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Juyoung Pak, Hyoung Nam Lee, Myung Sub Kim, Hyerim Park
Primary aldosteronism is a group of disorders in which the autonomous secretion of aldosterone is associated with hypertension and hypokalemia. It is crucial to determine the laterality of aldosterone hypersecretion because treatment options differ accordingly. Adrenal venous sampling (AVS) is considered the most reliable method for assessing the laterality of primary aldosteronism. This procedure is often technically challenging because of the small size and varied locations of the adrenal veins. A better understanding of anatomical variations and careful review of imaging studies would improve sampling success...
March 2024: J Korean Soc Radiol
#2
JOURNAL ARTICLE
Jorge Gabriel Ruiz-Sánchez, Álvaro Fernández Sánchez, Diego Meneses
PURPOSE: Primary aldosteronism (PA), a frequent cause of hypertension, is highly associated with cardiovascular risk and mortality. PA diagnosis is often difficult due to the need to discontinue antihypertensive medication interfering with the renin-angiotensin-aldosterone system (I-RAAS). Our objective was to ascertain diagnosis of PA through biochemical assessments during screening while maintaining I-RAAS medications. METHODS: Hypertensive patients assessed for PA were involved...
April 3, 2024: Endocrine
#3
JOURNAL ARTICLE
Silas A Culver, Nawar Suleman, Varun Kavuru, Helmy M Siragy
The majority of disorders which cause renal potassium wasting present with abnormalities in adrenal hormone secretion. While these findings frequently lead patients to seek endocrine evaluation, clinicians often struggle to accurately diagnose these conditions, delaying treatment and adversely impacting patient care. At the same time, growing insight into the genetic and molecular basis of these disorders continues to improve their diagnosis and management. In this review we outline a practical integrated approach to the evaluation of renal hypokalemia syndromes that are seen in endocrine practice while highlighting recent advances in understanding of the genetics and pathophysiology behind them...
March 28, 2024: Journal of Clinical Endocrinology and Metabolism
#4
JOURNAL ARTICLE
Giovanni Pintus, Teresa Maria Seccia, Laurence Amar, Michel Azizi, Anna Riester, Martin Reincke, Jiří Widimský, Mitsuhide Naruse, Tomaz Kocjan, Aurelio Negro, Gregory Kline, Akiyo Tanabe, Fumitoshi Satoh, Lars Christian Rump, Oliver Vonend, Peter J Fuller, Jun Yang, Nicholas Yong Nian Chee, Steven B Magill, Zulfiya Shafigullina, Marcus Quinkler, Anna Oliveras, Bo-Ching Lee, Chin-Chen Chang, Vin-Cent Wu, Zuzana Krátká, Michele Battistel, Domenico Bagordo, Brasilina Caroccia, Giulio Ceolotto, Giacomo Rossitto, Gian Paolo Rossi
BACKGROUND: Current guidelines and consensus documents recommend withdrawal of mineralocorticoid receptor antagonists (MRAs) before primary aldosteronism (PA) subtyping by adrenal vein sampling (AVS), but this practice can cause severe hypokalemia and uncontrolled high blood pressure. Our aim was to investigate if unilateral PA can be identified by AVS during MRA treatment. METHODS: We compared the rate of unilateral PA identification between patients with and without MRA treatment in large data sets of patients submitted to AVS while off renin-angiotensin system blockers and β-blockers...
March 25, 2024: Hypertension
#5
JOURNAL ARTICLE
Kazutaka Nanba, Amy R Blinder, Aaron M Udager, Yuusuke Hirokawa, Takayoshi Miura, Hiroshi Okuno, Koki Moriyoshi, Yuto Yamazaki, Hironobu Sasano, Akihiro Yasoda, Noriko Satoh-Asahara, William E Rainey, Tetsuya Tagami
Double somatic mutations in CTNNB1 and GNA11/Q have recently been identified in a small subset of aldosterone-producing adenomas (APAs). As a possible pathogenesis of APA due to these mutations, an association with pregnancy, menopause, or puberty has been proposed. However, because of its rarity, characteristics of APA with these mutations have not been well characterized. A 46-year-old Japanese woman presented with hypertension and hypokalemia. She had two pregnancies in the past but had no history of pregnancy-induced hypertension...
2024: Frontiers in Endocrinology
#6
REVIEW
Marta Araujo-Castro, Paola Parra, Patricia Martín Rojas-Marcos, Miguel Paja Fano, Marga González Boillos, Eider Pascual-Corrales, Ana María García Cano, Jorge Gabriel Ruiz-Sanchez, Almudena Vicente Delgado, Emilia Gómez Hoyos, Rui Ferreira, Iñigo García Sanz, Mònica Recasens Sala, Rebeca Barahona San Millan, María José Picón César, Patricia Díaz Guardiola, Carolina M Perdomo, Laura Manjón-Miguélez, Rogelio García Centeno, Ángel Rebollo Román, Paola Gracia Gimeno, Cristina Robles Lázaro, Manuel Morales-Ruiz, María Calatayud, Simone Andree Furio Collao, Diego Meneses, Miguel Sampedro Nuñez, Verónica Escudero Quesada, Elena Mena Ribas, Alicia Sanmartín Sánchez, Cesar Gonzalvo Diaz, Cristina Lamas, María Del Castillo Tous, Joaquín Serrano Gotarredona, Theodora Michalopoulou Alevras, Eva María Moya Mateo, Felicia A Hanzu
PURPOSE: To compare the clinical and hormonal characteristics of patients with familial hyperaldosteronism (FH) and sporadic primary aldosteronism (PA). METHODS: A systematic review of the literature was performed for the identification of FH patients. The SPAIN-ALDO registry cohort of patients with no suspicion of FH was chosen as the comparator group (sporadic group). RESULTS: A total of 360 FH (246 FH type I, 73 type II, 29 type III, and 12 type IV) cases and 830 sporadic PA patients were included...
2024: Frontiers in Endocrinology
#7
Elisabete Brum de Sousa, Maria do Mar Menezes, Ana Maria Cordeiro
Primary aldosteronism, the most common curable form of secondary hypertension, is associated with greater hypertension-related organ damage and cardiovascular complications compared to primary essential hypertension. The authors present a case involving a 41-year-old Black male admitted to the emergency department with left hemiparesis and blurred vision persisting for one hour, accompanied by markedly elevated blood pressure (220/140 mmHg). The patient was asymptomatic by then, and, aside from a history of tobacco smoking and occasional cannabis use, lacked significant medical comorbidities...
February 2024: Curēus
#8
JOURNAL ARTICLE
Wasita W Parksook, Jenifer M Brown, Kei Omata, Yuta Tezuka, Yoshikiyo Ono, Fumitoshi Satoh, Laura C Tsai, Yvonne Niebuhr, Julia Milks, Anna Moore, Brooke Honzel, Haiping Liu, Richard J Auchus, Sarat Sunthornyothin, Adina F Turcu, Anand Vaidya
CONTEXT: Primary aldosteronism is a form of low-renin hypertension characterized by dysregulated aldosterone production. OBJECTIVE: To investigate the contributions of renin-independent aldosteronism, and ACTH-mediated aldosteronism, in individuals with a low-renin phenotype representing the entire continuum of blood pressure.. DESIGN/PARTICIPANTS: Human physiology study of 348 participants with a low-renin phenotype with severe and/or resistant hypertension, hypertension with hypokalemia, elevated blood pressure and stage I/II hypertension, and normal blood pressure...
March 7, 2024: Journal of Clinical Endocrinology and Metabolism
#9
JOURNAL ARTICLE
Hui Dong, Yujie Zuo, Xuanqi An, Hongwu Li, Zhihao Zheng, Yang Chen, Yubao Zou, Xiongjing Jiang
Juxtaglomerular cell tumors (JGCTs) or reninoma are rare kidney tumors leading to secondary hypertension, and the non-specific clinical manifestations bring about challenges to the diagnosis. This study is to summarize the clinical features, laboratory findings, and treatment of JGCTs. The PubMed, EMBASE database, and manual search were utilized to find all cases, and 158 reports containing 261 patients were identified. Data on patients' demographics, clinical features, diagnostic methods, and treatment options were collected and analyzed...
March 4, 2024: Hypertension Research: Official Journal of the Japanese Society of Hypertension
#10
JOURNAL ARTICLE
T Golani, J Bleier, A Kaplan, T Hod, Y Sharabi, A Leibowitz, E Grossman, G Shlomai
BACKGROUND: The saline infusion test (SIT) to confirm primary aldosteronism requires infusing two liters of normal saline over 240 minutes. Previous studies raised concerns regarding increased blood pressure and worsening hypokalemia during SIT. We aimed to evaluate the diagnostic applicability of a SIT that requires one liter of saline infusion over 120 minutes. METHODS: A cross-sectional study, including all patients in a large medical center who underwent SIT from January 1st, 2015, to April 30th, 2023...
February 20, 2024: American Journal of Hypertension
#11
Yohsuke Ohkubo, Yasuho Shimada, Hiroki Tanaka, Masanori Yamazaki, Mitsuhisa Komatsu
Adrenocortical carcinoma (ACC) is a rare disease with a poor prognosis, which essentially needs an early diagnosis because surgery is the only hope of a cure. On the other hand, primary aldosteronism (PA) is an overproduction of aldosterone from the adrenal glands and is known as one of the most common causes of secondary hypertension and hypokalemia. It is mostly a benign disease. ACC accompanied by PA is extremely rare, which can result in delayed diagnosis and clinical pitfalls. A 56-year-old woman was diagnosed with PA...
January 2024: Curēus
#12
JOURNAL ARTICLE
Granhøj Jeff, Nøhr Thomas K, Hinrichs Gitte R, Rasmussen Maria, Svenningsen Per
BACKGROUND: Liddle syndrome was initially characterized by hypertension, hypokalemia, metabolic alkalosis, and suppressed plasma renin and aldosterone, resulting from gain-of-function variants in the epithelial Na+ channel (ENaC). Efficient treatment with ENaC inhibitors is available, but the phenotypic spectrum of genetically confirmed Liddle syndrome is unknown, and some patients may remain undiagnosed and risk inefficient treatment. Here, we used a reverse-phenotyping approach to investigate the Liddle syndrome phenotypic spectrum and genotype-phenotype correlations...
January 24, 2024: Clinical Journal of the American Society of Nephrology: CJASN
#13
Yunuo Zhang, Wenjuan Ni, Wei Wang
BACKGROUND: Primary aldosteronism (PA) is one of the main causes of secondary endocrine hypertension, especially refractory hypertension. Increased autonomous secretion leads to increased blood pressure and proinflammatory effects on different organ systems, including the cardiovascular system. However, because of its diverse clinical manifestations or the combination of other conditions, it sometimes causes problems for correct diagnosis. Therefore, we report and review the characteristics of some atypical and uncommon special case cases related to proaldosterone to provide clinical ideas for correct diagnosis and decision-making of proaldosterone...
2024: AME Case Reports
#14
Martina Antonello, Sabrina Dalla Mora, Leonardo A Sechi, Andrea Da Porto
Takayasu's arteritis is a rare vasculitis characterized by granulomatous inflammation of the large vessels, typically occurring in the second or third decade of life and preferentially affecting females. It commonly involves large vessels such as the aorta and its major branches (carotid and iliac arteries). Visceral arterial involvement is uncommon and reported in only a minority of patients. Clinical manifestations of Takayasu arteritis are heterogeneous and could include nonspecific symptoms such as fever of unknown origin, asthenia, myalgias, intermittent claudication, angina, and mild arterial hypertension...
December 2023: Curēus
#15
JOURNAL ARTICLE
Suranut Charoensri, Linda Bashaw, Cheryl Dehmlow, Tammy Ellies, Jennifer Wyckoff, Adina F Turcu
IMPORTANCE: Primary aldosteronism (PA) is a common cause of secondary hypertension and an independent risk factor for cardiovascular morbidity and mortality. Fewer than 2% to 4% of patients at risk are evaluated for PA. OBJECTIVE: To develop and evaluate an electronic health record best-practice advisory (BPA) that assists with PA screening. DESIGN, SETTING, AND PARTICIPANTS: This prospective quality improvement study was conducted at academic center outpatient clinics...
January 8, 2024: JAMA Internal Medicine
#16
REVIEW
Sharmin Jahan, Jun Yang, Jinbo Hu, Qifu Li, Peter J Fuller
Primary aldosteronism (PA) is the most common cause of endocrine hypertension and is often underdiagnosed. This condition is associated with increased cardiovascular morbidity and mortality in comparison to age and blood pressure matched individuals with essential hypertension (EH). The diagnostic pathway for PA consists of three phases: screening, confirmatory testing, and subtyping. The lack of specificity in the screening step, which relies on the aldosterone to renin ratio, necessitates confirmatory testing...
March 1, 2024: Endocrine Connections
#17
JOURNAL ARTICLE
Tao Liu, Wenhong Wang, Zhufeng Liu, Guanghua Pei, Chunxiang Wang, Ying Jiang, Chuyue Pang
A 3-year-old female patient with no significant medical history presented to her pediatrician with foamy urine. Initial testing revealed moderate proteinuria on qualitative testing, although she was incidentally noted to have severe hypertension (240/200 mmHg). Physical examination of the carotid and femoral areas revealed significant systolic vascular murmurs. Labs showed elevated serum creatinine, hypokalemia, metabolic alkalosis, elevated renin and aldosterone and hypercalciuria. Echocardiography identified ventricular hypertrophy...
January 2, 2024: Pediatric Nephrology
#18
JOURNAL ARTICLE
Inês Manique, Sara Amaral, Alexandra Matias, Bruno Bouça, Salomé Serranito, João Torres, Olga Gutu, Tiago Bilhim, Élia Coimbra, Isaura Rodrigues, Conceição Godinho, Luísa Cortez, José Silva-Nunes
INTRODUCTION: Primary aldosteronism is the most common cause of secondary hypertension. Adrenal vein sampling is the gold standard for subtyping primary aldosteronism. However, this procedure is technically challenging and often has a low success rate. Our center is one of the very few performing this technique in our country with an increasing experience. OBJECTIVE: The aim of this study was to evaluate the role of the cortisol intraprocedural assay in improving the performance of adrenal vein sampling...
2023: International Journal of Endocrinology
#19
JOURNAL ARTICLE
Gaytri Gupta, Ada E D Teo, Du Soon Swee, Lih Ming Loh, Matthew Chuah, Wann Jia Loh, Seyed Ehsan Saffari, Xuan Han Koh, Peng Chin Kek, Troy H Puar
INTRODUCTION: Primary Aldosteronism (PA) is a common cause of hypertension. However, diagnosis is often delayed, leading to poorer clinical outcomes. Hypokalemia with hypertension is characteristic of PA, and is an indication for screening. We evaluated if patients with PA had prolonged hypokalemia before diagnosis, the subsequent biochemical/clinical control, and factors associated with delayed diagnosis. METHODS: Our study included all PA patients with hypokalemia diagnosed between 2001 to 2022...
December 22, 2023: Journal of Clinical Endocrinology and Metabolism
#20
JOURNAL ARTICLE
Francesca Torresan, Federico Bernardo Rossi, Sofia Zanin, Ilaria Caputo, Brasilina Caroccia, Maurizio Iacobone, Gian Paolo Rossi
UNLABELLED: INTRODUCTION: This study will test the hypothesis that primary aldosteronism (PA) involves alterations in Na+ , K+ , and water content in the skin that are corrected by adrenalectomy. AIM AND METHODS: In skin biopsies, we will measure the content of Na+ , K+ , water, by physical-chemical methods and the osmotic-stress-responsive transcription factor Tonicity-responsive Enhancer Binding Protein (TonEBP, NFAT5) mRNA copy number by droplet digital PCR, in sex-balanced cohorts of 18 -75-year-old consecutive consenting patients with unilateral and bilateral PA, primary (essential) hypertension, and normotension...
December 21, 2023: High Blood Pressure & Cardiovascular Prevention: the Official Journal of the Italian Society of Hypertension
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