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diagnosis of primary aldosteronism

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https://www.readbyqxmd.com/read/29757946/role-of-venous-sampling-in-the-diagnosis-of-endocrine-disorders
#1
REVIEW
Ryan W England, Eliza B Geer, Amy R Deipolyi
Venous sampling is the gold standard for localizing abnormal hormone secretion in several endocrine disorders. The most common indication for venous sampling is in the workup of primary aldosteronism, adrenocorticotropic hormone-dependent Cushing's syndrome, and hyperparathyroidism. In experienced hands, venous sampling is safe and accurate. This review discusses the role of venous sampling in the workup of endocrine disease, describing the underlying anatomy and pathophysiology, as an understanding of these concepts is essential for technical and clinical success...
May 14, 2018: Journal of Clinical Medicine
https://www.readbyqxmd.com/read/29742971/insufficiency-of-the-zona-glomerulosa-of-the-adrenal-cortex-and-progressive-kidney-insufficiency-following-unilateral-adrenalectomy-case-report-and-discussion
#2
Joanna Kanarek-Kucner, Adrian Stefański, Rufus Barraclough, Tomasz Gorycki, Jacek Wolf, Krzysztof Narkiewicz, Michał Hoffmann
BACKGROUND: Primary aldosteronism (PA) is the most common cause of secondary hypertension and bilateral adrenal hyperplasia (BAH) and aldosterone-producing adenoma (APA) seem to be the most common causes of PA. Unilateral adrenalectomy (UA) is the preferred treatment for APA, although the benefits are still difficult to assess. CASE REPORT: We present a case report of a 69-year old man with a 30 year history of hypertension and probably long-standing PA due to APA, with typical organ complications...
May 9, 2018: Blood Pressure
https://www.readbyqxmd.com/read/29737255/should-all-hypertensive-patients-be-screened-for-primary-aldosteronism
#3
Stelina Alkagiet, Konstantinos Tziomalos
Primary aldosteronism (PA) is not only a leading cause of secondary and resistant hypertension, but is also quite frequent in unselected hypertensive patients. Moreover, PA is associated with increased cardiovascular risk, which is disproportionate to BP levels. In addition, timely diagnosis of PA and prompt initiation of treatment attenuates this increased risk. On the other hand, there are limited data regarding the usefulness of screening for PA in all asymptomatic or normokalemic hypertensive patients. More importantly, until now, no well-organized, large-scale, prospective, randomized controlled trial has proved the effectiveness of screening for PA for improving clinical outcome...
May 7, 2018: Current Hypertension Reviews
https://www.readbyqxmd.com/read/29709936/clinical-investigation-of-adrenal-incidentalomas-in-japanese-patients-of-the-fukuoka-region-with-updated-diagnostic-criteria-for-sub-clinical-cushing-s-syndrome
#4
Ichiro Abe, Kaoru Sugimoto, Tetsumasa Miyajima, Tomoko Ide, Midori Minezaki, Kaori Takeshita, Saori Takahara, Midori Nakagawa, Yuki Fujimura, Tadachika Kudo, Shigero Miyajima, Hiroshi Taira, Kenji Ohe, Tatsu Ishii, Toshihiko Yanase, Kunihisa Kobayashi
Objectives We retrospectively investigated the clinical and endocrinological characteristics of adrenal incidentalomas. Methods We studied 61 patients who had been diagnosed with adrenal incidentalomas and had undergone detailed clinical and endocrinological evaluations while hospitalized. We used common criteria to diagnose the functional tumors, but for sub-clinical Cushing's syndrome, we used an updated set of diagnosis criteria: serum cortisol ≥1.8 μg/dL after a positive response to a 1-mg dexamethasone suppression test if the patient has a low morning ACTH level (<10 pg/mL) and a loss of the diurnal serum cortisol rhythm...
April 27, 2018: Internal Medicine
https://www.readbyqxmd.com/read/29674485/management-of-endocrine-disease-diagnosis-and-management-of-primary-aldosteronism-the-endocrine-society-guideline-2016-revisited
#5
Tracy Ann Williams, Martin Reincke
The syndrome of primary aldosteronism (PA) is characterized by hypertension with excessive, autonomous aldosterone production and is usually caused by either a unilateral aldosterone-producing adenoma (APA) or bilateral adrenal hyperplasia (BAH). The diagnostic workup of PA is a sequence of three phases comprising screening tests, confirmatory tests and the differentiation of unilateral from bilateral forms. The latter step is necessary to determine the optimal treatment approach of unilateral laparoscopic adrenalectomy (for patients with unilateral PA) or medical treatment with a mineralocorticoid receptor antagonist (for patients with bilateral PA)...
April 19, 2018: European Journal of Endocrinology
https://www.readbyqxmd.com/read/29629943/primary-aldosteronism-in-the-primary-care-setting
#6
Fabrizio Buffolo, Silvia Monticone, Martina Tetti, Paolo Mulatero
PURPOSE OF REVIEW: The aim of the present manuscript is to provide an overview of the most updated studies on the prevalence of primary aldosteronism in primary care and to compare these figures with the actual rate of diagnosis in clinical practice and with the prevalence of primary aldosteronism in specific subgroup of patients. RECENT FINDINGS: Over the last 20 years the clinical spectrum of low renin hypertension and primary aldosteronism has changed dramatically...
June 2018: Current Opinion in Endocrinology, Diabetes, and Obesity
https://www.readbyqxmd.com/read/29528872/case-detection-in-primary-aldosteronism-high-diagnostic-value-of-the-aldosterone-to-renin-ratio-when-performed-under-standardized-conditions
#7
Wessel M C M Vorselaars, Gerlof D Valk, Menno R Vriens, Jan Westerink, Wilko Spiering
OBJECTIVE: The aldosterone-to-renin ratio is widely used and is the recommended screening modality for primary aldosteronism by the Endocrine Society Guideline. However, studies on its diagnostic accuracy have been inconsistent, which is mainly because of methodological limitations. We set out to evaluate this diagnostic value by using a highly standardized study protocol, which is in line with the Endocrine Society Guideline recommendations regarding indications for screening, testing conditions and reference standards in daily clinical practice...
March 9, 2018: Journal of Hypertension
https://www.readbyqxmd.com/read/29464741/accuracy-of-adrenal-computed-tomography-in-predicting-the-unilateral-subtype-in-young-patients-with-hypokalaemia-and-elevation-of-aldosterone-in-primary-aldosteronism
#8
Hironobu Umakoshi, Tatsuki Ogasawara, Yoshiyu Takeda, Isao Kurihara, Hiroshi Itoh, Takuyuki Katabami, Takamasa Ichijo, Norio Wada, Yui Shibayama, Takanobu Yoshimoto, Yoshihiro Ogawa, Junji Kawashima, Masakatsu Sone, Nobuya Inagaki, Katsutoshi Takahashi, Minemori Watanabe, Yuichi Matsuda, Hiroki Kobayashi, Hirotaka Shibata, Kohei Kamemura, Michio Otsuki, Yuichi Fujii, Koichi Yamamto, Atsushi Ogo, Toshihiko Yanase, Shintaro Okamura, Shozo Miyauchi, Tomoko Suzuki, Mika Tsuiki, Mitsuhide Naruse
CONTEXT: The current Endocrine Society Guideline suggests that patients aged <35 years with marked primary aldosteronism (PA) and unilateral adrenal lesions on adrenal computed tomography (CT) scan may not need adrenal vein sampling (AVS) before proceeding to unilateral adrenalectomy. This suggestion is, however, based on the data from only one report in the literature. OBJECTIVE: We sought to determine the accuracy of CT findings in young PA patients who had unilateral adrenal disease on CT with hypokalaemia and elevation of aldosterone...
May 2018: Clinical Endocrinology
https://www.readbyqxmd.com/read/29453922/a-short-review-of-primary-aldosteronism-in-a-question-and-answer-fashion
#9
Frederick-Anthony Farrugia, Nicolaos Zavras, Georgios Martikos, Panagiotis Tzanetis, Anestis Charalampopoulos, Evangelos P Misiakos, Dimitrios Sotiropoulos, Nikolaos Koliakos
OBJECTIVES: The aim of this study was to present up to date information concerning the diagnosis and treatment of primary aldosteronism (PA). PA is the most common cause of endocrine hypertension. It has been reported up to 24% of selective referred hypertensive patients. METHODS: We did a search in Pub-Med and Google Scholar using the terms: PA, hyperaldosteronism, idiopathic adrenal hyperplasia, diagnosis of PA, mineralocorticoid receptor antagonists, adrenalectomy, and surgery...
January 1, 2018: Endocrine Regulations
https://www.readbyqxmd.com/read/29437744/can-aldosterone-break-your-heart-takotsubo-cardiomyopathy-in-a-patient-with-newly-diagnosed-primary-aldosteronism
#10
Dominika M Zoltowska, Yashwant Agrawal, Jagadeesh K Kalavakunta
We report a case of a 47-year-old Caucasian woman with medical history of hypertension and hypokalemia, who presented to Emergency Room with symptoms resembling acute coronary syndrome ST-segment elevation myocardial infarction. Coronary angiogram revealed clear coronary arteries and left ventriculogram confirmed the diagnosis of Takotsubo cardiomyopathy. She was treated conservatively with good clinical outcome. Subsequent testing revealed underlying primary aldosteronism.
February 5, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29432258/overview-of-aldosterone-related-genetic-syndromes-and-recent-advances
#11
Maria-Christina Zennaro, Fabio L Fernandes-Rosa, Sheerazed Boulkroun
PURPOSE OF REVIEW: Primary aldosteronism is the most common form of secondary hypertension. Early diagnosis and treatment are key to cure of hypertension and prevention of cardiovascular complications. Recent genetic discoveries have improved our understanding on the pathophysiology of aldosterone production and triggered the development of new diagnostic procedures and targeted treatments for primary aldosteronism. RECENT FINDINGS: Different inherited genetic abnormalities distinguish specific forms of familial hyperaldosteronism...
June 2018: Current Opinion in Endocrinology, Diabetes, and Obesity
https://www.readbyqxmd.com/read/29409357/macrolides-for-kcnj5-mutated-aldosterone-producing-adenoma-mapa-design-of-a-study-for-personalized-diagnosis-of-primary-aldosteronism
#12
Giuseppe Maiolino, Giulio Ceolotto, Michele Battistel, Giulio Barbiero, Maurizio Cesari, Laurence Amar, Brasilina Caroccia, Roberto Padrini, Michel Azizi, Gian Paolo Rossi
PURPOSE: Aldosterone-producing adenoma (APA) is the main curable cause of endocrine hypertension cause of primary aldosteronism (PA) and it is in up to 66% of all cases investigated with adrenal vein sampling (AVS). Mutations in the KCNJ5 potassium channel involve up to 70% of APA and cause the most florid PA phenotypes. The recent finding that macrolide antibiotics specifically inhibit in vitro the altered function of mutated KCNJ5 channels has opened new horizons for the diagnosis and treatment of APA with KCNJ5 mutations in that it can allow identification and target treatment of PA patients harbouring a mutated APA...
February 6, 2018: Blood Pressure
https://www.readbyqxmd.com/read/29357735/niche-point-of-care-endocrine-testing-reviews-of-intraoperative-parathyroid-hormone-and-cortisol-monitoring
#13
Li-Sheng Chen, Ravinder J Singh
Point-of-care (POC) testing, which provides quick test results in near-patient settings with easy-to-use devices, has grown continually in recent decades. Among near-patient and on-site tests, rapid intraoperative and intra-procedural assays are used to quickly deliver critical information and thereby improve patient outcomes. Rapid intraoperative parathyroid hormone (ioPTH) monitoring measures postoperative reduction of parathyroid hormone (PTH) to predict surgical outcome in patients with primary hyperparathyroidism, and therefore contributes to the change of parathyroidectomy to a minimally invasive procedure...
March 2018: Critical Reviews in Clinical Laboratory Sciences
https://www.readbyqxmd.com/read/29335324/prevalence-of-primary-aldosteronism-in-primary-care-a-cross-sectional-study
#14
Sabine C Käyser, Jaap Deinum, Wim Jc de Grauw, Bianca Wm Schalk, Hans Jhj Bor, Jacques Wm Lenders, Tjard R Schermer, Marion Cj Biermans
BACKGROUND: Primary aldosteronism (PA) is the most frequent cause of secondary hypertension. Reported prevalences of PA vary considerably because of a large heterogeneity in study methodology. AIM: To examine the proportion of patients with PA among patients with newly diagnosed, never treated hypertension. DESIGN AND SETTING: A cross-sectional study set in primary care. METHOD: GPs measured aldosterone and renin in adult patients with newly diagnosed, never treated hypertension...
February 2018: British Journal of General Practice: the Journal of the Royal College of General Practitioners
https://www.readbyqxmd.com/read/29300995/evaluation-of-the-saline-infusion-test-and-the-captopril-challenge-test-in-chinese-patients-with-primary-aldosteronism
#15
Xiao Meng, Yanyan Li, Xiaohao Wang, Jianwei Li, Yuping Liu, Yerong Yu
Context: The aim of this study was to determine whether the diagnosis cutoff values associated with the saline infusion test (SIT) and captopril challenge test (CCT) in the Endocrine Society guidelines are applicable to Chinese subjects. Objective and Design: We performed a head-to-head comparison of the SIT and CCT among Chinese subjects with primary aldosteronism (PA) and essential hypertension (EH). Participants and Setting: One hundred sixty-four hypertensive patients were enrolled...
March 1, 2018: Journal of Clinical Endocrinology and Metabolism
https://www.readbyqxmd.com/read/29279502/giant-cavernous-hemangioma-of-the-adrenal-gland-in-an-elderly-patient
#16
Ayana Hashimoto, Hiroshi Yoshino, Fukumi Yoshikawa, Naoki Kumashiro, Yasuyo Ando, Fumito Yamabe, Yuri Akishima-Fukasawa, Naoko Honma, Hiroshi Uchino, Takahisa Hirose
Cavernous hemangioma is a rare, non-functional, benign adrenal tumor. Adrenal cavernous hemangioma is often diagnosed after surgery with a histologic examination. A 70-year-old man complaining of appetite loss was admitted to our hospital. An incidental large left adrenal mass was found by computed tomography (CT). There were no clinical signs of adrenogenital syndrome, Cushing's syndrome or primary aldosteronism. Total resection was carried out. The pathological diagnosis was cavernous hemangioma. The differentiation of adrenal tumor is necessary in cases of large tumors, and resection is desirable given the risks of hemorrhaging and rupture...
December 27, 2017: Internal Medicine
https://www.readbyqxmd.com/read/29279316/targeting-cxcr4-cxc-chemokine-receptor-type-4-for-molecular-imaging-of-aldosterone-producing-adenoma
#17
Britta Heinze, Carmina T Fuss, Paolo Mulatero, Felix Beuschlein, Martin Reincke, Mona Mustafa, Andreas Schirbel, Timo Deutschbein, Tracy Ann Williams, Yara Rhayem, Marcus Quinkler, Nada Rayes, Silvia Monticone, Vanessa Wild, Celso E Gomez-Sanchez, Anna-Carinna Reis, Stephan Petersenn, Hans-Juergen Wester, Saskia Kropf, Martin Fassnacht, Katharina Lang, Ken Herrmann, Andreas K Buck, Christina Bluemel, Stefanie Hahner
Primary aldosteronism is the most frequent cause of secondary hypertension and is associated with increased morbidity and mortality compared with hypertensive controls. The central diagnostic challenge is the differentiation between bilateral and unilateral disease, which determines treatment options. Bilateral adrenal venous sampling, currently recommended for differential diagnosis, is an invasive procedure with several drawbacks, making it desirable to develop novel noninvasive diagnostic tools. When investigating the expression pattern of chemokine receptors by quantitative real-time polymerase chain reaction and immunohistochemistry, we observed high expression of CXCR4 (CXC chemokine receptor type 4) in aldosterone-producing tissue in normal adrenals, adjacent adrenal cortex from adrenocortical adenomas, and in aldosterone-producing adenomas (APA), correlating strongly with the expression of CYP11B2 (aldosterone synthase)...
February 2018: Hypertension
https://www.readbyqxmd.com/read/29249599/analysis-of-postoperative-biochemical-values-and-clinical-outcomes-after-adrenalectomy-for-primary-aldosteronism
#18
Andrew J Swearingen, Bora Kahramangil, Rosebel Monteiro, Vikram Krishnamurthy, Judy Jin, Joyce Shin, Allan Siperstein, Eren Berber
BACKGROUND: Primary aldosteronism causes hypertension and hypokalemia and is often surgically treatable. Diagnosis includes elevated plasma aldosterone, suppressed plasma renin activity, and elevated aldosterone renin ratio. Adrenalectomy improves hypertension and hypokalemia. Postoperative plasma aldosterone and plasma renin activity may be useful in documenting cure or failure. METHOD: A retrospective analysis of patients who underwent adrenalectomy for primary aldosteronism from 2010 to 2016 was performed, analyzing preoperative and postoperative plasma aldosterone, plasma renin activity, hypertension, and hypokalemia...
April 2018: Surgery
https://www.readbyqxmd.com/read/29238437/persistent-primary-aldosteronism-despite-iatrogenic-adrenal-hemorrhage-after-adrenal-vein-sampling
#19
Keisuke Okamura, Tetsu Okuda, Kazuyuki Shirai, Ichiro Abe, Kunihisa Kobayashi, Tatsu Ishii, Seiji Haraoka, Hidenori Urata
Before surgery for primary aldosteronism (PA), localization is evaluated with adrenal vein sampling (AVS). A 56-year-old Japanese woman had a right adrenal mass, hypokalemia, and a high aldosterone/renin ratio. Stress tests confirmed the diagnosis of PA. Subsequently, preoperative AVS was performed and right adrenal hemorrhage (AH) occurred unexpectedly. Because hypertension persisted, laparoscopic right adrenalectomy was performed. Postoperatively, the blood pressure was normalized. Pathological examination revealed an adrenal cortical adenoma largely unaffected by necrosis and hemorrhage...
January 2018: Journal of Clinical Medicine Research
https://www.readbyqxmd.com/read/29202494/aldosterone-producing-cell-clusters-in-normal-and-pathological-states
#20
Kei Omata, Scott A Tomlins, William E Rainey
Primary aldosteronism (PA) significantly increases the risk of cardiovascular complications, and early diagnosis and targeted treatment based on its pathophysiology is warranted. Next-generation sequencing (NGS) has revealed recurrent somatic mutations in aldosterone-driving genes in aldosterone-producing adenoma (APA). By applying CYP11B2 (aldosterone synthase) immunohistochemistry and NGS to adrenal glands from normal subjects and PA patients, we and others have shown that CYP11B2-positive cells make small clusters, termed aldosterone-producing cell clusters (APCC), beneath the adrenal capsule, and that APCC harbor somatic mutations in genes mutated in APA...
December 2017: Hormone and Metabolic Research, Hormon- und Stoffwechselforschung, Hormones et Métabolisme
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