, Gracia Gimeno P, Robles Lazaro C, Michalopoulou T, Parra Ramírez P, Marazuela M, Álvarez Escolá C, García Centeno R. Genetic study in pheochromocytoma ¿is it possible to stratify the risk of hereditary pheochromocytoma? Neuroendocrinology 2023:000529319. [PMID: 36693324 DOI: 10.1159/000529319] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 01/17/2023] [Indexed: 01/25/2023]
Abstract
INTRODUCTION It is estimated that 30-40% of patients with apparently sporadic pheochromocytomas (PHEOs) have an inherited predisposition syndrome. The aim of our study was to develop a predictive model of hereditary pheochromocytoma (PHEO) based on the clinical, hormonal, and radiological features present at the diagnosis of patients with PHEOs. METHODS A retrospective multicenter cohort study of patients with PHEOs with available genetic study from 18 tertiary hospitals. Clinical, biochemical, and radiological features were used to build a multivariate logistic regression model. The estimation of all possible equations was used to select the model with the best diagnostic accuracy (lower Akaike index (AIC)). RESULTS A total of 245 patients were included: 169 (69.0%) patients with sporadic PHEOs and 76 (31%) with hereditary PHEOs. The parsimonious predictive model with the highest diagnostic accuracy for the prediction of hereditary PHEO combined the variables age, non-cardiovascular disease, urinary norepinephrine levels and tumor size. The area under the ROC curve of this model was of 0.800 (0.705-0.887). Based on the predictive model, the probability of hereditary PHEO in patients older than 60 years with cardiovascular disease, high levels of urinary norepinephrine and unilateral PHEOs >60 mm was <2%. And if the age was above 80 years, lower than 1%. The probability of sporadic PHEO linearly increased with age (MH Test for linear Trend: Chi2(1) = 30.05; P<0.001) Conclusion: In certain populations such as old patients with cardiovascular disease, with high levels of urinary norepinephrine and large tumors in which the probability of hereditary PHEO is very low, genetic testing could be avoided in the absence of specific suspicion.
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Parra Ramírez P, Martín Rojas-Marcos P, Cuesta Hernández M, Ruiz-Sánchez JG, Lamas Oliveira C, Hanzu FA, Araujo-Castro M. First survey on the diagnosis and treatment of primary aldosteronism by Spanish Endocrinology and Nutrition specialists. ENDOCRINOL DIAB NUTR 2022:S2530-0180(22)00241-4. [PMID: 36517385 DOI: 10.1016/j.endien.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/17/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To evaluate the indication and the resources for the screening/diagnosis of primary aldosteronism (PA) in Endocrinology units in Spain. MATERIAL AND METHODS An anonymous 2-phase (2020/2021) online survey was conducted by the AdrenoSEEN group among SEEN members with data about screening, confirmation tests, availability of catheterisation and the treatment of PA. RESULTS Eighty-eight (88) specialists completed the survey. Plasma aldosterone concentration and plasma renin activity were available at all centres; urinary aldosterone was available in 55% of them. The most frequent indications for determining the aldosterone/renin ratio (ARR) were adrenal incidentaloma (82.6%), hypertension with hypokalaemia (82.6%), hypertension in patients <40 years (79.1%) and a family history of PA (77.9%). 61% and 18% of the respondents used an ARR cut-off value of PA of ≥30 and 20ng/dl per ng/mL/, respectively. The intravenous saline loading test was the most commonly used confirmatory test (66.3%), followed by the captopril challenge test (24.4%), with the 25mg dose used more than the 50mg dose (65% versus 35%). 67.4% of the participants confirmed the availability of adrenal vein catheterization (AVC). 41% of this subgroup perform it with a continuous infusion versus 30.5% with an ACTH (1-24) bolus, whereas 70.3% employ sequential adrenal vein catheterization. 48% of the participants reported an AVC success <50%. Total laparoscopic adrenalectomy was the treatment of choice (90.6%), performed by specialists in General and Digestive Surgery specialising in endocrinological pathology. CONCLUSION PA screening and diagnostic tests are extensively available to Spanish endocrinologists. However, there is a major variability in their use and in the cut-off points of the diagnostic methods. The AVS procedure remains poorly standardised and is far from delivering optimal performance. Greater standardisation in the study and diagnosis of PA is called for.
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Affiliation(s)
- Paola Parra Ramírez
- Servicio de Endocrinología y Nutrición, Hospital Universitario La Paz, Madrid, Spain.
| | | | - Martín Cuesta Hernández
- Servicio de Endocrinología y Nutrición, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | - Cristina Lamas Oliveira
- Servicio de Endocrinología y Nutrición, Complejo Universitario Hospitalario de Albacete, Albacete, Spain
| | - Felicia A Hanzu
- Servicio de Endocrinología y Nutrición, Hospital Clínic, Universidad de Barcelona, IDIBAPS, Barcelona, Spain
| | - Marta Araujo-Castro
- Servicio de Endocrinología y Nutrición, Hospital Universitario Ramón y Cajal, Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Departamento de Ciencias de la Salud, Universidad Alcalá, Madrid, Spain
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17
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Araujo-Castro M, Mínguez Ojeda C, García Centeno R, López-García MC, Lamas C, Hanzu FA, Mora M, Del Castillo Tous M, Rodríguez de Vera Gómez P, Parra Ramírez P, Alvarez-Escola C, Blanco Carrera C, Barahona San Millán R, Recasens M, Valdés N, Gracia Gimeno P, de Miguel Novoa P, Vicente A, Manjón L, García Sanz I, Michalopoulou T, Calatayud M. Glycemic disorders in patients with pheochromocytomas and sympathetic paragangliomas. Endocr Relat Cancer 2022; 29:645-655. [PMID: 36069783 DOI: 10.1530/erc-22-0218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/06/2022] [Indexed: 11/08/2022]
Abstract
The objective of our study was to determine the prevalence of glycemic disorders (diabetes mellitus and prediabetes) in patients with pheochromocytomas and sympathetic paragangliomas (PPGLs) and identify risk factors for their development and the likelihood of their resolution after surgery. A multicentric retrospective study of patients with PPGLs submitted to surgery between 2000 and 2021 in 17 Spanish hospitals was performed. Diabetes-specific data were collected at diagnosis, in the immediate- and long-term postsurgical follow-up. A total of 229 patients with PPGLs were included (218 with pheochromocytomas and 11 with sympathetic paragangliomas). Before surgery, glycemic disorders were diagnosed in 35.4% of the patients (n = 81): 54 with diabetes and 27 with prediabetes. The variables independently associated with a higher risk of glycemic disorders were sporadic PPGL (odds ratio (OR) = 3.26 (1.14-9.36)) and hypertension (OR = 3.14 (1.09-9.01)). A significant decrease in fasting plasma glucose and HbA1c levels was observed after surgery, in the short-term and long-term follow-up (P < 0.001). After a median follow-up of 48.5 months (range 3.3-168.9), after surgery, 52% of diabetic and 68% of prediabetic patients experienced a complete resolution. Lower body mass index (BMI) (P = 0.001), lower glucose levels (P = 0.047) and shorter duration of diabetes prior to surgery (P = 0.021) were associated with a higher probability of diabetes resolution. In conclusion, glycemic disorders in patients with PPGLs are present in more than a third of them at diagnosis. Sporadic PPGLs and hypertension are risk factors for their development. More than 50% of cases experience a complete resolution of the glycemic disorder after resection of the PPGLs.
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Affiliation(s)
- Marta Araujo-Castro
- Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain
- University of Alcalá, Madrid, Spain
| | | | - Rogelio García Centeno
- Endocrinology & Nutrition Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | | | - Cristina Lamas
- Endocrinology & Nutrition Department, Hospital Universitario de Albacete, Albacete, Spain
| | | | - Mireia Mora
- Endocrinology & Nutrition Department, Hospital Clinic, Barcelona, Spain
| | - María Del Castillo Tous
- Endocrinology & Nutrition Department, Hospital Universitario Virgen de la Macarena, Sevilla, Spain
| | | | - Paola Parra Ramírez
- Endocrinology & Nutrition Department, Hospital Universitario La Paz Madrid, Madrid, Spain
| | | | | | | | - Mónica Recasens
- Endocrinology & Nutrition Department, Institut Català de la Salut Girona, Girona, Spain
| | - Nuria Valdés
- Endocrinology & Nutrition Department, Hospital Universitario de Cabueñes, Asturias, Spain
| | - Paola Gracia Gimeno
- Endocrinology & Nutrition Department, Hospital Royo Villanova, Zaragoza, Spain
| | - Paz de Miguel Novoa
- Endocrinology & Nutrition Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Almudena Vicente
- Endocrinology & Nutrition Department, Hospital Universitario de Toledo, Toledo, Spain
| | - Laura Manjón
- Endocrinology & Nutrition Department, Hospital Universitario Central de Asturias, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA)
| | - Iñigo García Sanz
- General & Digestive Surgery Department, Hospital Universitario de La Princesa, Madrid, Spain
| | - Theodora Michalopoulou
- Department of Endocrinology and Nutrition, Joan XXIII University Hospital, Tarragona, Spain
| | - María Calatayud
- Endocrinology & Nutrition Department, Hospital Universitario Doce de Octubre, Madrid, Spain
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18
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Araujo-Castro M, Paja Fano M, González Boillos M, Pla Peris B, Pascual-Corrales E, García Cano AM, Parra Ramírez P, Martín Rojas-Marcos P, Ruiz-Sanchez JG, Vicente Delgado A, Gómez Hoyos E, Ferreira R, García Sanz I, Recasens Sala M, Barahona San Millan R, Picón César MJ, Díaz Guardiola P, García González JJ, Perdomo CM, Manjón Miguélez L, García Centeno R, Percovich JC, Rebollo Román Á, Gracia Gimeno P, Robles Lázaro C, Morales-Ruiz M, Hanzu FA. Predictive model of hypertension resolution after adrenalectomy in primary aldosteronism: the SPAIN-ALDO score. J Hypertens 2022; 40:2486-2493. [PMID: 36018220 DOI: 10.1097/hjh.0000000000003284] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To develop a predictive model of hypertension resolution after adrenalectomy in patients with primary aldosteronism (PA), based on their presurgical characteristics. METHODS A retrospective multicenter study of PA patients in follow-up in 20 Spanish tertiary hospitals between 2018 and 2021 was performed (SPAIN-ALDO Register). Clinical response postadrenalectomy was classified according to the primary aldosteronism surgical outcome (PASO) consensus criteria. The predictive model was developed using a multivariate logistic regression model with the estimation of all possible equations. RESULTS A total of 146 patients (54.8% females; mean age of 51.5 ± 10.9 years) with PA who underwent unilateral adrenalectomy were included. After a mean follow-up of 29.1 ± 30.43 months after surgery, hypertension cure was obtained in 37.7% ( n = 55) of the patients. The predictive model with the highest diagnostic accuracy to predict hypertension cure combined the variables female sex, use of two or fewer antihypertensive medications, hypertension grade 1, without type 2 diabetes and nonobesity. The area under the receiver operating characteristic curve of this model was 0.841 [0.769-0.914]. Based on this model, the group of patients with a higher probability of cure (80.4%) were those without type 2 diabetes, BMI <30 kg/m 2 , female sex, hypertension grade 1 and who use two or fewer antihypertensives. Our predictive model offered a slightly higher diagnostic accuracy than Wachtel's (area under the curve [AUC]: 0.809), Utsumi's (AUC: 0.804) and Zarnegar's (AUC: 0.796) models and was similar than the Burello's (AUC: 0.833) model. CONCLUSION Female sex, use of two or fewer antihypertensive medications, hypertension grade 1, no type 2 diabetes and nonobesity may predict hypertension cure after adrenalectomy in patients with PA. Our score provides a potential tool to guide preoperative patient counseling.
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Affiliation(s)
- Marta Araujo-Castro
- Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS)
- University of Alcalá, Madrid
| | - Miguel Paja Fano
- Endocrinology & Nutrition Department, OSI Bilbao-Basurto, Hospital Universitario de Basurto, Bilbao, Spain & Basque Country University, Medicine Department, Bilbao
| | | | - Begoña Pla Peris
- Endocrinology & Nutrition Department. Hospital Universitario de Castellón, Castellón
| | - Eider Pascual-Corrales
- Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS)
| | | | | | | | | | | | - Emilia Gómez Hoyos
- Endocrinology & Nutrition Department, Hospital Universitario de Valladolid, Valladolid
| | | | - Iñigo García Sanz
- General & Digestive Surgery Department, Hospital Universitario de La Princesa, Madrid
| | - Mònica Recasens Sala
- Endocrinology & Nutrition Department, Institut Català de la Salut Girona, Girona
| | | | - María José Picón César
- Endocrinology & Nutrition Department, Hospital Universitario Virgen de la Victoria de Málaga, IBIMA Malaga, CIBEROBN, Madrid
| | | | | | - Carolina M Perdomo
- Endocrinology & Nutrition Department, Clínica Universidad de Navarra, Pamplona
| | - Laura Manjón Miguélez
- Endocrinology & Nutrition Department, Hospital Universitario Central de Asturias, Oviedo & Instituto de Investigación Sanitaria del Principado de Asturias (ISPA)
| | | | - Juan Carlos Percovich
- Endocrinology & Nutrition Department, Hospital Universitario Gregorio Marañón, Madrid
| | | | | | | | - Manuel Morales-Ruiz
- Biochemistry and Molecular Genetics Department-CDB, Hospital Clinic, IDIBAPS, CIBERehd
| | - Felicia A Hanzu
- Endocrinology & Nutrition Department, Hospital Clinic, Barcelona, Spain
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19
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Araujo-Castro M, Paja Fano M, González Boillos M, Pla Peris B, Pascual-Corrales E, García Cano AM, Parra Ramírez P, Rojas-Marcos PM, Ruiz-Sanchez JG, Vicente Delgado A, Gómez Hoyos E, Ferreira R, García Sanz I, Recasens Sala M, Barahona San Millan R, Picón César MJ, Díaz Guardiola P, García González JJ, Perdomo CM, Manjón Miguélez L, García Centeno R, Percovich JC, Rebollo Román Á, Gracia Gimeno P, Robles Lázaro C, Morales-Ruiz M, Hanzu FA. Adrenal venous sampling in primary aldosteronism: Experience of a Spanish multicentric study (Results from the SPAIN-ALDO Register). Endocrine 2022; 78:363-372. [PMID: 35751774 DOI: 10.1007/s12020-022-03122-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/17/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the rate of adrenal venous sampling (AVS) performance in patients with primary aldosteronism (PA), the main reasons for its non-performance, and the success and complications rate of this procedure in Spain. Moreover, the concordance between CT/MRI and AVS for PA subtyping was evaluated. METHODS A retrospective multicenter study of PA patient follow-up in 20 Spanish tertiary hospitals between 2018-2021 was performed (SPAIN-ALDO Register). RESULTS Of the 440 patients with PA included in the study, 153 underwent AVS (34.8%). The main reasons for not performing AVS were: patient rejection to the procedure, low catheterization rate in the center and unilateral disease based on CT/MRI. The overall success rate was 44.4% (the left adrenal vein was properly canulated in 77.8% and the right adrenal vein in 48.4%). Only 3 patients experienced minor complications. In the 45 patients with unilateral disease according to AVS, CT/MRI indicated bilateral disease or normal adrenal glands in 17. In the 23 patients with bilateral disease, CT/MRI indicated unilateral disease in 14. However, no significant differences were observed in biochemical response (P = 0.051) and hypertension resolution (P = 0.150) between patients who underwent surgery based on CT/MRI results and those who underwent surgery based on AVS results. CONCLUSION In our setting, AVS is still an underused technique in patients with PA. The low experience and success rate in AVS partially justify these results. More training for providers and patients needs to be done to include appropriate well performed AVS in the diagnosis algorithm of PA.
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Affiliation(s)
- Marta Araujo-Castro
- Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.
- University of Alcalá, Madrid, Spain.
- Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain.
| | - Miguel Paja Fano
- Endocrinology & Nutrition Department. OSI Bilbao-Basurto, Hospital Universitario de Basurto, Bilbao, Spain
- Basque Country University, Medicine Department, Bilbao, Spain
| | - Marga González Boillos
- Endocrinology & Nutrition Department, Hospital Universitario de Castellón, Castellón, Spain
| | - Begoña Pla Peris
- Endocrinology & Nutrition Department, Hospital Universitario de Castellón, Castellón, Spain
| | - Eider Pascual-Corrales
- Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Paola Parra Ramírez
- Endocrinology & Nutrition Department, Hospital Universitario La Paz Madrid, Madrid, Spain
| | | | | | | | - Emilia Gómez Hoyos
- Endocrinology & Nutrition Department, Hospital Universitario de Valladolid, Valladolid, Spain
| | - Rui Ferreira
- Endocrinology & Nutrition Department, Hospital Universitario de La Princesa, Madrid, Spain
| | - Iñigo García Sanz
- General & Digestive Surgery Department, Hospital Universitario de La Princesa, Madrid, Spain
| | - Mònica Recasens Sala
- Endocrinology & Nutrition Department, Institut Català de la Salut Girona, Girona, Spain
| | | | - María José Picón César
- Endocrinology & Nutrition Department, Hospital Universitario Virgen de la Victoria de Málaga. IBIMA, Malaga, Spain
- CIBEROBN, Madrid, Spain
| | | | | | - Carolina M Perdomo
- Endocrinology & Nutrition Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Laura Manjón Miguélez
- Endocrinology & Nutrition Department, Hospital Universitario Central de Asturias, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Rogelio García Centeno
- Endocrinology & Nutrition Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Juan Carlos Percovich
- Endocrinology & Nutrition Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | | | - Paola Gracia Gimeno
- Endocrinology & Nutrition Department, Hospital Rollo Villanueva, Zaragoza, Spain
| | - Cristina Robles Lázaro
- Endocrinology & Nutrition Department, Complejo Universitario de Salamanca, Salamanca, Spain
| | - Manuel Morales-Ruiz
- Biochemistry and Molecular Genetics Department-CDB, Hospital Clinic. IDIBAPS, CIBERehd, Barcelona, Spain
| | - Felicia A Hanzu
- Endocrinology & Nutrition Department. Hospital Clinic, Barcelona, Spain.
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Parra Ramírez P, Martín Rojas-Marcos P, Cuesta Hernández M, Ruiz-Sánchez JG, Lamas Oliveira C, Hanzu FA, Araujo-Castro M. Primera encuesta sobre el diagnóstico y tratamiento del hiperaldosteronismo primario por especialistas españoles en Endocrinología y Nutrición. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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21
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Araujo-Castro M, Paja Fano M, González Boillos M, Pla Peris B, Pascual-Corrales E, García Cano AM, Parra Ramírez P, Rojas-Marcos PM, Ruiz-Sanchez JG, Vicente Delgado A, Gómez Hoyos E, Ferreira R, García Sanz I, Díaz Guardiola P, García González JJ, Perdomo CM, Morales M, Hanzu FA. Evolution of the cardiometabolic profile of primary hyperaldosteronism patients treated with adrenalectomy and with mineralocorticoid receptor antagonists: results from the SPAIN-ALDO Registry. Endocrine 2022; 76:687-696. [PMID: 35275344 DOI: 10.1007/s12020-022-03029-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/22/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To analyze the evolution of the cardiometabolic profile of patients with primary hyperaldosteronism (PA) after the treatment with surgery and with mineralocorticoid receptor antagonists (MRA). DESIGN Retrospective multicentric study of patients with PA on follow-up in twelve Spanish centers between 2018 and 2020. RESULTS 268 patients with PA treated by surgery (n = 100) or with MRA (n = 168) were included. At baseline, patients treated with surgery were more commonly women (54.6% vs 41.7%, P = 0.042), had a higher prevalence of hypokalemia (72.2% vs 58%, P = 0.022) and lower prevalence of obesity (37.4% vs 51.3%, P = 0.034) than patients treated with MRA. Adrenalectomy resulted in complete biochemical cure in 94.0% and clinical response in 83.0% (complete response in 41.0% and partial response in 42.0%). After a median follow-up of 23.6 (IQR 9.7-53.8) months, the reduction in blood pressure (BP) after treatment was similar between the group of surgery and MRA, but patients surgically treated reduced the number of antihypertensive pills for BP control more than those medically treated (∆antihypertensives: -1.3 ± 1.3 vs 0.0 ± 1.4, P < 0.0001) and experienced a higher increased in serum potassium levels (∆serum potassium: 0.9 ± 0.7 vs 0.6 ± 0.8mEq/ml, P = 0.003). However, no differences in the risk of the onset of new renal and cardiometabolic comorbidities was observed between the group of surgery and MRA (HR = 0.9 [0.5-1.5], P = 0.659). CONCLUSION In patients with PA, MRA and surgery offer a similar short-term cardiovascular protection, but surgery improves biochemical control and reduces pill burden more commonly than MRA, and lead to hypertension cure or improvement in up to 83% of the patients.
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Affiliation(s)
- Marta Araujo-Castro
- Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.
- Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain.
- University of Alcalá, Madrid, Spain.
| | - Miguel Paja Fano
- Endocrinology & Nutrition Department, Hospital Universitario de Basurto, Bilbao, Spain
| | - Marga González Boillos
- Endocrinology & Nutrition Department, Hospital Universitario de Castellón, Castellón, Spain
| | - Begoña Pla Peris
- Endocrinology & Nutrition Department, Hospital Universitario de Castellón, Castellón, Spain
| | - Eider Pascual-Corrales
- Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain
| | | | - Paola Parra Ramírez
- Endocrinology & Nutrition Department, Hospital Universitario La Paz Madrid, Madrid, Spain
| | | | | | | | - Emilia Gómez Hoyos
- Endocrinology & Nutrition Department, Hospital Universitario de Valladolid, Valladolid, Spain
| | - Rui Ferreira
- Endocrinology & Nutrition Department, Hospital Universitario de La Princesa, Madrid, Spain
| | - Iñigo García Sanz
- General & Digestive Surgery Department, Hospital Universitario de La Princesa, Madrid, Spain
| | | | | | - Carolina M Perdomo
- Endocrinology & Nutrition Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Manuel Morales
- Biochemistry Department, Hospital Clinic, Barcelona, Spain
| | - Felicia A Hanzu
- Endocrinology & Nutrition Department, Hospital Clinic, Barcelona, Spain
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22
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Parra Ramírez P, Rojas-Marcos PM, Paja Fano M, González Boillos M, Pascual-Corrales E, García-Cano A, Ruiz-Sanchez JG, Vicente A, Gómez-Hoyos E, Ferreira R, García Sanz I, Recasens M, Pla Peris B, Barahona San Millan R, Picón César MJ, Díaz Guardiola P, Jesús García González J, Perdomo C, Manjón L, García-Centeno R, Percovich JC, Rebollo Román Á, Gracia Gimeno P, Robles Lázaro C, Morales M, Hanzu F, Araujo-Castro M. Differences in the presentation and evolution of primary aldosteronism in elderly (≥65 years) and young patients (<65 years). Endocr Connect 2022; 11:EC-22-0169. [PMID: 35583179 PMCID: PMC9254285 DOI: 10.1530/ec-22-0169] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 05/18/2022] [Indexed: 12/02/2022]
Abstract
OBJECTIVE To compare the presentation and evolution of primary aldosteronism (PA) in the elderly (≥65 years) and young patients (<65 years). METHODS A retrospective multicenter study was performed in 20 Spanish hospitals of PA patients in follow-up between 2018 and 2021. RESULTS Three hundred fifty-two patients with PA <65 years and 88 patients ≥65 years were included. Older PA patients had a two-fold higher prevalence of type 2 diabetes, dyslipidemia, and cerebrovascular disease, but these differences disappeared after adjusting for hypertension duration. At diagnosis, diastolic blood pressure was lower than in young patients (83.3 ± 11.54 vs 91.6 ± 14.46 mmHg, P < 0.0001). No differences in the rate of overall correct cannulation (56.5% vs 42.3%, P = 0.206) or the diagnosis of unilaterality (76.9% vs 62.5%, P = 0.325) in the adrenal venous sampling (AVS) was observed between the elderly and young groups. However, there was a lower proportion of PA patients who underwent adrenalectomy in the elderly group than in the younger group (22.7% (n = 20) vs 37.5% (n = 132), P = 0.009). Nevertheless, no differences in the rate of postsurgical biochemical (100% (n = 14) vs 92.8% (n = 90), P = 0.299) and hypertension cure (38.6% (n = 51) vs 25.0% (n = 5), P = 0.239) were observed between both groups. CONCLUSION Older patients with PA have a worse cardiometabolic profile than young patients with PA that it is related to a longer duration of hypertension. However, the results of the AVS, and adrenalectomy are similar in both groups. Therefore, the management of elderly patients with PA should be based not only on age, but rather on the overall medical, physical, social, and mental characteristics of the patients.
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Affiliation(s)
- Paola Parra Ramírez
- Endocrinology & Nutrition Department, La Paz University Hospital, Madrid, Spain
- Correspondence should be addressed to P Parra Ramírez or M Araujo-Castro: or
| | | | - Miguel Paja Fano
- Endocrinology & Nutrition Department, Hospital Universitario de Basurto, Bilbao, Spain
- Medicine Department, Basque Country University, Bilbao, Spain
| | - Marga González Boillos
- Endocrinology & Nutrition Department, Hospital Universitario de Castellón, Castellón, Spain
| | - Eider Pascual-Corrales
- Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain
| | - Ana García-Cano
- Biochemistry Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Almudena Vicente
- Endocrinology & Nutrition Department, Complejo Universitario de Toledo, Toledo, Spain
| | - Emilia Gómez-Hoyos
- Endocrinology & Nutrition Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Rui Ferreira
- Endocrinology & Nutrition Department, Hospital Universitario de La Princesa, Madrid, Spain
| | - Iñigo García Sanz
- General & Digestive Surgery Department, Hospital Universitario de La Princesa, Madrid, Spain
| | - Mònica Recasens
- Endocrinology & Nutrition Department, Hospital Josep Trueta, Servei d’Endocrinologia, Girona, Spain
| | - Begoña Pla Peris
- Endocrinology & Nutrition Department, Hospital Universitario de Castellón, Castellón, Spain
| | | | - María José Picón César
- Endocrinology & Nutrition Department, Complejo Hospitalario Málaga (Hospital Virgen de la Victoria), IBIMA Malaga, Malaga, Spain
- CIBEROBN, Madrid, Spain
| | | | | | - Carolina Perdomo
- Endocrinology & Nutrition Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Laura Manjón
- Endocrinology & Nutrition Department, Hospital Universitario Central de Asturias, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Rogelio García-Centeno
- Endocrinology & Nutrition Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Juan Carlos Percovich
- Endocrinology & Nutrition Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Paola Gracia Gimeno
- Endocrinology & Nutrition Department, Hospital Royo Villanova, Zaragoza, Spain
| | - Cristina Robles Lázaro
- Endocrinology & Nutrition Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Manuel Morales
- Biochemistry and Molecular Genetics Department-CDB, Hospital Clinic, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Felicia Hanzu
- Endocrinology & Nutrition Department, Hospital Clinic, Barcelona, Spain
| | - Marta Araujo-Castro
- Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain
- University of Alcalá, Madrid, Spain
- Correspondence should be addressed to P Parra Ramírez or M Araujo-Castro: or
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Benítez Valderrama P, Castro Calvo A, Rodrigañez Riesco L, Regojo Zapata R, Parra Ramírez P. Tiroiditis de Hashimoto variante fibrosante como manifestación de enfermedad por IgG4, simulando un linfoma tiroideo: reporte de un caso. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Araujo-Castro M, García Centeno R, Robles Lázaro C, Parra Ramírez P, Gracia Gimeno P, Rojas-Marcos PM, Fernández-Ladreda MT, Percovich Hualpa JC, Sampedro Núñez M, López-García MC, Lamas C, Álvarez Escolá C, Calatayud Gutiérrez M, Blanco Carrera C, de Miguel Novoa P, Valdés Gallego N, Hanzu F, Marazuela M, Mora Porta M, Mínguez Ojeda C, García Gómez Muriel I, Escobar-Morreale HF, Valderrabano P. Predictive model of pheochromocytoma based on the imaging features of the adrenal tumours. Sci Rep 2022; 12:2671. [PMID: 35177692 PMCID: PMC8854552 DOI: 10.1038/s41598-022-06655-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 02/03/2022] [Indexed: 12/18/2022] Open
Abstract
The purpose of our study was to develop a predictive model to rule out pheochromocytoma among adrenal tumours, based on unenhanced computed tomography (CT) and/or magnetic resonance imaging (MRI) features. We performed a retrospective multicentre study of 1131 patients presenting with adrenal lesions including 163 subjects with histological confirmation of pheochromocytoma (PHEO), and 968 patients showing no clinical suspicion of pheochromocytoma in whom plasma and/or urinary metanephrines and/or catecholamines were within reference ranges (non-PHEO). We found that tumour size was significantly larger in PHEO than non-PHEO lesions (44.3 ± 33.2 versus 20.6 ± 9.2 mm respectively; P < 0.001). Mean unenhanced CT attenuation was higher in PHEO (52.4 ± 43.1 versus 4.7 ± 17.9HU; P < 0.001). High lipid content in CT was more frequent among non-PHEO (83.6% versus 3.8% respectively; P < 0.001); and this feature alone had 83.6% sensitivity and 96.2% specificity to rule out pheochromocytoma with an area under the receiver operating characteristics curve (AUC-ROC) of 0.899. The combination of high lipid content and tumour size improved the diagnostic accuracy (AUC-ROC 0.961, sensitivity 88.1% and specificity 92.3%). The probability of having a pheochromocytoma was 0.1% for adrenal lesions smaller than 20 mm showing high lipid content in CT. Ninety percent of non-PHEO presented loss of signal in the “out of phase” MRI sequence compared to 39.0% of PHEO (P < 0.001), but the specificity of this feature for the diagnosis of non-PHEO lesions low. In conclusion, our study suggests that sparing biochemical screening for pheochromocytoma might be reasonable in patients with adrenal lesions smaller than 20 mm showing high lipid content in the CT scan, if there are no typical signs and symptoms of pheochromocytoma.
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Affiliation(s)
- Marta Araujo-Castro
- Department of Endocrinology & Nutrition, Hospital Universitario Ramón y Cajal, Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Universidad de Alcalá, Madrid, Spain.
| | - Rogelio García Centeno
- Department of Endocrinology & Nutrition, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Cristina Robles Lázaro
- Department of Endocrinology & Nutrition, Hospital Universitario Virgen de La Concha, Zamora, Spain
| | - Paola Parra Ramírez
- Department of Endocrinology & Nutrition, Hospital Universitario La Paz, Madrid, Spain
| | - Paola Gracia Gimeno
- Department of Endocrinology & Nutrition, Hospital Universitario Rollo Villanova, Zaragoza, Spain
| | | | | | | | - Miguel Sampedro Núñez
- Department of Endocrinology & Nutrition, Hospital Universitario La Princesa, Madrid, Spain
| | - María-Carmen López-García
- Department of Endocrinology & Nutrition, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Cristina Lamas
- Department of Endocrinology & Nutrition, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | | | | | | | - Paz de Miguel Novoa
- Department of Endocrinology & Nutrition, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Nuria Valdés Gallego
- Department of Endocrinology & Nutrition, Hospital Universitario de Cabueñes, Asturias, Spain
| | - Felicia Hanzu
- Department of Endocrinology & Nutrition, Hospital Clinic, Barcelona, Spain
| | - Mónica Marazuela
- Department of Endocrinology & Nutrition, Hospital Universitario La Princesa, Madrid, Spain
| | - Mireia Mora Porta
- Department of Endocrinology & Nutrition, Hospital Clinic, Barcelona, Spain
| | | | | | - Héctor F Escobar-Morreale
- Department of Endocrinology & Nutrition, Hospital Universitario Ramón y Cajal, Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Universidad de Alcalá, Madrid, Spain
| | - Pablo Valderrabano
- Department of Endocrinology & Nutrition, Hospital Universitario Ramón y Cajal, Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Universidad de Alcalá, Madrid, Spain.
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Araujo-Castro M, Parra Ramírez P, Robles Lázaro C, García Centeno R, Gracia Gimeno P, Fernández-Ladreda MT, Sampedro Núñez MA, Marazuela M, Escobar-Morreale HF, Valderrabano P. Accuracy of the dexamethasone suppression test for the prediction of autonomous cortisol secretion-related comorbidities in adrenal incidentalomas. Hormones (Athens) 2021; 20:735-744. [PMID: 34273083 DOI: 10.1007/s42000-021-00308-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 06/30/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to evaluate the diagnostic accuracy of the 1 mg dexamethasone suppression test (DST) for the prediction of autonomous cortisol secretion (ACS)-related comorbidities in patients with adrenal incidentalomas (AIs). METHODS This was a retrospective multicenter study. We recruited patients with AI/s ≥ 1 cm, excluding those who, during the study, were found during the extension study of an extra-adrenal cancer, with a known diagnosis of hereditary syndromes characterized by adrenal tumors, those presenting with overt hormonal excess syndromes, and those in whom the DST results were missing. RESULTS A total of 823 patients met the inclusion criteria. Based on the 1.8, 3.0, and 5.0 µg/dl post-DST cortisol thresholds, the prevalence of ACS was 33.5%, 13.7%, and 5.6%, respectively. The prevalence of hypertension (OR = 1.8, 95% CI = 1.3-2.4), diabetes (OR = 1.6, 95% CI = 1.2-2.2), and dyslipidemia (OR = 1.4, 95% CI = 1.0-1.9) was higher with cortisol post-DST ≥ 1.8 µg/dl; the prevalence of hypertension (OR = 2.1, 95% CI = 1.4-3.3) and diabetes (OR = 1.7, 95% CI = 1.1-2.6) was higher with values ≥ 3.0 µg/dl; and the prevalence of hypertension (OR = 2.0, 95% CI = 1.0-3.7) was higher with levels ≥ 5.0 µg/dl. However, the diagnostic accuracy of the DST for the prediction of cardiometabolic comorbidities in patients with AIs was poor, with areas under the ROC curve < 0.61. CONCLUSIONS The DST is a poor predictor of cardiometabolic comorbidities in patients with AIs regardless of the cortisol cut-off values applied. This finding suggests that the diagnosis of ACS should not be based solely on the results of the DST. Other clinical, metabolic, or imaging markers showing a better performance for the prediction of the development and progression of cardiometabolic comorbidities in AIs need to be identified.
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Affiliation(s)
- Marta Araujo-Castro
- Neuroendocrinology Unit, Department of Endocrinology & Nutrition, Instituto de Investigación Biomédica (IRYCIS), Hospital Universitario Ramón Y Cajal, Madrid, Spain.
- Department of Health Science, Universidad de Alcalá, Madrid, Spain.
| | | | | | | | | | | | | | - Mónica Marazuela
- Endocrinology Department, Hospital Universitario de La Princesa, Madrid, Spain
| | - Héctor F Escobar-Morreale
- Department of Endocrinology & Nutrition, Hospital Universitario Ramón Y Cajal, Madrid, Spain
- Universidad de Alcalá & Instituto Ramón Y Cajal de Investigación Sanitaria & Centro de Investigación Biomédica en Red Diabetes Y Enfermedades Metabólicas Asociadas, Madrid, Spain
| | - Pablo Valderrabano
- Department of Endocrinology & Nutrition, Hospital Universitario Ramón Y Cajal, Madrid, Spain
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Ruiz-Sánchez JG, Parra Ramírez P, Martín Rojas-Marcos P, Lecumberri Santamaría B, Álvarez Escolá C. In-patient management protocol for diabetes insipidus associated with adipsia. Developed from a clinical case. ENDOCRINOL DIAB NUTR 2021; 68:668-670. [PMID: 34906348 DOI: 10.1016/j.endien.2020.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 09/07/2020] [Indexed: 06/14/2023]
Affiliation(s)
- Jorge Gabriel Ruiz-Sánchez
- Servicio de Endocrinología y Nutrición, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain.
| | - Paola Parra Ramírez
- Servicio de Endocrinología y Nutrición, Hospital Universitario La Paz, Madrid, Spain
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27
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Ruiz-Sánchez JG, Parra Ramírez P, Lisbona Catalán A. A rare association of two endocrine tumours: non-functional oncocytic adrenocortical carcinoma and Papillary thyroid carcinoma. Horm Mol Biol Clin Investig 2021; 42:199-201. [PMID: 33675218 DOI: 10.1515/hmbci-2020-0080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/16/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To describe a rare association of two endocrine tumours in a clinical case. CASE PRESENTATION A 54-year-old woman with a classic Papillary thyroid cancer (PTC) assessed by the Endocrinology Department of a tertiary hospital from May-2015 to May-2020. PTC was treated with a total thyroidectomy and lymphadenectomy in May-2015. Initial staging (AJCC/TNM 7th edition): T3N1bMx. Additionally, two ablative doses of 150 mCi of 131-I (RAI) were administered until September-2016. No pathological uptake was found on the post-RAI whole-body scan at any level. Due to a persistent incomplete biochemical response in February-2017, a 18Fluor-dexosiglucose positron emission computed tomography (FDG-PET) was performed. FDG-PET showed an intense pathological deposit in the right adrenal, suggestive of malignancy. Right adrenalectomy was carried out, and pathology revealed an Adrenocortical carcinoma (ACC). Genetic syndromes associated to ACC are: Li-Fraumeni syndrome (caused by an autosomal mutation in the TP53 gene), the Multiple Endocrine Neoplasia (MEN) type 1 (caused by Menin gene mutations), and MEN type 4 (caused by heterozygous mutations in the CDNK1B gene). However, none of them are associated to PTC. CONCLUSIONS To our knowledge this is the sixth published case reporting an ACC in presence of a PTC. The pathological factors behind the relation between these malignancies have not been elucidated. We do not discard the possibility of a genetic relationship between PTC and ACC.
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Affiliation(s)
- Jorge Gabriel Ruiz-Sánchez
- Servicio de Endocrinología y Nutrición, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
| | - Paola Parra Ramírez
- Servicio de Endocrinología y Nutrición, Hospital Universitario La Paz, Madrid, Spain
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28
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Ruiz-Sánchez JG, Parra Ramírez P, Martín Rojas-Marcos P, Lecumberri Santamaría B, Álvarez Escolá C. In-patient management protocol for diabetes insipidus associated with adipsia. Developed from a clinical case. ENDOCRINOL DIAB NUTR 2021; 68:S2530-0164(20)30255-X. [PMID: 33451963 DOI: 10.1016/j.endinu.2020.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 08/20/2020] [Accepted: 09/07/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Jorge Gabriel Ruiz-Sánchez
- Servicio de Endocrinología y Nutrición, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, España.
| | - Paola Parra Ramírez
- Servicio de Endocrinología y Nutrición, Hospital Universitario La Paz, Madrid, España
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Araujo-Castro M, Robles Lázaro C, Parra Ramírez P, Cuesta Hernández M, Sampedro Núñez MA, Marazuela M. Cardiometabolic profile of non-functioning and autonomous cortisol-secreting adrenal incidentalomas. Is the cardiometabolic risk similar or are there differences? Endocrine 2019; 66:650-659. [PMID: 31473918 DOI: 10.1007/s12020-019-02066-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 08/20/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To study the differences in the cardiometabolic profile between patients with non-functioning adrenal incidentalomas (NFAI) and incidentalomas with autonomous cortisol secretion (ACS). METHODS A total of 149 patients with adrenal incidentalomas were retrospectively evaluated and followed-up for a mean time of 34.6 months at Departments of Endocrinology and Metabolic Diseases Units of four tertiary Spanish hospitals. Patients were grouped as NFAI or ACS adenomas based on two cutoffs in the dexamethasone suppression test (DST): 3.0 µg/dl (NFAIDST3 or ACSDST3) and 1.8 µg/dl (ACSDST1.8 and NFAIDST1.8). RESULTS The mean age of both groups was 62.0 (10.31) and was similar in ACS and NFAI. The prevalence of diabetes, high blood pressure, cardiovascular, and cerebrovascular disease was higher in ACS than in NFAI, but differences only reached statistical significance for cerebrovascular disease using the 3.0 µg/dl cutoff (15.8% vs 2.3%, p = 0.01) and for diabetes using the 1.8 µg/dl cutoff (38.0% vs 22.0%, p = 0.04). No differences were found in the prevalence of dyslipidemia. The prevalence of obesity was lower in patients with ACS than in NFAI 26.3% vs 39.2%, p = 0.18 (NFAIDST3 vs ACSDST3) and 32.1% vs 40.6%, p = 0.56 (ACSDST1.8 vs NFAIDST1.8), but the differences did not reach statistical significance. Maximum adenoma diameter (R-squared = 0.15, p < 0.001) and cerebrovascular disease (OR = 1.59, p = 0.04) were the only parameters that could be predicted by the DST. The DST was an inadequate predictor of clinical (systolic and diastolic blood pressure, body mass index), hormonal (DHEAS, ACTH, UFC, and basal serum cortisol), biochemical (glucose, cholesterol, LDL, HDL, and triglycerides), and other radiological (laterality, lipid content) parameters. Throughout the follow-up, patients did not develop overt Cushing's Syndrome; three NFAIDST3 developed ACSDST3, eight NFAIDST1.8 developed ACSDST1.8, and one NFAIDST1.8 progressed to ACSDST3. In both groups (NFAI and ACS) the metabolic profile remained stable. CONCLUSIONS Our data suggest higher prevalence of diabetes and cerebrovascular disease in ACS patients compared with NFAI. However, probably because of the small sample size, the differences only reached statistical significance using the cutoffs of 1.8 µg/dl for diabetes and 3.0 µg/dl for cerebrovascular disease. Patients with ACS and NFAI rarely progress to more aggressive forms of hypercortisolism, and the metabolic profile usually remains stable during the follow-up.
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Affiliation(s)
| | | | | | - Martín Cuesta Hernández
- Endocrinology Department, San Carlos Clinical University Hospital, Madrid, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
| | | | - Mónica Marazuela
- Endocrinology Department, Princesa University Hospital, Madrid, Spain
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Parra Ramírez P, Santiago Hernando A, Barquiel Alcalá B, Martín Rojas-Marcos P, Lisbona Catalán A, Álvarez Escolá C. Potential Utility of Contrast-Enhanced Ultrasound in the Preoperative Evaluation of Primary Hyperparathyroidism. J Ultrasound Med 2019; 38:2565-2571. [PMID: 30693978 DOI: 10.1002/jum.14949] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/18/2018] [Accepted: 12/30/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES We aimed to compare the effectiveness of contrast-enhanced ultrasound (CEUS), technetium Tc 99m methoxyisobutylisonitrile (99m Tc-MIBI) single-photon emission computed tomographic (SPECT) scintigraphy, and high-resolution ultrasound (US) in the detection of a pathologic parathyroid gland in patients with primary hyperparathyroidism (pHPT). METHODS Twenty-nine consecutive patients with pHPT were prospectively enrolled and underwent preoperative imaging with 99m Tc-MIBI SPECT scintigraphy, high-resolution US, and CEUS and subsequent parathyroidectomy. Contrast-enhanced US examinations were performed by an experienced examiner who was blinded to the results of scintigraphy and high-resolution US. The diagnostic performance of all of the imaging tests was analyzed in comparison with the pathologic anatomic findings. All investigations were performed at La Paz University Hospital. RESULTS In the 29 patients (22 female and 7 male), a total of 31 parathyroid adenomas were detected: single lesions in 27 patients and a double lesion in 2 patients. Contrast-enhanced US revealed sensitivity of 66.7% (95% confidence interval [CI], 46%-82.7%) for detection of single adenomas in comparison with 77.8 % (95% CI, 57.3%-90.6) for 99m Tc-MIBI SPECT scintigraphy and 51.8% (95% CI, 32.3%-70.8%) for high-resolution US (P = .100). With CEUS, double adenomas could be detected in both cases (sensitivity, 100%); however, scintigraphy and high-resolution US did not detect any cases of double adenomas. In addition, CEUS allowed the differentiation of lymphatic nodes from parathyroid glands in 2 patients. No side effects were observed for CEUS. CONCLUSIONS In our study, CEUS facilitated the detection and diagnosis of double adenomas compared with high-resolution US and 99m Tc-MIBI SPECT scintigraphy. Additionally, CEUS was useful in the differentiation between parathyroid adenomas and lymph nodes.
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Abstract
In the last three decades, the prevalence of obesity in developed countries has reached epidemic proportions, and continues rising. Many factors have influence on the incidence of obesity, and with the decline of physical activity, overeating plays a role in the emergence of this public health problem. Although a clear relationship between fat intake and weight gain has been established, the role of carbohydrates and more specifically from sucrose and the development of obesity is more controversial. Much of this controversy is due to the growing demand for sweetened drinks and caloric increase posed by these in the diet. Despite multiple studies and communications on this subject in recent years, there are still many areas of uncertainty about the role played by diets rich in sugars over the increase in obesity in last years.
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