1
|
Shen Z, Xu S, Guan S, Chen B, Li Q, Yu M, Gao Z. Utility of right adrenal signature veins in venous sampling for primary aldosteronism. Ann Med 2023; 55:2234934. [PMID: 37452706 PMCID: PMC10351465 DOI: 10.1080/07853890.2023.2234934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND This study aimed to identify the appropriate signature veins for the right adrenal gland using a 3D model fused with adrenal venography images and to verify their accuracy through the selectivity index (SI) >2. METHODS We analyzed the right adrenal venography images of 41 patients who underwent adrenal venous sampling (AVS). These images were merged with a 3D structure of the adrenal gland to identify the signature veins of the right adrenal gland. We then used the signature veins observed during adrenal venography to determine the optimal position of the catheter tip during AVS for 53 other patients. Finally, we verified the accuracy of this method according to the SI. RESULTS We successfully fused the 3D models of 41 cases with adrenal venography images. We identified the trunk branch type as the major venous morphology in the right anterior oblique at degrees of 30 (38 cases, 92.7%). In addition, the central vein, brush vein, uvula vein, and capsular vein were identified as signature veins for the right AVS. The accuracy of AVS was 100% in the other 53 patients, as verified by an SI >2. CONCLUSIONS Our study identified the right adrenal signature veins, including the previously overlooked uvula vein, which can be used to determine the position of the catheter tip and improve the success rate of AVS.
Collapse
Affiliation(s)
- Zhenglin Shen
- Hybrid Operation Room, Xiangyang Central Hospital, Affiliated Xiangyang Hospital of Hubei College of Arts and Sciences, Xiangyang, Hubei, China
| | - Shaoyong Xu
- Department of Endocrinology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
- Center for Clinical Evidence-Based and Translational Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Siyu Guan
- Department of General Practice, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Bo Chen
- Center for Clinical Evidence-Based and Translational Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Qingan Li
- Department of General Practice, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Ming Yu
- Department of General Practice, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Zhao Gao
- Department of Nephrology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| |
Collapse
|
2
|
Bottiglieri A, O'Halloran M, Ruvio G, Farina L. Management of adreno-cortical adenomas using microwave ablation: study of the effects of the fat tissue. Int J Hyperthermia 2022; 39:1179-1194. [PMID: 36096484 DOI: 10.1080/02656736.2022.2114611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Adrenocortical neoplasms are the main causes of secondary hypertension and related comorbidities including hypokalemia and cardiovascular diseases. Conventional techniques for the management of this condition are often invasive and not resolutive. Recent studies proposed microwave thermal ablation (MWA) to eradicate adrenocortical adenomas arising in proximity to sensitive structures. This study explores a new MWA approach to selectively direct the electromagnetic energy into the target and shield the surrounding tissues. The new solution relies on the anatomical and dielectric characteristics of the adrenal gland and the surrounding fat capsule. METHODS A 3 D model of the adrenal gland is developed, and a cooled microwave applicator is placed parallel to the interface between the fat and adrenal tissue. Numerical simulations are conducted at 2.45 GHz accounting for two energy delivery settings, two orientations of the applicator and blood perfusion of the tissues. Ex vivo and in vivo ablation procedures are conducted on ovine adrenal glands. Histology analysis completes the experimental studies. RESULTS Numerical results show asymmetric ablation profiles in ex vivo and in vivo conditions. The asymmetry ratio is influenced by the procedure settings and orientation of the applicator. Ablation zones obtained experimentally agree with those predicted by the numerical simulations. Histology analysis confirms irreversible cellular changes only in the adrenal tissue close to the applicator. CONCLUSIONS The outcomes show that the dielectric contrast between the fat layer and tissue target can be a tool in MWA to shape ablation zones to protect the surrounding structures from excessive temperature increases.
Collapse
Affiliation(s)
- Anna Bottiglieri
- Electrical and Electronic Engineering, National University of Ireland Galway, Galway, Ireland.,Translational Medical Device Lab, National University of Ireland Galway, Galway, Ireland
| | - Martin O'Halloran
- Translational Medical Device Lab, National University of Ireland Galway, Galway, Ireland
| | | | - Laura Farina
- Translational Medical Device Lab, National University of Ireland Galway, Galway, Ireland.,Endowave Ltd, Galway, Ireland
| |
Collapse
|
3
|
Milicic Stanic B, Ilincic B, Zeravica R, Milicic Ivanovski D, Cabarkapa V, Mijovic R. The Importance of Correlation between Aldosterone and Parathyroid Hormone in Patients with Primary Hyperparathyroidism. Int J Endocrinol 2022; 2022:3804899. [PMID: 36389124 PMCID: PMC9663215 DOI: 10.1155/2022/3804899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 10/21/2022] [Indexed: 11/09/2022] Open
Abstract
In primary hyperparathyroidism, an increased risk of developing the cardiovascular disease may exist due to increased activity of the renin-angiotensin-aldosterone system. The aim of this study was to evaluate the relationship between parathyroid hormone and aldosterone in patients with primary hyperparathyroidism. The study included 48 patients with primary hyperparathyroidism and 30 healthy subjects who matched age and gender to the study group. This study was conducted at the Center for Laboratory medicine, Clinical center of Vojvodina, Novi Sad, Serbia. In addition to clinical data and laboratory determination of the concentration of total and ionized calcium, phosphorus, measurements of parathyroid hormone, vitamin D, direct renin, and aldosterone were performed by the method of chemiluminescent technology. Compared to the controls, the study group had statistically significantly higher values of aldosterone (p=0.028), total calcium (p=0.01), ionized calcium (p=0.003) and parathyroid hormone (P ≤ 0.001) Serum aldosterone and parathyroid hormone levels were correlated positively in patients with primary hyperparathyroidism (r=0.509, p < 0.05). A statistically significant positive correlation between renin and parathyroid hormone (r=0.688, p < 0.05) and renin and calcium (r=0.673, p < 0.05) was determined in hyperparathyroid patients. In multivariate regression analysis, the strongest predictive variable of aldosterone secretion was parathyroid hormone (p=0.011). An independent relationship between parathyroid hormone and aldosterone in patients with primary hyperparathyroidism and the correlation between renin and parathyroid hormone as well as with calcium indicate not only the direct but also the indirect associations between parathyroid hormone and aldosterone in primary hyperparathyroidism. These findings may represent another possible model of renin-angiotensin-aldosterone-induced organ damage.
Collapse
Affiliation(s)
- Branka Milicic Stanic
- Department of Medicine, Georgetown University Medical Center, 4000 Reservoir Road, NW, Washington, DC 20057, USA
- University of Novi Sad, Faculty of Medicine, Hajduk Veljkova 3, Novi Sad 21000, Serbia
| | - Branislava Ilincic
- University of Novi Sad, Faculty of Medicine, Hajduk Veljkova 3, Novi Sad 21000, Serbia
- Center for Laboratory Medicine, Clinical Center of Vojvodina, Hajduk Veljkova 1–9, Novi Sad 21000, Serbia
| | - Radmila Zeravica
- University of Novi Sad, Faculty of Medicine, Hajduk Veljkova 3, Novi Sad 21000, Serbia
- Center for Laboratory Medicine, Clinical Center of Vojvodina, Hajduk Veljkova 1–9, Novi Sad 21000, Serbia
| | - Dragana Milicic Ivanovski
- Center for Pathophysiology of Breathing and Respiratory Sleep Disorders, The Institute for Pulmonary Diseases of Vojvodina, Put dr Goldmana 4, Sr Kamenica 21204, Serbia
| | - Velibor Cabarkapa
- University of Novi Sad, Faculty of Medicine, Hajduk Veljkova 3, Novi Sad 21000, Serbia
- Center for Laboratory Medicine, Clinical Center of Vojvodina, Hajduk Veljkova 1–9, Novi Sad 21000, Serbia
| | - Romana Mijovic
- University of Novi Sad, Faculty of Medicine, Hajduk Veljkova 3, Novi Sad 21000, Serbia
- Center for Laboratory Medicine, Clinical Center of Vojvodina, Hajduk Veljkova 1–9, Novi Sad 21000, Serbia
| |
Collapse
|
4
|
Solanki P, Gwini SM, Doery JCG, Choy KW, Shen J, Young MJ, Fuller PJ, Yang J. Age- and sex-specific reference ranges are needed for the aldosterone/renin ratio. Clin Endocrinol (Oxf) 2020; 93:221-228. [PMID: 32306417 DOI: 10.1111/cen.14199] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/01/2020] [Accepted: 04/15/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Current Endocrine Society Clinical Practice Guidelines use a specific aldosterone/renin ratio (ARR) threshold to screen for primary aldosteronism (a treatable disease causing up to 15% of hypertension in primary care) in all patients. We sought to characterize demographic variations in the ARR, hypothesizing a need for age- and sex-specific reference ranges to improve the accuracy of the test. DESIGN Retrospective cross-sectional analysis of ARR measurements at a single tertiary hospital from December 2016 to June 2018. PATIENTS A total of 442 patients with clinically indicated ARR were included, after excluding those who were on spironolactone or the oral contraceptive pill, were pregnant or had an existing adrenal condition. MEASUREMENTS Aldosterone, renin and the ARR. RESULTS Among those aged 20-39 years (n = 74), females had significantly higher median aldosterone (369 vs 244 pmol/L, P = .028), lower median renin (17.0 vs 27.6 mIU/L, P = .034) and higher median ARR (20.7 vs 10.3 (pmol/L)/(mIU/L), P = .001) than males, despite having lower systolic (135 vs 145 mmHg, P = .021) and diastolic (89 vs 96.5 mmHg, P = .007) blood pressure. The ≥ 60-year age group (n = 157) also had significant sex differences in the ARR. With increasing age (20-39 vs ≥ 60 years), there was a significant fall in plasma aldosterone in females (369 pmol/L vs 264 pmol/L, P = .005), with no change observed in males. CONCLUSIONS For those 20-39 years old, aldosterone and the ARR are significantly higher in females despite a lower systolic and diastolic BP, highlighting the potential for false-positive results. Our findings indicate the need for prospective studies with a control population to define age- and sex-specific ARR reference ranges.
Collapse
Affiliation(s)
- Pravik Solanki
- Department of Endocrinology, Monash Health, Clayton, Vic., Australia
- Department of Medicine, Monash University, Clayton, Vic., Australia
| | - Stella May Gwini
- Barwon Health, University Hospital Geelong, Geelong, Vic., Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - James C G Doery
- Department of Medicine, Monash University, Clayton, Vic., Australia
| | - Kay Weng Choy
- Department of Endocrinology, Monash Health, Clayton, Vic., Australia
| | - Jimmy Shen
- Department of Endocrinology, Monash Health, Clayton, Vic., Australia
- Hudson Institute of Medical Research, Clayton, Vic., Australia
| | - Morag J Young
- Hudson Institute of Medical Research, Clayton, Vic., Australia
| | - Peter J Fuller
- Department of Endocrinology, Monash Health, Clayton, Vic., Australia
- Hudson Institute of Medical Research, Clayton, Vic., Australia
| | - Jun Yang
- Department of Endocrinology, Monash Health, Clayton, Vic., Australia
- Department of Medicine, Monash University, Clayton, Vic., Australia
- Hudson Institute of Medical Research, Clayton, Vic., Australia
| |
Collapse
|
5
|
Rossi GP, Ceolotto G, Rossitto G, Maiolino G, Cesari M, Seccia TM. Effects of Mineralocorticoid and AT1 Receptor Antagonism on The Aldosterone-Renin Ratio In Primary Aldosteronism-the EMIRA Study. J Clin Endocrinol Metab 2020; 105:5739618. [PMID: 32067030 DOI: 10.1210/clinem/dgaa080] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 02/14/2020] [Indexed: 12/16/2022]
Abstract
CONTEXT While current guidelines recommend the withdrawal of mineralocorticoid receptor antagonist (MRA) and renin-angiotensin system blockers for the screening and detection of primary aldosteronism (PA), this can worsen hypokalemia and control of high blood pressure (BP) values. OBJECTIVE To investigate whether aldosterone/renin ratio (ARR) values were affected by the MRA canrenone and/or by canrenone plus olmesartan treatment in patients with PA. DESIGN Within-patient study. SETTING The European Society of Hypertension center of excellence at the University of Padua. PATIENTS Consecutive patients with an unambiguous diagnosis of PA subtyped by adrenal vein sampling. INTERVENTIONS Patients were treated for 1 month with canrenone (50-100 mg orally), and for an additional month with canrenone plus olmesartan (10-20 mg orally). Canrenone and olmesartan were up-titrated over the first 2 weeks until BP values and hypokalemia were controlled. Patients with unilateral PA were adrenalectomized; those with bilateral PA were treated medically. MAIN OUTCOME MEASURES BP, plasma levels of sodium and potassium, renin and aldosterone. RESULTS Canrenone neither lowered plasma aldosterone nor increased renin; thus, the high ARR and true positive rate remained unaffected. Addition of the angiotensin type 1 receptor blocker raised renin and slightly lowered aldosterone, which reduced the ARR and increased the false negative rate. CONCLUSIONS At doses that effectively controlled serum potassium and BP values, canrenone did not preclude an accurate diagnosis in patients with PA. Addition of the angiotensin type 1 receptor blocker olmesartan slightly raised the false negative rate. Hence, MRA did not seem to endanger the accuracy of the diagnosis of PA.
Collapse
Affiliation(s)
- Gian Paolo Rossi
- Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED; University of Padova, Padova, Italy
| | - Giulio Ceolotto
- Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED; University of Padova, Padova, Italy
| | - Giacomo Rossitto
- Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED; University of Padova, Padova, Italy
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
| | - Giuseppe Maiolino
- Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED; University of Padova, Padova, Italy
| | - Maurizio Cesari
- Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED; University of Padova, Padova, Italy
| | - Teresa Maria Seccia
- Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED; University of Padova, Padova, Italy
| |
Collapse
|
6
|
Kwak MK, Lee JY, Kim BJ, Lee SH, Koh JM. Effects of Primary Aldosteronism and Different Therapeutic Modalities on Glucose Metabolism. J Clin Med 2019; 8:jcm8122194. [PMID: 31842354 PMCID: PMC6947343 DOI: 10.3390/jcm8122194] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 12/09/2019] [Indexed: 01/09/2023] Open
Abstract
Despite findings that aldosterone impairs glucose metabolism, studies concerning the effect of primary aldosteronism (PA) and its treatment on glucose metabolism are controversial. We aimed to determine glucose metabolism in PA and the effect of the treatment modality. We compared glucose metabolism between PA patients (N = 286) and age-, sex-, and body mass index-matched controls (N = 816), and the changes in glucose metabolism depending on the treatment modality (adrenalectomy vs. spironolactone treatment). Hyperglycemia including diabetes mellitus (DM; 19.6% vs. 13.1%, p = 0.011) was more frequent in PA patients. Hyperglycemia was also more frequent in PA patients without subclinical hypercortisolism (SH: p < 0.001) and in those regardless of hypokalemia (p < 0.001-0.001). PA patients and PA patients without SH had higher DM risk (odds ratio (OR); 95% confidence interval (CI): 1.63; 1.11-2.39 and 1.65; 1.08-2.51, respectively) after adjusting confounders. In PA patients, there was significant decrease in the DM prevalence (21.3% to 16.7%, p = 0.004) and fasting plasma glucose (p = 0.006) after adrenalectomy. However, there was no significant change in them after spironolactone treatment. Adrenalectomy was associated with more improved glucose status than spironolactone treatment (OR; 95% CI: 2.07; 1.10-3.90). Glucose metabolism was impaired in PA, regardless of hypokalemia and SH status, and was improved by adrenalectomy, but not spironolactone treatment.
Collapse
Affiliation(s)
- Mi Kyung Kwak
- Division of Endocrinology and Metabolism, Hallym University Dongtan Sacred Heart Hospital, Dongtan, 7, Keunjaebong-gil, Hwaseong 18450, Gyeonggi-do, Korea;
| | - Jee Yang Lee
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (J.Y.L.); (B.-J.K.)
| | - Beom-Jun Kim
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (J.Y.L.); (B.-J.K.)
| | - Seung Hun Lee
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (J.Y.L.); (B.-J.K.)
- Correspondence: (S.H.L.); (J.-M.K.); Tel.: +82-2-3010-5666 (S.H.L.); +82-2-3010-3247 (J.-M.K.)
| | - Jung-Min Koh
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (J.Y.L.); (B.-J.K.)
- Correspondence: (S.H.L.); (J.-M.K.); Tel.: +82-2-3010-5666 (S.H.L.); +82-2-3010-3247 (J.-M.K.)
| |
Collapse
|
7
|
Pons Fernández N, Moreno F, Morata J, Moriano A, León S, De Mingo C, Zuñiga Á, Calvo F. Familial hyperaldosteronism type III a novel case and review of literature. Rev Endocr Metab Disord 2019; 20:27-36. [PMID: 30569443 DOI: 10.1007/s11154-018-9481-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Less than 15% of hypertension cases in children are secondary to a primary hyperaldosteronism. This is idiopathic in 60% of the cases, secondary to a unilateral adenoma in 30% and 10% remaining by primary adrenal hyperplasia, familial hyperaldosteronism, ectopic aldosterone production or adrenocortical carcinoma.To date, four types of familial hyperaldosteronism (FH I to FH IV) have been reported. FH III is caused by germline mutations in KCNJ5, encoding the potassium channel Kir3.4. The mutations cause the channel to lose its selectivity for potassium, allowing large quantities of sodium to enter the cell. As a consequence, the membrane depolarizes, voltage-gated calcium channels open, calcium enters the cell, initiating the cascade that leads to aldosterone synthesis. Somatic mutations in KCNJ5 has also been described in aldosterone-producing adenomas. The most frequent presentation of FH III is with severe hyperaldosteronism symptoms and resistance to pharmacological therapy which leads to bilateral adrenalectomy. We will review current literature and describe a child with FH III due to a novel de novo deletion in KCNJ5 with wild phenotype as a sign of clinical variability of this disease.
Collapse
Affiliation(s)
- Natividad Pons Fernández
- Department of Pediatrics, Hospital Lluís Alcanyís de Xàtiva, Ctra. Xàtiva a Silla km 2, 46800, Xàtiva, Valencia, Spain.
| | - Francisca Moreno
- Hospital Universitario y Politécnico la Fe de Valencia, Valencia, Spain
| | - Julia Morata
- Department of Pediatrics, Hospital Lluís Alcanyís de Xàtiva, Ctra. Xàtiva a Silla km 2, 46800, Xàtiva, Valencia, Spain
| | - Ana Moriano
- Department of Pediatrics, Hospital Lluís Alcanyís de Xàtiva, Ctra. Xàtiva a Silla km 2, 46800, Xàtiva, Valencia, Spain
| | - Sara León
- Hospital Universitario y Politécnico la Fe de Valencia, Valencia, Spain
| | - Carmen De Mingo
- Hospital Universitario y Politécnico la Fe de Valencia, Valencia, Spain
| | - Ángel Zuñiga
- Hospital Universitario y Politécnico la Fe de Valencia, Valencia, Spain
| | - Fernando Calvo
- Department of Pediatrics, Hospital Lluís Alcanyís de Xàtiva, Ctra. Xàtiva a Silla km 2, 46800, Xàtiva, Valencia, Spain
| |
Collapse
|
8
|
Saint F, Prader R, Cordonnier C, Choukroun G, Elesper N, Desailloud R. [Long-term blood pressure outcome after unilateral adrenalectomy for primary hyperaldosteronism]. Prog Urol 2017; 27:389-394. [PMID: 28259701 DOI: 10.1016/j.purol.2017.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 09/26/2016] [Accepted: 01/31/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To evaluate long-term results of adrenalectomy for primary aldosteronism (PA) and to identify prognostic factors associated. METHODS Exhaustive retrospective review of all consecutive patients undergoing adrenalectomy for PA between 2002 and 2013 in our department. All patients underwent preoperative: clinical evaluation (age, sex, height, weight, systolic and diastolic BP under treatment, identification of anti-hypertension treatment), biological evaluation (potassium, renin, aldosterone) and radiological evaluation (CT and/or MRI). Blood pressure was assessed postoperatively at 1 month, 1 year, then at the date of the latest news. The patients were classified into three categories: cured (no antihypertensive therapy in postoperative associated with strictly lower blood pressures of 140/90mmHg), improved (decreased number of drugs or number unchanged but with better blood pressure control), and refractory (no change in the number of drug and blood pressure, or deterioration of one or other of these two parameters). RESULTS We evaluated 43 patients, 23 men and 20 women, with a median follow-up of 74.4 months [16.8 to 141]. Pathological analysis described 34 adenomas (79%), 7 hyperplasias (16%) (5 micro-nodular and 2 macro-nodular) and 2 adrenocortical carcinoma (5%). The postoperative long-term assessment found 20% of cured patients (n=8), 65% of improved (n=26) and 15% of refractory (n=6). Prognostic factors associated with favorable long-term blood pressure outcome were those typically associated with ARS score [preoperative number of anti-hypertension drugs (P=0.005), BMI<25kg/m2 (P=0.009), and duration of hypertension (P=0.007)]. CONCLUSION Adrenalectomy for PA is a long-term effective treatment for blood pressure control. Prognostic factors associated with long-term success are those conventionally described in ARS score. LEVEL OF EVIDENCE 4.
Collapse
Affiliation(s)
- F Saint
- Service d'urologie - transplantation, université de Picardie Jules-Verne, CHU d'Amiens, 80000 Amiens, France; Laboratoire de recherche HeRVI EA3801, université de Picardie Jules-Verne, CHU d'Amiens, 80000 Amiens, France; Centre de ressources biologiques, biobanque de Picardie, université de Picardie Jules-Verne, CHU d'Amiens, 80000 Amiens, France.
| | - R Prader
- Service d'urologie - transplantation, université de Picardie Jules-Verne, CHU d'Amiens, 80000 Amiens, France
| | - C Cordonnier
- Service d'anatomie et cytologie pathologiques, université de Picardie Jules-Verne, CHU d'Amiens, 80000 Amiens, France
| | - G Choukroun
- Service de néphrologie, médecine interne, dialyse, transplantation et réanimation, université de Picardie Jules-Verne, CHU d'Amiens, 80000 Amiens, France
| | - N Elesper
- Service de néphrologie, médecine interne, dialyse, transplantation et réanimation, université de Picardie Jules-Verne, CHU d'Amiens, 80000 Amiens, France
| | - R Desailloud
- Service d'endocrinologie, maladies métaboliques, diabétologie et nutrition, université de Picardie Jules-Verne, CHU d'Amiens, 80000 Amiens, France
| |
Collapse
|
9
|
Pignatti E, Leng S, Carlone DL, Breault DT. Regulation of zonation and homeostasis in the adrenal cortex. Mol Cell Endocrinol 2017; 441:146-155. [PMID: 27619404 PMCID: PMC5235909 DOI: 10.1016/j.mce.2016.09.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 09/01/2016] [Accepted: 09/06/2016] [Indexed: 12/23/2022]
Abstract
The adult adrenal cortex is organized into concentric zones, each specialized to produce distinct steroid hormones. Cellular composition of the cortex is highly dynamic and subject to diverse signaling controls. Cortical homeostasis and regeneration rely on centripetal migration of steroidogenic cells from the outer to the inner cortex, which is accompanied by direct conversion of zona glomerulosa (zG) into zona fasciculata (zF) cells. Given the important impact of tissue structure and growth on steroidogenic function, it is essential to understand the mechanisms governing adrenal zonation and homeostasis. Towards this end, we review the distinctions between each zone by highlighting their morphological and ultra-structural features, discuss key signaling pathways influencing zonal identity, and evaluate current evidence for long-term self-renewing stem cells in the adult cortex. Finally, we review data supporting zG-to-zF transdifferentiation/direct conversion as a major mechanism of adult cortical renewal.
Collapse
Affiliation(s)
- Emanuele Pignatti
- Division of Endocrinology, Boston Children's Hospital, Boston, MA 02115, USA; Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
| | - Sining Leng
- Division of Endocrinology, Boston Children's Hospital, Boston, MA 02115, USA; Division of Medical Sciences, Harvard Medical School, Boston, MA 02115, USA
| | - Diana L Carlone
- Division of Endocrinology, Boston Children's Hospital, Boston, MA 02115, USA; Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA; Harvard Stem Cell Institute, Cambridge, MA 02138, USA
| | - David T Breault
- Division of Endocrinology, Boston Children's Hospital, Boston, MA 02115, USA; Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA; Harvard Stem Cell Institute, Cambridge, MA 02138, USA.
| |
Collapse
|
10
|
Kuhn E, Suter PM. [Not Available]. PRAXIS 2017; 106:255-259. [PMID: 28253810 DOI: 10.1024/1661-8157/a002612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Zusammenfassung. In diesem Mini-Review wird aufgezeigt, dass die Diagnostik der sekundären Hypertonie eigentlich eine relativ einfache Unternehmung ist. Neben einer umfassenden Anamnese sowie einer korrekt durchgeführten klinischen Untersuchung muss bei jeder Diagnosestellung einer arteriellen Hypertonie an die Möglichkeit einer sekundären Ursache gedacht werden. Oft ist es auch kostengünstiger, beim geringsten Verdacht direkt nach einer sekundären Ursache zu suchen, als durch langwierige Umstellungen der Therapie und damit auch Verunsicherung des Patienten die Diagnostik zu verzögern.
Collapse
Affiliation(s)
- Eric Kuhn
- 1 Hypertonie- und Adipositassprechstunde, KPIM, Universitätsspital Zürich
| | - Paolo M Suter
- 1 Hypertonie- und Adipositassprechstunde, KPIM, Universitätsspital Zürich
| |
Collapse
|
11
|
Does catheter shape influence the success of right adrenal venous sampling? The interaction of catheter shape to anatomical factors on CT. Jpn J Radiol 2016; 34:707-717. [DOI: 10.1007/s11604-016-0571-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 07/21/2016] [Indexed: 11/25/2022]
|
12
|
He J, Cao Y, Su T, Jiang Y, Jiang L, Zhou W, Zhang C, Wang W, Ning G. Downregulation of miR-375 in aldosterone-producing adenomas promotes tumour cell growth via MTDH. Clin Endocrinol (Oxf) 2015; 83:581-9. [PMID: 25944465 DOI: 10.1111/cen.12814] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 03/09/2015] [Accepted: 04/29/2015] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Previous studies have investigated the genetic and molecular basis of primary aldosteronism (PA), a common cause of human hypertension, but the effects of microRNAs (miRNAs) on the adrenocortical cell proliferation and aldosterone production are largely obscure. Here, we characterized miRNA expression patterns in the subtypes of PA to gain a better understanding of its pathogenesis. METHODS miRNA expression was assessed by microarray profiling analysis in aldosterone-producing adenoma (APA), unilateral adrenal hyperplasia (UAH) and normal adrenal cortex tissues. Selected differentially expressed miRNAs were further validated in a validation cohort by qRT-PCR. A gain-of-function approach was used to explore the functional role of the specific miRNA in vitro. RESULTS Of 31 miRNAs including miR-375, miR-7 and miR-29b were found to be significantly differentially expressed among these three groups. miR-375 was the most downregulated one in adrenal cortex tissues from PA patients, and its expression level was inversely correlated with the tumour size in APA. Overexpression of miR-375 in a human adrenocortical cell line (H295R) reduced cell proliferation and suppressed the expression of MTDH (metadherin, also known as astrocyte elevated gene-1). Moreover, MTDH was verified as a direct target of miR-375 through luciferase reporter assays. Knock-down of MTDH in H295R cells attenuated Akt-Ser473 phosphorylation and inhibited cell viability. CONCLUSION Our findings suggest that miR-375 exerts its tumour-suppressive function via targeting MTDH/Akt pathway and implicate a potential therapeutic target in PA.
Collapse
Affiliation(s)
- Juan He
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai Key Laboratory for Endocrine Tumors, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanan Cao
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai Key Laboratory for Endocrine Tumors, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tingwei Su
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai Key Laboratory for Endocrine Tumors, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiran Jiang
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai Key Laboratory for Endocrine Tumors, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Jiang
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai Key Laboratory for Endocrine Tumors, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiwei Zhou
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai Key Laboratory for Endocrine Tumors, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Cui Zhang
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai Key Laboratory for Endocrine Tumors, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiqing Wang
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai Key Laboratory for Endocrine Tumors, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guang Ning
- Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Shanghai Key Laboratory for Endocrine Tumors, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Laboratory of Endocrinology and Metabolism, Institute of Health Sciences, Shanghai Institutes for Biological Science (SIBS), Chinese Academy of Science (CAS), Shanghai Jiao Tong University School of Medicine (SJTUSM), Shanghai, China
| |
Collapse
|
13
|
Abstract
Adrenal diseases, including Cushing syndrome (CS), primary aldosteronism (PA), pheochromocytoma, and adrenocortical carcinoma, are uncommon in pregnancy; a high degree of clinical suspicion must exist. Physiologic changes to the hypothalamus-pituitary-adrenal axis in a normal pregnancy result in increased cortisol, renin, and aldosterone levels, making the diagnosis of CS and PA in pregnancy challenging. However, catecholamines are not altered in pregnancy and allow a laboratory diagnosis of pheochromocytoma that is similar to that of the nonpregnant state. Although adrenal tumors in pregnancy result in significant maternal and fetal morbidity, and sometimes mortality, early diagnosis and appropriate treatment often improve outcomes.
Collapse
Affiliation(s)
- Deirdre Cocks Eschler
- Endocrinology Division, Department of Medicine, Stony Brook University School of Medicine, HSC T15-060, Stony Brook, NY 11794, USA.
| | - Nina Kogekar
- Department of Medicine, Mount Sinai School of Medicine, 1 Gustave L Levy Place, New York, NY 10029, USA
| | - Rachel Pessah-Pollack
- Endocrinology Division, Department of Medicine, Mount Sinai School of Medicine, 1 Gustave L Levy Place, New York, NY 10029, USA; Department of Endocrinology, ProHealth Care Associates, Ohio Drive, Lake Success, NY 11042, USA
| |
Collapse
|
14
|
Laboratory challenges in primary aldosteronism screening and diagnosis. Clin Biochem 2015; 48:377-87. [DOI: 10.1016/j.clinbiochem.2015.01.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 01/08/2015] [Accepted: 01/12/2015] [Indexed: 01/07/2023]
|
15
|
Maliha G, Townsend RR. An Update on Treatment Options for Drug Resistant Hypertension. CURRENT CARDIOVASCULAR RISK REPORTS 2014. [DOI: 10.1007/s12170-014-0394-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
16
|
Combination of LC–MS/MS aldosterone and automated direct renin in screening for primary aldosteronism. Clin Chim Acta 2014; 433:209-15. [DOI: 10.1016/j.cca.2014.03.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 02/24/2014] [Accepted: 03/15/2014] [Indexed: 01/14/2023]
|
17
|
Abstract
The surgical treatment of adrenal tumours has evolved over the past century, as has our understanding of which hormones are secreted by the adrenal glands and what these hormones do. This article reviews the preoperative evaluation of patients with adrenal tumours that could be benign or malignant, including metastases. The biochemical evaluation of excess levels of hormones is discussed, as are imaging characteristics that differentiate benign tumours from malignant tumours. The options for surgical management are outlined, including the advantages and disadvantages of various open and laparoscopic approaches. The surgical management of adrenocortical carcinoma is specifically reviewed, including controversies in operative approaches as well as surgical management of invasive or recurrent disease.
Collapse
Affiliation(s)
- Barbra S Miller
- University of Michigan Health System, 1500 East Medical Center Drive, 2920F Taubman Center, Ann Arbor, MI 48109-5331, USA
| | - Gerard M Doherty
- Department of Surgery, Boston University, 75 East Newton Street, Boston, MA 02118, USA
| |
Collapse
|
18
|
Petramala L, Zinnamosca L, Settevendemmie A, Marinelli C, Nardi M, Concistrè A, Corpaci F, Tonnarini G, De Toma G, Letizia C. Bone and mineral metabolism in patients with primary aldosteronism. Int J Endocrinol 2014; 2014:836529. [PMID: 24864141 PMCID: PMC4016829 DOI: 10.1155/2014/836529] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 03/12/2014] [Indexed: 12/31/2022] Open
Abstract
Primary aldosteronism represents major cause of secondary hypertension, strongly associated with high cardiovascular morbidity and mortality. Aldosterone excess may influence mineral homeostasis, through higher urinary calcium excretion inducing secondary increase of parathyroid hormone. Recently, in a cohort of PA patients a significant increase of primary hyperparathyroidism was found, suggesting a bidirectional functional link between the adrenal and parathyroid glands. The aim of this study was to evaluate the impact of aldosterone excess on mineral metabolism and bone mass density. In 73 PA patients we evaluated anthropometric and biochemical parameters, renin-angiotensin-aldosterone system, calcium-phosphorus metabolism, and bone mineral density; control groups were 73 essential hypertension (EH) subjects and 40 healthy subjects. Compared to HS and EH, PA subjects had significantly lower serum calcium levels and higher urinary calcium excretion. Moreover, PA patients showed higher plasma PTH, lower serum 25(OH)-vitamin D levels, higher prevalence of vitamin D deficiency (65% versus 25% and 25%; P < 0.001), and higher prevalence of osteopenia/osteoporosis (38.5 and 10.5%) than EH (28% and 4%) and NS (25% and 5%), respectively. This study supports the hypothesis that bone loss and fracture risk in PA patients are potentially the result of aldosterone mediated hypercalciuria and the consecutive secondary hyperparathyroidism.
Collapse
Affiliation(s)
- Luigi Petramala
- Internal Medicine and Secondary Hypertension Unit, Department of Internal Medicine and Medical Specialties, University of Rome La Sapienza, Viale del Policlinico 155, 00165 Rome, Italy
| | - Laura Zinnamosca
- Internal Medicine and Secondary Hypertension Unit, Department of Internal Medicine and Medical Specialties, University of Rome La Sapienza, Viale del Policlinico 155, 00165 Rome, Italy
| | - Amina Settevendemmie
- Internal Medicine and Secondary Hypertension Unit, Department of Internal Medicine and Medical Specialties, University of Rome La Sapienza, Viale del Policlinico 155, 00165 Rome, Italy
| | - Cristiano Marinelli
- Internal Medicine and Secondary Hypertension Unit, Department of Internal Medicine and Medical Specialties, University of Rome La Sapienza, Viale del Policlinico 155, 00165 Rome, Italy
| | - Matteo Nardi
- Internal Medicine and Secondary Hypertension Unit, Department of Internal Medicine and Medical Specialties, University of Rome La Sapienza, Viale del Policlinico 155, 00165 Rome, Italy
| | - Antonio Concistrè
- Internal Medicine and Secondary Hypertension Unit, Department of Internal Medicine and Medical Specialties, University of Rome La Sapienza, Viale del Policlinico 155, 00165 Rome, Italy
| | - Francesco Corpaci
- Internal Medicine and Secondary Hypertension Unit, Department of Internal Medicine and Medical Specialties, University of Rome La Sapienza, Viale del Policlinico 155, 00165 Rome, Italy
| | - Gianfranco Tonnarini
- Internal Medicine and Secondary Hypertension Unit, Department of Internal Medicine and Medical Specialties, University of Rome La Sapienza, Viale del Policlinico 155, 00165 Rome, Italy
| | - Giorgio De Toma
- Department of Surgery, P.Valdoni, University of Rome La Sapienza, Viale del Policlinico 155, 00165 Rome, Italy
| | - Claudio Letizia
- Internal Medicine and Secondary Hypertension Unit, Department of Internal Medicine and Medical Specialties, University of Rome La Sapienza, Viale del Policlinico 155, 00165 Rome, Italy
- *Claudio Letizia:
| |
Collapse
|