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Primary aldosteronism with normal aldosterone

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https://www.readbyqxmd.com/read/28416583/physiological-and-pathological-roles-in-human-adrenal-of-the-glomeruli-defining-matrix-protein-npnt-nephronectin
#1
Ada Ee Der Teo, Sumedha Garg, Timothy Isaac Johnson, Wanfeng Zhao, Junhua Zhou, Celso Enrique Gomez-Sanchez, Mark Gurnell, Morris Jonathan Brown
Primary aldosteronism is a common cause of hypertension, which becomes refractory if undiagnosed, but potentially curable when caused by an aldosterone-producing adenoma (APA). The discovery of somatic mutations and differences in clinical presentations led to recognition of small but common zona glomerulosa (ZG)-like adenomas, distinct from classical large zona fasciculata-like adenomas. The inverse correlation between APA size and aldosterone synthase expression prompted us to undertake a systematic study of genotype-phenotype relationships...
April 17, 2017: Hypertension
https://www.readbyqxmd.com/read/28378030/potassium-regulation-in-the-neonate
#2
Melvin Bonilla-Félix
Potassium, the major cation in intracelluar fluids, is essential for vital biological functions. Neonates maintain a net positive potassium balance, which is fundamental to ensure somatic growth but places these infants, especially those born prematurely, at risk for life-threatening disturbances in potassium concentration [K(+)] in the extracellular fluid compartment. Potassium conservation is achieved by maximizing gastrointestinal absorption and minimizing renal losses. A markedly low glomerular filtration rate, plus adaptations in tubular transport along the nephron, result in low potassium excretion in the urine of neonates...
April 4, 2017: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/28303624/effect-of-eplerenone-in-patients-with-heart-failure-and-reduced-ejection-fraction-potential-effect-modification-by-abdominal-obesity-insight-from-the-emphasis-hf-trial
#3
Arnaud Olivier, Bertram Pitt, Nicolas Girerd, Zohra Lamiral, Jean-Loup Machu, John J V McMurray, Karl Swedberg, Dirk J van Veldhuisen, Timothy J Collier, Stuart J Pocock, Patrick Rossignol, Faiez Zannad, Anne Pizard
AIMS: An excessive production of aldosterone influences outcome in patients with heart failure (HF) and in obese patients. Findings from laboratory studies suggest that chronic aldosterone blockade maybe more beneficial in abdominally obese HF-prone rats. In the current study, we investigated if the clinical response to a mineralocorticoid receptor antagonist in mildly symptomatic HF patients varied by abdominal obesity. METHODS AND RESULTS: A total of 2587 NYHA class II, reduced ejection fraction HF (HFrEF) patients enrolled in the EMPHASIS-HF trial were randomly assigned to eplerenone and placebo...
March 16, 2017: European Journal of Heart Failure
https://www.readbyqxmd.com/read/28299775/accuracy-of-adrenal-imaging-and-adrenal-venous-sampling-in-diagnosing-unilateral-primary-aldosteronism
#4
Roland Ladurner, Sandra Sommerey, Stefan Buechner, Anna Dietz, Christoph Degenhart, Klaus Hallfeldt, Julia Gallwas
INTRODUCTION: The correct differentiation between unilateral and bilateral adrenal involvement in patients with primary aldosteronism (PA) is of utmost importance to justify surgical treatment. The aim of this study was to determine the accuracy of adrenal imaging compared to adrenal venous sampling (AVS), histopathology and postoperative outcome. METHODS: The data of all patients with unequivocal AVS who underwent unilateral laparoscopic adrenalectomy for primary aldosteronism between May 2004 and April 2015 were entered in this retrospective study...
March 16, 2017: European Journal of Clinical Investigation
https://www.readbyqxmd.com/read/28289910/acid-base-disturbances-in-nephrotic-syndrome-analysis-using-the-co2-hco3-method-traditional-boston-model-and-the-physicochemical-method-stewart-model
#5
Tomomichi Kasagi, Hirokazu Imai, Naoto Miura, Keisuke Suzuki, Masabumi Yoshino, Hironobu Nobata, Takuhito Nagai, Shogo Banno
BACKGROUND: The Stewart model for analyzing acid-base disturbances emphasizes serum albumin levels, which are ignored in the traditional Boston model. We compared data derived using the Stewart model to those using the Boston model in patients with nephrotic syndrome. METHODS: Twenty-nine patients with nephrotic syndrome and six patients without urinary protein or acid-base disturbances provided blood and urine samples for analysis that included routine biochemical and arterial blood gas tests, plasma renin activity, and aldosterone...
March 13, 2017: Clinical and Experimental Nephrology
https://www.readbyqxmd.com/read/28202622/the-hypertension-pandemic-an-evolutionary-perspective
#6
REVIEW
Bernard C Rossier, Murielle Bochud, Olivier Devuyst
Hypertension affects over 1.2 billion individuals worldwide and has become the most critical and expensive public health problem. Hypertension is a multifactorial disease involving environmental and genetic factors together with risk-conferring behaviors. The cause of the disease is identified in ∼10% of the cases (secondary hypertension), but in 90% of the cases no etiology is found (primary or essential hypertension). For this reason, a better understanding of the mechanisms controlling blood pressure in normal and hypertensive patients is the aim of very active experimental and clinical research...
March 2017: Physiology
https://www.readbyqxmd.com/read/28129245/plasma-aldosterone-level-within-the-normal-range-is-less-associated-with-cardiovascular-and-cerebrovascular-risk-in-primary-aldosteronism
#7
Masahiko Murata, Tetsuhiro Kitamura, Daisuke Tamada, Kosuke Mukai, Shogo Kurebayashi, Tsunehiko Yamamoto, Kunihiko Hashimoto, Reiko D Hayashi, Haruhiko Kouhara, Sachi Takeiri, Yoshitaka Kajimoto, Makoto Nakao, Toshimitsu Hamasaki, Michio Otsuki, Iichiro Shimomura
BACKGROUND: Previous studies showed higher risk of cardiovascular and cerebrovascular (CCV) events in primary aldosteronism compared with essential hypertension, but the patients of these studies were limited to primary aldosteronism patients with high plasma aldosterone concentration (PAC). The introduction of the aldosterone-renin ratio as the screening test for primary aldosteronism led to the recognition of primary aldosteronism patients with normal PAC (nPA). However, there is no information on the risk of primary aldosteronism including nPA...
May 2017: Journal of Hypertension
https://www.readbyqxmd.com/read/28101185/hypokalemic-myopathy-in-primary-aldosteronism-a-case-report
#8
Chuifen Wu, Jun Xin, Minghua Xin, Hai Zou, Lie Jing, Caoyong Zhu, Wenhui Lei
Primary aldosteronism (PA) is a rare disorder. The majority of patients with PA present with typical features and are easily diagnosed. This disorder is usually diagnosed with hypokalemia, hypertension or an adrenal mass. However, patients with atypical symptoms may present a challenge for diagnosis and treatment. In the present study, a case of PA is described that presented with hypokalemic myopathy simulating polymyositis. The patient was a 44-year-old woman who presented with weakness and difficulty walking...
December 2016: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/28074381/adrenal-hormones-before-and-after-venography-during-adrenal-venous-sampling-a-self-controlled-study
#9
Yuya Koike, Seishi Matsui, Masao Omura, Kohzoh Makita, Alfonso W D Obara, Nobukazu Moriya, Tetsuo Nishikawa
OBJECTIVE: A stress reaction involving increased adrenal hormone release occurs when starting adrenal venous sampling (AVS). The purpose of the present study was to investigate the effect of single shot venography on adrenal hormone production during AVS. SUBJECTS AND METHODS: This was a prospective self-controlled study. We enrolled 54 consecutive patients (21 men, 33 women; mean age 52 ± 11 years) with primary aldosteronism who underwent AVS from May 2014 to February 2015...
March 2017: Japanese Journal of Radiology
https://www.readbyqxmd.com/read/27965370/genetic-characterization-of-a-mouse-line-with-primary-aldosteronism
#10
L G Perez-Rivas, Y Rhayem, S Sabrautzki, C Hantel, B Rathkolb, M Hrabě de Angelis, M Reincke, F Beuschlein, A Spyroglou
In an attempt to define novel genetic loci involved in the pathophysiology of primary aldosteronism, a mutagenesis screen after treatment with the alkylating agent N-ethyl-N-nitrosourea was established for the parameter aldosterone. One of the generated mouse lines with hyperaldosteronism was phenotypically and genetically characterized. This mouse line had high aldosterone levels but normal creatinine and urea values. The steroidogenic enzyme expression levels in the adrenal gland did not differ significantly among phenotypically affected and unaffected mice...
February 2017: Journal of Molecular Endocrinology
https://www.readbyqxmd.com/read/27957422/unmasked-chronic-renal-function-deterioration-after-unilateral-adrenalectomy-in-patients-with-primary-aldosteronism
#11
Su Min Park, Woo Jin Jung, Jong Man Park, Harin Rhee, Il Young Kim, Eun Young Seong, Dong Won Lee, Soo Bong Lee, Ihm Soo Kwak, Nari Shin, Sang Heon Song
We report 2 cases of chronic estimated glomerular filtration rate (eGFR) decline after unilateral adrenalectomy due to primary aldosteronism. The patients were diagnosed with unilateral adrenal cortical adenoma releasing aldosterone. Two patients were examined for hypertension and hypokalemia. Unilateral laparoscopic adrenalectomy was performed in both cases, and pathology confirmed adrenal cortical adenoma. After adrenalectomy, hypertension and hypokalemia improved to within normal range. However, the eGFR decreased postoperatively, and abdominal computed tomography scan showed decreased kidney size compared to previous images...
December 2016: Kidney Research and Clinical Practice
https://www.readbyqxmd.com/read/27836073/changes-in-the-renin-angiotensin-aldosterone-system-in-response-to-dietary-salt-intake-in-normal-and-hypertensive-pregnancy-a-randomized-trial
#12
Lise H Nielsen, Per Ovesen, Mie R Hansen, Steven Brantlov, Bente Jespersen, Peter Bie, Boye L Jensen
It was hypothesized that primary renal sodium retention blunted the reactivity of the renin-angiotensin-aldosterone system to changes in salt intake in preeclampsia (PE). A randomized, cross-over, double-blinded, dietary intervention design was used to measure the effects of salt tablets or placebo during low-salt diet in PE patients (n = 7), healthy pregnant women (n = 15), and nonpregnant women (n = 13). High-salt intake decreased renin and angiotensin II concentrations significantly in healthy pregnant women (P < ...
November 2016: Journal of the American Society of Hypertension: JASH
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
#13
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/27753896/os-01-05-high-aldosterone-renin-ratio-arr-is-associated-with-the-development-of-essential-hypertension-from-white-coat-hypertension
#14
Ami Kwon, Woo-Baek Chung, Tae-Hoon Kim, Suk Min Suh, Eun Ho Chu, Sung-Won Jang, GeeHee Kim, Sang Hyun Ihm
OBJECTIVE: There are many reports about white coat hypertension (WCH), still the clinical significance and pathophysiology of WCH is ambiguous. The aim of this study was to find out the difference of RAAS activity in WCH compared with the essential hypertension (EH) group, which could suggest the role of RAAS activity in the development of WCH. DESIGN AND METHOD: Never treated hypertension patients who visited 8 hospitals of The Catholic University of Korea from January 2011 through July 2012 were enrolled...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27753830/sy-03-3-overview-of-somatic-mutations-and-epigenetic-regulation-of-aldosterone-producing-adenoma-apa
#15
Satoshi Umemura
Primary aldosteronism (PA) is a heterogeneous group of disorders including both sporadic and familial forms (familial hyperaldosteronism type I, II and III). PA is the most frequent endocrine cause of secondary hypertension and associated with a higher rate of cardiovascular complications, compared with essential hypertension.Here I review the recent progress in understanding of the genetic and molecular mechanisms leading to autonomous aldosterone production in PA.Systematic screening detects primary aldosteronism in 5 to 10% of all patients with hypertension and in approximately 20% of patients with resistant hypertension...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27748964/volumetric-and-densitometric-evaluation-of-the-adrenal-glands-in-patients-with-primary-aldosteronism
#16
Christoph Degenhart, Julia Schneller, Andrea Osswald, Anna Pallauf, Anna Riester, Maximilian F Reiser, Martin Reincke, Felix Beuschlein
OBJECTIVE: To evaluate volumetric and densitometric properties of the adrenal glands in patients with unilateral and bilateral disease in comparison with normal controls. DESIGN: A total of 77 patients (56 males and 21 females) diagnosed with primary aldosteronism (PA) with a mean age of 53 ± 10 years were prospectively enrolled. Unenhanced and contrast-enhanced computed tomography scans were analysed for adrenal volumes and mean densities. These values were compared with normal controls and between PA subtypes...
March 2017: Clinical Endocrinology
https://www.readbyqxmd.com/read/27678389/volume-regulatory-hormones-and-plasma-volume-in-pregnant-women-with-sickle-cell-disorder
#17
Bosede B Afolabi, Olajumoke O Oladipo, Alani S Akanmu, Olalekan O Abudu, Olusoga A Sofola, Fiona Broughton Pipkin
BACKGROUND: Sickle cell disease (haemoglobin SS (HbSS)) mainly affects those of West African origin and is associated with hypervolaemia. Plasma volume rises by up to 50% in normal pregnancy but was previously found to be paradoxically contracted in late sickle cell pregnancy. The renin-angiotensin-aldosterone system is activated very early in human pregnancy to support the plasma volume expansion. We hypothesised that activation of the renin-angiotensin-aldosterone system would be blunted in pregnant women with sickle cell disease...
July 2016: Journal of the Renin-angiotensin-aldosterone System: JRAAS
https://www.readbyqxmd.com/read/27648962/aldosterone-producing-adenoma-with-a-somatic-kcnj5-mutation-revealing-apc-dependent-familial-adenomatous-polyposis
#18
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/27643242/os-01-05-high-aldosterone-renin-ratio-arr-is-associated-with-the-development-of-essential-hypertension-from-white-coat-hypertension
#19
Ami Kwon, Woo-Baek Chung, Tae-Hoon Kim, Suk Min Suh, Eun Ho Chu, Sung-Won Jang, GeeHee Kim, Sang Hyun Ihm
OBJECTIVE: There are many reports about white coat hypertension (WCH), still the clinical significance and pathophysiology of WCH is ambiguous. The aim of this study was to find out the difference of RAAS activity in WCH compared with the essential hypertension (EH) group, which could suggest the role of RAAS activity in the development of WCH. DESIGN AND METHOD: Never treated hypertension patients who visited 8 hospitals of The Catholic University of Korea from January 2011 through July 2012 were enrolled...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27643155/js-ish-eccr-3-a-novel-algorithm-for-the-case-detection-of-the-most-common-form-of-endocrine-hypertension
#20
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
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