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diagnosis of primary aldosteronism

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https://www.readbyqxmd.com/read/27869719/targeted-molecular-imaging-in-adrenal-disease-an-emerging-role-for-metomidate-pet-ct
#1
REVIEW
Iosif A Mendichovszky, Andrew S Powlson, Roido Manavaki, Franklin I Aigbirhio, Heok Cheow, John R Buscombe, Mark Gurnell, Fiona J Gilbert
Adrenal lesions present a significant diagnostic burden for both radiologists and endocrinologists, especially with the increasing number of adrenal 'incidentalomas' detected on modern computed tomography (CT) or magnetic resonance imaging (MRI). A key objective is the reliable distinction of benign disease from either primary adrenal malignancy (e.g., adrenocortical carcinoma or malignant forms of pheochromocytoma/paraganglioma (PPGL)) or metastases (e.g., bronchial, renal). Benign lesions may still be associated with adverse sequelae through autonomous hormone hypersecretion (e...
November 18, 2016: Diagnostics
https://www.readbyqxmd.com/read/27864805/endocrine-hypertension-a-practical-approach
#2
REVIEW
Joseph M Pappachan, Harit N Buch
Elevated blood pressure resulting from few endocrine disorders (endocrine hypertension) accounts for a high proportion of cases of secondary hypertension. Although some features may be suggestive, many cases of endocrine hypertension remain silent until worked up for the disease. A majority of cases result from primary aldosteronism. Other conditions that can cause endocrine hypertension are: congenital adrenal hyperplasia, Liddle syndrome, pheochromocytomas, Cushing's syndrome, acromegaly, thyroid diseases, primary hyperparathyroidism and iatrogenic hormone manipulation...
November 19, 2016: Advances in Experimental Medicine and Biology
https://www.readbyqxmd.com/read/27862131/scoring-system-for-the-diagnosis-of-bilateral-primary-aldosteronism-in-the-outpatient-setting-before-adrenal-venous-sampling
#3
Hiroki Kobayashi, Akira Haketa, Takahiro Ueno, Yukihiro Ikeda, Yoshinari Hatanaka, Sho Tanaka, Hiromasa Otsuka, Masanori Abe, Noboru Fukuda, Masayoshi Soma
OBJECTIVE: The only reliable method for subtyping primary aldosteronism (PA) is adrenal venous sampling (AVS), which is costly and time consuming. Considering the limited availability of AVS, it would be helpful to obtain information on the diagnosis of bilateral hyperaldosteronism (BHA) from routine tests. We aimed to establish new, simple criteria for outpatients to diagnose BHA from PA before AVS. DESIGN: We retrospectively analysed 82 patients who were diagnosed with PA and underwent AVS...
November 8, 2016: Clinical Endocrinology
https://www.readbyqxmd.com/read/27776721/primary-aldosteronism-diagnosis-and-management
#4
Geeta Gyamlani, Carol M Headley, Adnan Naseer, Ganpat S Valaulikar, Stephen A Geraci
Primary aldosteronism (PA) is an important and commonly unrecognized cause of secondary hypertension. Idiopathic hyperaldosteronism and aldosterone-producing adenomas account for more than 95% of PA and are characterized, respectively, by bilateral or unilateral involvement of the adrenal glands. When there is suspicion for the presence of PA, a plasma aldosterone to renin ratio should be obtained initially. Localization to determine adrenal gland involvement is done by imaging, with computerized tomography or magnetic resonance imaging...
October 2016: American Journal of the Medical Sciences
https://www.readbyqxmd.com/read/27773179/west-australian-experience-with-adrenal-venous-sampling-studies-in-the-diagnosis-of-primary-aldosteronism
#5
Michael M Page, Paul Glendenning
No abstract text is available yet for this article.
February 2016: Pathology
https://www.readbyqxmd.com/read/27754305/lbos-02-06-histopathological-specific-mutation-spectrum-of-aldosterone-producing-adenomas
#6
Elena Azizan, Norlela Sukor, Nor Azmi Kamaruddin, A Rahman A Jamal, Jiri Ceral, Miroslav Solar, Isa Mohamed Rose, Geok Chin Tan
OBJECTIVE: Aldosterone-producing adenoma (APA) is a common curable cause of hypertension. Somatic mutations in five genes (KCNJ5, ATP1A1, ATP2B3, CACNA1D, and CTNNB1) have been found to cause the excess aldosterone production of two thirds of APAs [1-4]. KCNJ5 mutant APAs, the most common and largest, had explicit genotype-phenotype relationship - a low protein expression of KCNJ5 relative to their peritumoural zona glomerulosa (ZG) and a zona fasciculata-like composition [5-6]. Conversely for the other genes, controversy arises on whether they have the opposite cell phenotype [4,7-8]...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27754249/os-35-09-long-term-outcome-of-surgically-and-medically-treated-patients-of-the-primary-aldosteronism-prevalence-in-hypertensives-papy-study
#7
Giuseppe Maiolino, Alberto Flego, Gian Paolo Rossi
OBJECTIVE: PA causes excess cardiovascular (CV) damage, but whether it worsens prognosis remained uncertain as there are no prospective studies. To compare long-term outcome of the 1125 patients recruited in the PAPY study. DESIGN AND METHOD: 11.2% of the PAPY study patients had PA: 6.4% idiopathic hyperaldosteronism (IHA) received medical therapy; 4,8% aldosterone-producing adenoma (APA) required adrenalectomy. Endpoints were total and CV mortality, major adverse cardiovascular events (MACE) and total CV events...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27754248/os-35-08-does-adrenocorticotropic-hormone-acth-administration-improve-the-diagnostic-performance-of-adrenal-vein-sampling-for-primary-aldosteronism
#8
Martin Wolley, Ashraf Ahmed, Richard Gordon, Michael Stowasser
OBJECTIVE: Adrenal vein sampling (AVS) is vital for determining treatment options for primary aldosteronism (PA), but is a difficult procedure. Adrenocorticotropic hormone (ACTH) infusion or bolus has been reported to improve AVS success rates by increasing cortisol secretion, but effects on aldosterone and thus lateralisation are controversial. We therefore aimed to determine the effects of ACTH on AVS in regard to success rates and lateralization. DESIGN AND METHOD: AVS was performed in the morning after overnight recumbency in patients with PA confirmed by fludrocortisone suppression testing...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27754245/os-35-05-measurement-of-angiotensin-ii-at-equilibrium-in-the-diagnostic-workup-of-primary-aldosteronism-impact-of-patient-positioning-and-ace-inhibitor-treatment
#9
Marko Poglitsch, Ashraf H Ahmed, Andrea Stoller, Dunja Van Oyen, Cornelia Schwager, Claudia Aigner, Oliver Domenig, Manuel Haschke, Michael Stowasser
OBJECTIVE: Primary aldosteronism (PA) is a widely under-diagnosed, potentially curable and specifically treatable cause of hypertension. PA screening involves measuring the aldosterone-to-renin-ratio (ARR), but false negative results can occur in the setting of medications, which block the renin-angiotensin system (RAS). Withdrawing RAS blockers from patients with resistant hypertension is not without cardiovascular risk. A novel diagnostic approach, the aldosterone-to-angiotensin-II-ratio (AA2-Ratio), has the potential for less drug interference and improved reliability in PA screening and confirmation of diagnosis...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27754244/os-35-04-the-aa2-ratio-towards-improved-screening-for-primary-aldosteronism-in-hypertension
#10
Marko Poglitsch, Ashraf H Ahmed, Michael Resl, Andrea Stoller, Dunja Van Oyen, Cornelia Schwager, Claudia Aigner, Oliver Domenig, Michael Krebs, Manuel Haschke, Michael Stowasser
OBJECTIVE: Primary aldosteronism (PA) is form of hypertension characterized by production of aldosterone by the adrenal that is excessive and relatively autonomous of the renin-angiotensin system. Once detected, unilateral PA can be usually cured by surgical removal of the affected adrenal, while bilateral PA can be specifically treated by medications, which antagonize aldosterone action. Clinical guidelines of Endocrine Societies in Europe and the US recommend screening for PA among most hypertensive patients...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27754199/js-ish-eccr-4-the-plasma-aldosterone-angiotensin-ii-ratio-for-the-screening-of-secondary-hypertension
#11
Marko Poglitsch
Primary aldosteronism (PA) is severe form of hypertension characterized by a strongly increased aldosterone secretion mediated by adenomas or other forms of adrenal hyper-activity. Once detected, PA can be usually cured by either surgical intervention or by appropriate pharmacologic treatments. The incidence of PA among hypertensive patients varies strongly between different studies, which is in part caused by the complex state-of-the-art testing procedure that is unfortunately far away from being a versatile PA screening tool...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27754198/js-ish-eccr-3-a-novel-algorithm-for-the-case-detection-of-the-most-common-form-of-endocrine-hypertension
#12
Gian Paolo Rossi
Primary aldosteronism (PA) involves more than 11% of patients referred to specialized hypertension centers and, therefore, is much more common than commonly held. Moreover, it causes a damage to the heart, blood vessels and kidneys, which translates into a high rate of cardiovascular events, in excess to the degree of blood pressure raise. Along with the notion that a timely diagnosis entails a fundamental step for the choice of an appropriate therapy, which can correct the arterial hypertension and the hypokalemia, this justifies efforts to search for PA in the majority of the patients with hypertension...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27754085/os-19-08-the-activated-intrarenal-renin-angiotensin-systems-and-oxidative-stress-in-tubular-can-be-the-original-mechanism-of-renal-damage-in-primary-aldosteronism
#13
Yoshitsugu Iwakura, Ryo Morimoto, Kumi Kikuchi, Yoshikiyo Ono, Yuta Tezuka, Yasuko Tsukada, Masahiro Nezu, Yasuhiro Igarashi, Masataka Kudo, Akira Nishiyama, Sadayoshi Ito, Fumitoshi Satoh
OBJECTIVE: High prevalence of renal damage has been demonstrated in patients with primary aldosteronism (PA). However, the original mechanism and onset still be elucidated. The purpose of this study is to investigate the possible original mechanisms of renal damages in PA. DESIGN AND METHOD: Consecutive 72 patients with aldosterone producing adenoma (APA) and 70 patients with essential hypertension (EH) participated. No patients had renal damages defined as eGFR (based on Cystatin C) < 60 ml/min/1...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27751767/immunohistochemistry-of-aldosterone-synthase-leads-the-way-to-the-pathogenesis-of-primary-aldosteronism
#14
Koshiro Nishimoto, Minae Koga, Tsugio Seki, Kenji Oki, Elise P Gomez-Sanchez, Celso E Gomez-Sanchez, Mitsuhide Naruse, Tomokazu Sakaguchi, Shinya Morita, Takeo Kosaka, Mototsugu Oya, Tadashi Ogishima, Masanori Yasuda, Makoto Suematsu, Yasuaki Kabe, Masao Omura, Tetsuo Nishikawa, Kuniaki Mukai
Our group previously purified human and rat aldosterone synthase (CYP11B2 and Cyp11b2, respectively) from their adrenals and verified that it is distinct from steroid 11β-hydroxylase (CYP11B1 or Cyp11b1), the cortisol- or corticosterone-synthesizing enzyme. We now describe their distributions immunohistochemically with specific antibodies. In rats, there is layered functional zonation with the Cyp11b2-positive zona glomerulosa (ZG), Cyp11b1-positive zona fasciculata (ZF), and Cyp11b2/Cyp11b1-negative undifferentiated zone between the ZG and ZF...
October 14, 2016: Molecular and Cellular Endocrinology
https://www.readbyqxmd.com/read/27729216/cacna1h-mutations-are-associated-with-different-forms-of-primary-aldosteronism
#15
Georgios Daniil, Fabio L Fernandes-Rosa, Jean Chemin, Iulia Blesneac, Jacques Beltrand, Michel Polak, Xavier Jeunemaitre, Sheerazed Boulkroun, Laurence Amar, Tim M Strom, Philippe Lory, Maria-Christina Zennaro
Primary aldosteronism (PA) is the most common form of secondary hypertension. Mutations in KCNJ5, ATP1A1, ATP2B3 and CACNA1D are found in aldosterone producing adenoma (APA) and familial hyperaldosteronism (FH). A recurrent mutation in CACNA1H (coding for Cav3.2) was identified in a familial form of early onset PA. Here we performed whole exome sequencing (WES) in patients with different types of PA to identify new susceptibility genes. Four different heterozygous germline CACNA1H variants were identified. A de novo Cav3...
October 4, 2016: EBioMedicine
https://www.readbyqxmd.com/read/27684853/comparison-between-adrenal-venous-sampling-and-computed-tomography-in-the-diagnosis-of-primary-aldosteronism-and-in-the-guidance-of-adrenalectomy
#16
Limin Zhu, Ying Zhang, Hua Zhang, Wenlong Zhou, Zhoujun Shen, Fangfang Zheng, Xiaofeng Tang, Bo Tao, Jin Zhang, Xiaohong Lu, Jianzhong Xu, Shaoli Chu, Dingliang Zhu, Pingjin Gao, Ji-Guang Wang
In our series of patients with primary aldosteronism, we compared diagnostic concordance and clinical outcomes after adrenalectomy between adrenal venous sampling (AVS) and computed tomography (CT) imaging.Our retrospective analysis included 886 patients with primary aldosteronism diagnosed in our hospital between 2005 and 2014. Of them, 269 patients with CT unilateral adrenal disease were included in the analysis on the diagnostic concordance and 126 patients with follow-up data in the analysis on clinical outcomes after adrenalectomy...
September 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27648962/aldosterone-producing-adenoma-with-a-somatic-kcnj5-mutation-revealing-apc-dependent-familial-adenomatous-polyposis
#17
Julien Vouillarmet, Fabio Fernandes-Rosa, Julia Graeppi-Dulac, Pierre Lantelme, Myriam Decaussin-Petrucci, Charles Thivolet, Jean-Louis Peix, Sheerazed Boulkroun, Eric Clauser, Maria-Christina Zennaro
CONTEXT: Recurrent somatic mutations in KCNJ5, CACNA1D, ATP1A1 and ATP2B3 have been identified in aldosterone producing adenomas (APA). The question as to whether they are responsible for both nodulation and aldosterone production is not solved. CASE DESCRIPTION: We describe the case of a young patient who was diagnosed with severe arterial hypertension due to primary aldosteronism at age 26, followed by hemorrhagic stroke four years later. Abdominal computed tomography showed bilateral macronodular adrenal hyperplasia...
September 20, 2016: Journal of Clinical Endocrinology and Metabolism
https://www.readbyqxmd.com/read/27643307/lbos-02-06-histopathological-specific-mutation-spectrum-of-aldosterone-producing-adenomas
#18
Elena Azizan, Norlela Sukor, Nor Azmi Kamaruddin, A Rahman A Jamal, Jiri Ceral, Miroslav Solar, Isa Mohamed Rose, Geok Chin Tan
OBJECTIVE: Aldosterone-producing adenoma (APA) is a common curable cause of hypertension. Somatic mutations in five genes (KCNJ5, ATP1A1, ATP2B3, CACNA1D, and CTNNB1) have been found to cause the excess aldosterone production of two thirds of APAs [1-4]. KCNJ5 mutant APAs, the most common and largest, had explicit genotype-phenotype relationship - a low protein expression of KCNJ5 relative to their peritumoural zona glomerulosa (ZG) and a zona fasciculata-like composition [5-6]. Conversely for the other genes, controversy arises on whether they have the opposite cell phenotype [4,7-8]...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27643214/os-35-09-long-term-outcome-of-surgically-and-medically-treated-patients-of-the-primary-aldosteronism-prevalence-in-hypertensives-papy-study
#19
Giuseppe Maiolino, Alberto Flego, Gian Paolo Rossi
OBJECTIVE: PA causes excess cardiovascular (CV) damage, but whether it worsens prognosis remained uncertain as there are no prospective studies. To compare long-term outcome of the 1125 patients recruited in the PAPY study. DESIGN AND METHOD: 11.2% of the PAPY study patients had PA: 6.4% idiopathic hyperaldosteronism (IHA) received medical therapy; 4,8% aldosterone-producing adenoma (APA) required adrenalectomy. Endpoints were total and CV mortality, major adverse cardiovascular events (MACE) and total CV events...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27643213/os-35-08-does-adrenocorticotropic-hormone-acth-administration-improve-the-diagnostic-performance-of-adrenal-vein-sampling-for-primary-aldosteronism
#20
Martin Wolley, Ashraf Ahmed, Richard Gordon, Michael Stowasser
OBJECTIVE: Adrenal vein sampling (AVS) is vital for determining treatment options for primary aldosteronism (PA), but is a difficult procedure. Adrenocorticotropic hormone (ACTH) infusion or bolus has been reported to improve AVS success rates by increasing cortisol secretion, but effects on aldosterone and thus lateralisation are controversial. We therefore aimed to determine the effects of ACTH on AVS in regard to success rates and lateralization. DESIGN AND METHOD: AVS was performed in the morning after overnight recumbency in patients with PA confirmed by fludrocortisone suppression testing...
September 2016: Journal of Hypertension
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