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Mulatero P, Scholl UI, Fardella CE, Charmandari E, Januszewicz A, Reincke M, Gomez-Sanchez CE, Stowasser M, Dekkers OM. Familial hyperaldosteronism: an European Reference Network on Rare Endocrine Conditions clinical practice guideline. Eur J Endocrinol 2024; 190:G1-G14. [PMID: 38571460 DOI: 10.1093/ejendo/lvae041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 03/15/2024] [Indexed: 04/05/2024]
Abstract
We describe herein the European Reference Network on Rare Endocrine Conditions clinical practice guideline on diagnosis and management of familial forms of hyperaldosteronism. The guideline panel consisted of 10 experts in primary aldosteronism, endocrine hypertension, paediatric endocrinology, and cardiology as well as a methodologist. A systematic literature search was conducted, and because of the rarity of the condition, most recommendations were based on expert opinion and small patient series. The guideline includes a brief description of the genetics and molecular pathophysiology associated with each condition, the patients to be screened, and how to screen. Diagnostic and treatment approaches for patients with genetically determined diagnosis are presented. The recommendations apply to patients with genetically proven familial hyperaldosteronism and not to families with more than one case of primary aldosteronism without demonstration of a responsible pathogenic variant.
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Affiliation(s)
- Paolo Mulatero
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, 10126 Torino, Italy
| | - Ute I Scholl
- Center of Functional Genomics, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, 10115 Berlin, Germany
| | - Carlos E Fardella
- Department of Endocrinology, School of Medicine, Centro Traslacional de Endocrinología Universidad Católica (CETREN-UC), Pontificia Universidad Católica de Chile, 8330033 Santiago, Chile
| | - Evangelia Charmandari
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, Athens 11527, Greece
- Division of Endocrinology and Metabolism, Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens 11527, Greece
| | - Andrzej Januszewicz
- Department of Hypertension, National Institute of Cardiology, 02-628 Warsaw, Poland
| | - Martin Reincke
- Department of Medicine 4, LMU University Hospital, LMU Munich, Munich D-80336, Germany
| | - Celso E Gomez-Sanchez
- Research Service, G. V. (Sonny) Montgomery VA Medical Center, Jackson, MS 39216, United States
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, 39216 MS, United States
| | - Michael Stowasser
- Endocrine Hypertension Research Centre, University of Queensland Frazer Institute, Greenslopes and Princess Alexandra Hospitals, Brisbane, 4102 Queensland, Australia
| | - Olaf M Dekkers
- Departments of Clinical Epidemiology and Internal Medicine, Leiden University Medical Centre, 2311 Leiden, The Netherlands
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Pathophysiologic approach in genetic hypokalemia: An update. ANNALES D'ENDOCRINOLOGIE 2023; 84:298-307. [PMID: 36639120 DOI: 10.1016/j.ando.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 11/30/2022] [Indexed: 01/12/2023]
Abstract
The pathophysiology of genetic hypokalemia is close to that of non-genetic hypokalemia. New molecular pathways physiologically involved in renal and extrarenal potassium homeostasis have been highlighted. A physiological approach to diagnosis is illustrated here, with 6 cases. Mechanisms generating and sustaining of hypokalemia are discussed. After excluding acute shift of extracellular potassium to the intracellular compartment, related to hypokalemic periodic paralysis, inappropriate kaliuresis (>40mmol/24h) concomitant to hypokalemia indicates renal potassium wasting. Clinical analysis distinguishes hypertension-associated hypokalemia, due to hypermineralocorticism or related disorders. Genetic hypertensive hypokalemia is rare. It includes familial hyperaldosteronism, Liddle syndrome, apparent mineralocorticoid excess,11beta hydroxylase deficiency and Geller syndrome. In case of normo- or hypo-tensive hypokalemia, two etiologies are to be considered: chloride depletion or salt-wasting tubulopathy. Diarrhea chlorea is a rare disease responsible for intestinal chloride depletion. Due to the severity of hypokalemic metabolic alkalosis, this disease can be misdiagnosed as pseudo-Bartter syndrome. Gitelman syndrome is the most frequent cause of genetic hypokalemia. It typically associates renal sodium and potassium wasting, hypomagnesemia, conserved chloride excretion (>40mmol/24h), and low-range calcium excretion (urinary Ca/creatinine ratio<0.20mmol/mmol). Systematic analysis of hydroelectrolytic disorder and dynamic hormonal investigation optimizes indications for and orientation of genotyping of hereditary salt-losing tubulopathy.
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Ectopic localization of CYP11B1 and CYP11B2-expressing cells in the normal human adrenal gland. PLoS One 2022; 17:e0279682. [PMID: 36584094 PMCID: PMC9803228 DOI: 10.1371/journal.pone.0279682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 12/12/2022] [Indexed: 12/31/2022] Open
Abstract
The sharp line of demarcation between zona glomerulosa (ZG) and zona fasciculata (ZF) has been recently challenged suggesting that this interface is no longer a compartment boundary. We have used immunohistochemical analyses to study the steroid 11β-hydroxylase (CYP11B1) and aldosterone synthase (CYP11B2) pattern of expression and investigate the remodeling of the adrenal cortex in relation to aging. We analyzed human adrenal glands prepared from 47 kidney donors. No aldosterone-producing micronodules (APMs) were detectable in the younger donors aged between 22-39 but the functional ZG depicted by positive CYP11B2 staining demonstrated a lack of continuity. In contrast, the development of APMs was found in samples from individuals aged 40-70. Importantly, the progressive replacement of CYP11B2-expressing cells in the histological ZG by CYP11B1-expressing cells highlights the remodeling capacity of the adrenal cortex. In 70% of our samples, immunofluorescence studies revealed the presence of isolated or clusters of CYP11B2 positive cells in the ZF and zona reticularis. Our data emphasize that mineralocorticoid- and glucocorticoid-producing cells are distributed throughout the cortex and the medulla making the determination of the functional status of a cell or group of cells a unique tool in deciphering the changes occurring in adrenal gland particularly during aging. They also suggest that, in humans, steroidogenic cell phenotype defined by function is a stable feature and thus, the functional zonation might be not solely maintained by cell lineage conversion/migration.
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Zennaro MC, Boulkroun S, Fernandes-Rosa FL. Pathogenesis and treatment of primary aldosteronism. Nat Rev Endocrinol 2020; 16:578-589. [PMID: 32724183 DOI: 10.1038/s41574-020-0382-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2020] [Indexed: 12/19/2022]
Abstract
Early diagnosis and appropriate treatment of primary aldosteronism, the most frequent cause of secondary hypertension, are crucial to prevent deleterious cardiovascular outcomes. In the past decade, the discovery of genetic abnormalities responsible for sporadic and familial forms of primary aldosteronism has improved the knowledge of the pathogenesis of this disorder. Mutations in genes encoding ion channels and pumps lead to increased cytosolic concentrations of calcium in zona glomerulosa cells, which triggers CYP11B2 expression and autonomous aldosterone production. Improved understanding of the mechanisms underlying the disease is key to improving diagnostics and to developing and implementing targeted treatments. This Review provides an update on the genetic abnormalities associated with sporadic and familial forms of primary aldosteronism, their frequency among different populations and the mechanisms explaining excessive aldosterone production and adrenal nodule development. The possible effects and uses of these findings for improving the diagnostics for primary aldosteronism are discussed. Furthermore, current treatment options of primary aldosteronism are reviewed, with particular attention to the latest studies on blood pressure and cardiovascular outcomes following medical or surgical treatment. The new perspectives regarding the use of targeted drug therapy for aldosterone-producing adenomas with specific somatic mutations are also addressed.
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Affiliation(s)
- Maria-Christina Zennaro
- INSERM, PARCC, Université de Paris, Paris, France.
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Génétique, Paris, France.
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Guo Z, Nanba K, Udager A, McWhinney BC, Ungerer JPJ, Wolley M, Thuzar M, Gordon RD, Rainey WE, Stowasser M. Biochemical, Histopathological, and Genetic Characterization of Posture-Responsive and Unresponsive APAs. J Clin Endocrinol Metab 2020; 105:5855173. [PMID: 32516371 PMCID: PMC7426003 DOI: 10.1210/clinem/dgaa367] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 06/05/2020] [Indexed: 01/27/2023]
Abstract
CONTEXT AND OBJECTIVE Posture-responsive and posture-unresponsive aldosterone-producing adenomas (APAs) account for approximately 40% and 60% of APAs, respectively. Somatic gene mutations have been recently reported to exist in approximately 90% of APAs. This study was designed to characterize the biochemical, histopathologic, and genetic properties of these 2 types of APA. METHODS Plasma levels of aldosterone and hybrid steroids (18-oxocortisol and 18-hydroxycortisol) were measured by liquid chromatography-tandem mass spectrometry. Immunohistochemistry for CYP11B2 (aldosterone synthase) and CYP17A1 (17α-hydroxylase) and deoxyribonucleic acid sequencing (Sanger and next-generation sequencing) were performed on APA tissue collected from 23 posture-unresponsive and 17 posture-responsive APA patients. RESULTS Patients with posture-unresponsive APA displayed higher (P < 0.01) levels of hybrid steroids, recumbent aldosterone and cortisol, larger (P < 0.01) zona fasciculata (ZF)-like tumors with higher (P < 0.01) expression of CYP17A1 (but not of CYP11B2) than patients with posture-responsive APA (most of which were not ZF-like). Of 40 studied APAs, 37 (92.5%) were found to harbor aldosterone-driving somatic mutations (KCNJ5 = 14 [35.0%], CACNA1D = 13 [32.5%], ATP1A1 = 8 [20.0%], and ATP2B3 = 2 [5.0%]), including 5 previously unreported mutations (3 in CACNA1D and 2 in ATP1A1). Notably, 64.7% (11/17) of posture-responsive APAs carried CACNA1D mutations, whereas 56.5% (13/23) of posture-unresponsive APAs harbored KCNJ5 mutations. CONCLUSIONS The elevated production of hybrid steroids by posture-unresponsive APAs may relate to their ZF-like tumor cell composition, resulting in expression of CYP17A1 (in addition to somatic gene mutation-driven CYP11B2 expression), thereby allowing production of cortisol, which acts as the substrate for CYP11B2-generated hybrid steroids.
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Affiliation(s)
- Zeng Guo
- Endocrine Hypertension Research Centre, University of Queensland Diamantina Institute, Greenslopes and Princess Alexandra Hospitals, Brisbane, Australia
| | - Kazutaka Nanba
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, US
- Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Aaron Udager
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, US
- Michigan Center for Translational Pathology, Ann Arbor, MI, US
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, US
| | - Brett C McWhinney
- Department of Chemical Pathology, Pathology Queensland, Queensland Health, Brisbane, Australia
| | - Jacobus P J Ungerer
- Department of Chemical Pathology, Pathology Queensland, Queensland Health, Brisbane, Australia
- School of Biomedical Sciences, University of Queensland, Brisbane, Australia
| | - Martin Wolley
- Endocrine Hypertension Research Centre, University of Queensland Diamantina Institute, Greenslopes and Princess Alexandra Hospitals, Brisbane, Australia
| | - Moe Thuzar
- Endocrine Hypertension Research Centre, University of Queensland Diamantina Institute, Greenslopes and Princess Alexandra Hospitals, Brisbane, Australia
- Department of Endocrinology, Princess Alexandra Hospital, Brisbane, Australia
| | - Richard D Gordon
- Endocrine Hypertension Research Centre, University of Queensland Diamantina Institute, Greenslopes and Princess Alexandra Hospitals, Brisbane, Australia
| | - William E Rainey
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, US
- Division of Metabolism, Endocrine, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, US
| | - Michael Stowasser
- Endocrine Hypertension Research Centre, University of Queensland Diamantina Institute, Greenslopes and Princess Alexandra Hospitals, Brisbane, Australia
- Correspondence and Reprint Requests: Professor Michael Stowasser (MBBS, FRACP, PhD), Hypertension Unit, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Brisbane, Queensland, 4102, Australia. E-mail:
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Fernandes-Rosa FL, Boulkroun S, Zennaro MC. Genetic and Genomic Mechanisms of Primary Aldosteronism. Trends Mol Med 2020; 26:819-832. [PMID: 32563556 DOI: 10.1016/j.molmed.2020.05.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/13/2020] [Accepted: 05/20/2020] [Indexed: 02/07/2023]
Abstract
Aldosterone-producing adenoma (APA) and bilateral adrenal hyperplasia are the main cause of primary aldosteronism (PA), the most frequent form of secondary hypertension. Mutations in ion channels and ATPases have been identified in APA and inherited forms of PA, highlighting the central role of calcium signaling in PA development. Different somatic mutations are also found in aldosterone-producing cell clusters in adrenal glands from healthy individuals and from patients with unilateral and bilateral PA, suggesting additional pathogenic mechanisms. Recent mouse models have also contributed to a better understanding of PA. Application of genetic screening in familial PA, development of surrogate biomarkers for somatic mutations in APA, and use of targeted treatment directed at mutated proteins may allow improved management of patients.
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Affiliation(s)
| | | | - Maria-Christina Zennaro
- Inserm, PARCC, Université de Paris, F-75015 Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Génétique, Paris, France.
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Abstract
Primary aldosteronism (PA) is the most common form of secondary hypertension affecting 5%-10% of patients with arterial hypertension. In PA, high blood pressure is associated with high aldosterone and low renin levels, and often hypokalemia. In a majority of cases, autonomous aldosterone production by the adrenal gland is caused by an aldosterone producing adenoma (APA) or bilateral adrenal hyperplasia (BAH). During the last ten years, a better knowledge of the pathophysiology of PA came from the discovery of somatic and germline mutations in different genes in both sporadic and familial forms of the disease. Those genes code for ion channels and pumps, as well as proteins involved in adrenal cortex development and function. Targeted next generation sequencing following immunohistochemistry guided detection of aldosterone synthase expression allows detection of somatic mutations in up to 90% of APA, while whole exome sequencing has discovered the genetic causes of four different familial forms of PA. The identification, in BAH, of somatic mutations in aldosterone producing cell clusters open new perspectives in our understanding of the bilateral form of the disease and the development of new therapeutic approaches.
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Affiliation(s)
| | | | - Maria-Christina Zennaro
- Université de Paris, PARCC, INSERM, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Génétique, Paris, France
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Lin YF, Peng KY, Chang CH, Hu YH, Wu VC, Chueh JS, Wu KD. Adrenalectomy Completely Cured Hypertension in Patients With Familial Hyperaldosteronism Type I Who Had Somatic KCNJ5 Mutation. J Clin Endocrinol Metab 2019; 104:5462-5466. [PMID: 31287546 DOI: 10.1210/jc.2019-00689] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/02/2019] [Indexed: 12/21/2022]
Abstract
CONTEXT Familial hyperaldosteronism type I (FH-I) or glucocorticoid-remediable aldosteronism (GRA) is caused by unequal crossing over of the steroid 11β-hydroxylase (CYP11B1) and aldosterone synthase (CYP11B2) genes. Somatic KCNJ5 mutations have not been reported in patients with GRA; therefore, the appropriate treatment and prognosis of such concurrent cases remain unknown. CASE DESCRIPTION Two siblings of a Taiwanese family with GRA were found to have adrenal adenomas and somatic KCNJ5 mutations. Complete clinical cure was achieved after unilateral adrenalectomy. Furthermore, the conversion site of the chimeric gene was identified by direct sequencing. CONCLUSIONS We report the coexistence of a somatic KCNJ5 mutation and GRA. Patients with GRA whose blood pressure management develops resistance to glucocorticoid treatment could therefore benefit from a lateralization test. The promising outcomes after unilateral adrenalectomy presented in this report offer new perspectives for further research into various PA subtypes.
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Affiliation(s)
- Yu-Fang Lin
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - Kang-Yung Peng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - Chia-Hui Chang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, New Taipei City, Taiwan
| | - Ya-Hui Hu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, New Taipei City, Taiwan
| | - Vin-Cent Wu
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - Jeff S Chueh
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kwan-Dun Wu
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
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Seccia TM, Caroccia B, Gomez-Sanchez EP, Gomez-Sanchez CE, Rossi GP. The Biology of Normal Zona Glomerulosa and Aldosterone-Producing Adenoma: Pathological Implications. Endocr Rev 2018; 39:1029-1056. [PMID: 30007283 PMCID: PMC6236434 DOI: 10.1210/er.2018-00060] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 07/03/2018] [Indexed: 01/09/2023]
Abstract
The identification of several germline and somatic ion channel mutations in aldosterone-producing adenomas (APAs) and detection of cell clusters that can be responsible for excess aldosterone production, as well as the isolation of autoantibodies activating the angiotensin II type 1 receptor, have rapidly advanced the understanding of the biology of primary aldosteronism (PA), particularly that of APA. Hence, the main purpose of this review is to discuss how discoveries of the last decade could affect histopathology analysis and clinical practice. The structural remodeling through development and aging of the human adrenal cortex, particularly of the zona glomerulosa, and the complex regulation of aldosterone, with emphasis on the concepts of zonation and channelopathies, will be addressed. Finally, the diagnostic workup for PA and its subtyping to optimize treatment are reviewed.
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Affiliation(s)
- Teresa M Seccia
- Department of Medicine-DIMED, University of Padua, Padua PD, Italy
| | | | - Elise P Gomez-Sanchez
- Department of Pharmacology and Toxicology, G.V. (Sonny) Montgomery VA Medical Center, Jackson, Mississippi
| | - Celso E Gomez-Sanchez
- Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center, Jackson, Mississippi.,University of Mississippi Medical Center, Jackson, Mississippi
| | - Gian Paolo Rossi
- Department of Medicine-DIMED, University of Padua, Padua PD, Italy
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Nishimoto K, Koga M, Seki T, Oki K, Gomez-Sanchez EP, Gomez-Sanchez CE, Naruse M, Sakaguchi T, Morita S, Kosaka T, Oya M, Ogishima T, Yasuda M, Suematsu M, Kabe Y, Omura M, Nishikawa T, Mukai K. Immunohistochemistry of aldosterone synthase leads the way to the pathogenesis of primary aldosteronism. Mol Cell Endocrinol 2017; 441:124-133. [PMID: 27751767 PMCID: PMC5470036 DOI: 10.1016/j.mce.2016.10.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 10/13/2016] [Accepted: 10/13/2016] [Indexed: 10/20/2022]
Abstract
Our group previously purified human and rat aldosterone synthase (CYP11B2 and Cyp11b2, respectively) from their adrenals and verified that it is distinct from steroid 11β-hydroxylase (CYP11B1 or Cyp11b1), the cortisol- or corticosterone-synthesizing enzyme. We now describe their distributions immunohistochemically with specific antibodies. In rats, there is layered functional zonation with the Cyp11b2-positive zona glomerulosa (ZG), Cyp11b1-positive zona fasciculata (ZF), and Cyp11b2/Cyp11b1-negative undifferentiated zone between the ZG and ZF. In human infants and children (<12 years old), the functional zonation is similar to that in rats. In adults, the adrenal cortex remodels and subcapsular aldosterone-producing cell clusters (APCCs) replace the continuous ZG layer. We recently reported possible APCC-to-APA transitional lesions (pAATLs) in 2 cases of unilateral multiple adrenocortical micro-nodules. In this review, we present 4 additional cases of primary aldosteronism, from which the extracted adrenals contain pAATLs, with results of next generation sequencing for these lesions. Immunohistochemistry for CYP11B2 and CYP11B1 has become an important tool for the diagnosis of and research on adrenocortical pathological conditions and suggests that APCCs may be the origin of aldosterone-producing adenoma.
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Affiliation(s)
- Koshiro Nishimoto
- Department of Uro-Oncology, Saitama Medical University International Medical Center, Hidaka 350-1241, Japan; Department of Biochemistry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
| | - Minae Koga
- Endocrinology & Diabetes Center, Yokohama Rosai Hospital, Yokohama 222-0036, Japan
| | - Tsugio Seki
- Department of Medical Education, School of Medicine, California University of Science and Medicine, 1405 West Valley Blvd #101, Colton, CA 92324, USA
| | - Kenji Oki
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan
| | - Elise P Gomez-Sanchez
- Department of Pharmacology & Toxicology, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Celso E Gomez-Sanchez
- Endocrinology Section, G.V. (Sonny) Montgomery VA Medical Center and University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Mitsuhide Naruse
- Department of Endocrinology, Metabolism and Hypertension, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan
| | - Tomokazu Sakaguchi
- Department of Surgery, Misato Kenwa Hospital, 4-494-1 Takano, Misato, Saitama 341-8555, Japan
| | - Shinya Morita
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Takeo Kosaka
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Tadashi Ogishima
- Department of Chemistry, Faculty of Sciences, Kyushu University, Fukuoka 819-0395, Japan
| | - Masanori Yasuda
- Department of Pathology, Saitama Medical University International Medical Center, Hidaka 350-1241, Japan
| | - Makoto Suematsu
- Department of Biochemistry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Yasuaki Kabe
- Department of Biochemistry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Masao Omura
- Endocrinology & Diabetes Center, Yokohama Rosai Hospital, Yokohama 222-0036, Japan
| | - Tetsuo Nishikawa
- Endocrinology & Diabetes Center, Yokohama Rosai Hospital, Yokohama 222-0036, Japan
| | - Kuniaki Mukai
- Department of Biochemistry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; Department of Medical Education Center, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
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Tsai YY, Rainey WE, Bollag WB. Very low-density lipoprotein (VLDL)-induced signals mediating aldosterone production. J Endocrinol 2017; 232:R115-R129. [PMID: 27913572 PMCID: PMC8310676 DOI: 10.1530/joe-16-0237] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 12/02/2016] [Indexed: 01/14/2023]
Abstract
Aldosterone, secreted by the adrenal zona glomerulosa, enhances sodium retention, thus increasing blood volume and pressure. Excessive production of aldosterone results in high blood pressure and contributes to cardiovascular and renal disease, stroke and visual loss. Hypertension is also associated with obesity, which is correlated with other serious health risks as well. Although weight gain is associated with increased blood pressure, the mechanism by which excess fat deposits increase blood pressure remains unclear. Several studies have suggested that aldosterone levels are elevated with obesity and may represent a link between obesity and hypertension. In addition to hypertension, obese patients typically have dyslipidemia, including elevated serum levels of very low-density lipoprotein (VLDL). VLDL, which functions to transport triglycerides from the liver to peripheral tissues, has been demonstrated to stimulate aldosterone production. Recent studies suggest that the signaling pathways activated by VLDL are similar to those utilized by AngII. Thus, VLDL increases cytosolic calcium levels and stimulates phospholipase D (PLD) activity to result in the induction of steroidogenic acute regulatory (StAR) protein and aldosterone synthase (CYP11B2) expression. These effects seem to be mediated by the ability of VLDL to increase the phosphorylation (activation) of their regulatory transcription factors, such as the cAMP response element-binding (CREB) protein family of transcription factors. Thus, research into the pathways by which VLDL stimulates aldosterone production may identify novel targets for the development of therapies for the treatment of hypertension, particularly those associated with obesity, and other aldosterone-modulated pathologies.
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Affiliation(s)
- Ying-Ying Tsai
- Department of PhysiologyMedical College of Georgia at Augusta University (formerly Georgia Regents University), Augusta, Georgia, USA
| | - William E Rainey
- Departments of Molecular & Integrative Physiology and Internal MedicineUniversity of Michigan, Ann Arbor, Michigan, USA
| | - Wendy B Bollag
- Department of PhysiologyMedical College of Georgia at Augusta University (formerly Georgia Regents University), Augusta, Georgia, USA
- Charlie Norwood VA Medical CenterOne Freedom Way, Augusta, Georgia, USA
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Stowasser M, Gordon RD. Primary Aldosteronism: Changing Definitions and New Concepts of Physiology and Pathophysiology Both Inside and Outside the Kidney. Physiol Rev 2016; 96:1327-84. [DOI: 10.1152/physrev.00026.2015] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
In the 60 years that have passed since the discovery of the mineralocorticoid hormone aldosterone, much has been learned about its synthesis (both adrenal and extra-adrenal), regulation (by renin-angiotensin II, potassium, adrenocorticotrophin, and other factors), and effects (on both epithelial and nonepithelial tissues). Once thought to be rare, primary aldosteronism (PA, in which aldosterone secretion by the adrenal is excessive and autonomous of its principal regulator, angiotensin II) is now known to be the most common specifically treatable and potentially curable form of hypertension, with most patients lacking the clinical feature of hypokalemia, the presence of which was previously considered to be necessary to warrant further efforts towards confirming a diagnosis of PA. This, and the appreciation that aldosterone excess leads to adverse cardiovascular, renal, central nervous, and psychological effects, that are at least partly independent of its effects on blood pressure, have had a profound influence on raising clinical and research interest in PA. Such research on patients with PA has, in turn, furthered knowledge regarding aldosterone synthesis, regulation, and effects. This review summarizes current progress in our understanding of the physiology of aldosterone, and towards defining the causes (including genetic bases), epidemiology, outcomes, and clinical approaches to diagnostic workup (including screening, diagnostic confirmation, and subtype differentiation) and treatment of PA.
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Affiliation(s)
- Michael Stowasser
- Endocrine Hypertension Research Centre, University of Queensland School of Medicine, Greenslopes and Princess Alexandra Hospitals, Brisbane, Queensland, Australia
| | - Richard D. Gordon
- Endocrine Hypertension Research Centre, University of Queensland School of Medicine, Greenslopes and Princess Alexandra Hospitals, Brisbane, Queensland, Australia
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Rehman KS, Carr BR, Rainey WE. Profiling the Steroidogenic Pathway in Human Fetal and Adult Adrenals. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/s1071-55760300118-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Bruce R. Carr
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - William E. Rainey
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9032
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14
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Zennaro MC, Jeunemaitre X. SFE/SFHTA/AFCE consensus on primary aldosteronism, part 5: Genetic diagnosis of primary aldosteronism. ANNALES D'ENDOCRINOLOGIE 2016; 77:214-9. [PMID: 27315758 DOI: 10.1016/j.ando.2016.02.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 02/05/2016] [Indexed: 11/15/2022]
Abstract
While the majority of cases of primary aldosteronism (PA) are sporadic, four forms of autosomal-dominant inheritance have been described: familial hyperaldosteronism (FH) types I to IV. FH-I, also called glucocorticoid-remediable aldosteronism, is characterized by early and severe hypertension, usually before the age of 20 years. It is due to the formation of a chimeric gene between the adjacent CYP11B2 and CYP11B1 genes (coding for aldosterone synthase and 11β-hydroxylase, respectively). FH-I is often associated with family history of stroke before 40years of age. FH-II is clinically and biochemically indistinguishable from sporadic forms of PA and is only diagnosed on the basis of two or more affected family members. No causal genes have been identified so far and no genetic test is available. FH-III is characterized by severe and early-onset hypertension in children and young adults, resistant to treatment and associated with severe hypokalemia. Mild forms, resembling FH-II, have been described. FH-III is due to gain-of-function mutations in the KCNJ5 gene. Recently, a new autosomal-dominant form of familial PA, FH-IV, associated with mutations in the CACNA1H gene, was described in patients with hypertension and PA before the age of 10years. In rare cases, PA may be associated with complex neurologic disorder involving epileptic seizures and cerebral palsy (Primary Aldosteronism, Seizures, and Neurologic Abnormalities [PASNA]) due to de novo germline CACNA1D mutations.
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Affiliation(s)
- Maria-Christina Zennaro
- INSERM, U970, Paris Cardiovascular Research Center-PARCC, 56, rue Leblanc, 75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Service de génétique, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, Paris, France.
| | - Xavier Jeunemaitre
- INSERM, U970, Paris Cardiovascular Research Center-PARCC, 56, rue Leblanc, 75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Service de génétique, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, Paris, France
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15
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Affiliation(s)
- Rita Bernhardt
- Lehrstuhl für Biochemie, Universität des Saarlandes, Saarbrücken, Germany
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16
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Menabò S, Boccassini S, Gambineri A, Balsamo A, Pasquali R, Prontera O, Mazzanti L, Baldazzi L. Improving the diagnosis of 11β-hydroxylase deficiency using home-made MLPA probes: identification of a novel chimeric CYP11B2/CYP11B1 gene in a Sicilian patient. J Endocrinol Invest 2016; 39:291-5. [PMID: 26280318 DOI: 10.1007/s40618-015-0362-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 07/12/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE 11β-Hydroxylase deficiency (11OHD) represents the second most common cause of congenital adrenal hyperplasia. It is caused by mutations in the CYP11B1 gene localized about 40 kb from the CYP11B2 gene with which it shares a homology of 95 %. The asymmetric recombination of these two genes is involved both in 11OHD and in glucocorticoid-remediable aldosteronism (GRA). Our objective was to set up an easy and rapid method to detect these hybrid genes and other kinds of deletions, to improve the molecular diagnosis of 11OHD. METHODS A set of 8 specific probes for both the CYP11B1 and the CYP11B2 genes to be used for multiplex ligation-dependent probe amplification (MLPA) analysis was designed to detect rearrangements of these genes. RESULTS The method developed was tested on 15 healthy controls and was proved to be specific and reliable; it led us to identify a novel chimeric CYP11B2/CYP11B1 gene in one patient that carried the known A306V mutation on the other allele. Specific amplification and sequencing of the hybrid gene confirmed the breakpoint localization in the second intron. CONCLUSIONS The MLPA kit developed enables the detection of deletions, duplications or chimeric genes and represents an optimal supplement to DNA sequence analysis in patients with 11OHD. In addition, it can also be used to show the presence of the opposite chimaera associated with GRA.
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Affiliation(s)
- S Menabò
- Pediatric Endocrinology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
| | - S Boccassini
- Pediatric Endocrinology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - A Gambineri
- Endocrinology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - A Balsamo
- Pediatric Endocrinology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - R Pasquali
- Endocrinology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - O Prontera
- Endocrinology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - L Mazzanti
- Pediatric Endocrinology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - L Baldazzi
- Pediatric Endocrinology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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17
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Ardhanari S, Kannuswamy R, Chaudhary K, Lockette W, Whaley-Connell A. Mineralocorticoid and apparent mineralocorticoid syndromes of secondary hypertension. Adv Chronic Kidney Dis 2015; 22:185-95. [PMID: 25908467 DOI: 10.1053/j.ackd.2015.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 03/02/2015] [Accepted: 03/04/2015] [Indexed: 11/11/2022]
Abstract
The mineralocorticoid aldosterone is a key hormone in the regulation of plasma volume and blood pressure in man. Excessive levels of this mineralocorticoid have been shown to mediate metabolic disorders and end-organ damage more than what can be attributed to its effects on blood pressure alone. Inappropriate excess levels of aldosterone contribute significantly to the cardiorenal metabolic syndrome and target organ injury that include atherosclerosis, myocardial hypertrophy, fibrosis, heart failure, and kidney disease. The importance of understanding the role of excess mineralocorticoid hormones such as aldosterone in resistant hypertension and in those with secondary hypertension should be visited. Primary aldosteronism is one of the commonly identified causes of hypertension and is treatable and/or potentially curable. We intend to review the management of mineralocorticoid-induced hypertension in the adult population along with other disease entities that mimic primary aldosteronism.
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18
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Angiotensin II triggers expression of the adrenal gland zona glomerulosa-specific 3β-hydroxysteroid dehydrogenase isoenzyme through de novo protein synthesis of the orphan nuclear receptors NGFIB and NURR1. Mol Cell Biol 2014; 34:3880-94. [PMID: 25092869 DOI: 10.1128/mcb.00852-14] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The 3β-hydroxysteroid dehydrogenase (3β-HSD) is an enzyme crucial for steroid synthesis. Two different 3β-HSD isoforms exist in humans. Classically, HSD3B2 was considered the principal isoform present in the adrenal. However, we recently showed that the alternative isoform, HSD3B1, is expressed specifically within the adrenal zona glomerulosa (ZG), where aldosterone is produced, raising the question of why this isozyme needs to be expressed in this cell type. Here we show that in both human and mouse, expression of the ZG isoform 3β-HSD is rapidly induced upon angiotensin II (AngII) stimulation. AngII is the key peptide hormone regulating the capacity of aldosterone synthesis. Using the human adrenocortical H295R cells as a model system, we show that the ZG isoform HSD3B1 differs from HSD3B2 in the ability to respond to AngII. Mechanistically, the induction of HSD3B1 involves de novo protein synthesis of the nuclear orphan receptors NGFIB and NURR1. The HSD3B1 promoter contains a functional NGFIB/NURR1-responsive element to which these proteins bind in response to AngII. Knockdown of these proteins and overexpression of a dominant negative NGFIB both reduce the AngII responsiveness of HSD3B1. Thus, the AngII-NGFIB/NURR1 pathway controls HSD3B1. Our work reveals HSD3B1 as a new regulatory target of AngII.
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19
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Gomez-Sanchez CE, Qi X, Velarde-Miranda C, Plonczynski MW, Parker CR, Rainey W, Satoh F, Maekawa T, Nakamura Y, Sasano H, Gomez-Sanchez EP. Development of monoclonal antibodies against human CYP11B1 and CYP11B2. Mol Cell Endocrinol 2014; 383:111-7. [PMID: 24325867 PMCID: PMC3939805 DOI: 10.1016/j.mce.2013.11.022] [Citation(s) in RCA: 206] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 11/26/2013] [Accepted: 11/29/2013] [Indexed: 01/27/2023]
Abstract
1. The final enzymes in the biosynthesis of aldosterone and cortisol are by the cytochrome P450 CYP11B2 and CYP11B1, respectively. The enzymes are 93% homologous at the amino acid level and specific antibodies have been difficult to generate. 2. Mice and rats were immunized with multiple peptides conjugated to various immunogenic proteins and monoclonal antibodies were generated. The only peptide sequences that generated specific antibodies were amino acids 41-52 for the CYP11B2 and amino acids 80-90 for the CYP11B1 enzyme. 3. The mouse monoclonal CYP11B2-41 was specific and sensitive for use in western blots and produced specific staining of the zona glomerulosa of normal adrenal glands. The rat monoclonal CYP11B1-80 also detected a single band by western blot and detected only the zona fasciculata. Triple immunofluorescence of the adrenal demonstrated that the CYP11B1 and the CYP11B2 did not co-localize, while as expected the CYP11B1 co-localized with the 17α-hydroxylase.
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Affiliation(s)
- Celso E Gomez-Sanchez
- Endocrine Section, G.V. (Sonny) Montgomery VA Medical Center, USA; Endocrinology, University of Mississippi Medical Center, USA.
| | - Xin Qi
- Endocrinology, University of Mississippi Medical Center, USA
| | | | | | - C Richard Parker
- Department of Obstetrics and Gynecology, University of Alabama, Birmingham, AL, USA
| | - William Rainey
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Fumitoshi Satoh
- Tohoku University, Department of Pathology, Tohoku University, Sendai, Japan
| | - Takashi Maekawa
- Tohoku University, Department of Pathology, Tohoku University, Sendai, Japan
| | - Yasuhiro Nakamura
- Tohoku University, Department of Pathology, Tohoku University, Sendai, Japan
| | - Hironobu Sasano
- Tohoku University, Department of Pathology, Tohoku University, Sendai, Japan
| | - Elise P Gomez-Sanchez
- Endocrine Section, G.V. (Sonny) Montgomery VA Medical Center, USA; Endocrinology, University of Mississippi Medical Center, USA; Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, MS, USA
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20
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Abstract
Aldosterone plays a major role in the regulation of sodium and potassium homeostasis and blood pressure. More recently, aldosterone has emerged as a key hormone mediating end organ damage. In extreme cases, dysregulated aldosterone production leads to primary aldosteronism (PA), the most common form of secondary hypertension. However, even within the physiological range, high levels of aldosterone are associated with an increased risk of developing hypertension over time. PA represents the most common and curable form of hypertension, with a prevalence that increases with the severity of hypertension. Although genetic causes underlying glucocorticoid-remediable aldosteronism, one of the three Mendelian forms of PA, were established some time ago, somatic and inherited mutations in the potassium channel GIRK4 have only recently been implicated in the formation of aldosterone-producing adenoma (APA) and in familial hyperaldosteronism type 3. Moreover, recent findings have shown somatic mutations in two additional genes, involved in maintaining intracellular ionic homeostasis and cell membrane potential, in a subset of APAs. This review summarizes our current knowledge on the genetic determinants that contribute to variations in plasma aldosterone and renin levels in the general population and the genetics of familial and sporadic PA. Various animal models that have significantly improved our understanding of the pathophysiology of excess aldosterone production are also discussed. Finally, we outline the cardiovascular, renal, and metabolic consequences of mineralocorticoid excess beyond blood pressure regulation.
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21
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Stowasser M, Gordon RD. The Renaissance of Primary Aldosteronism: What Has it Taught Us? Heart Lung Circ 2013; 22:412-20. [DOI: 10.1016/j.hlc.2013.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 01/05/2013] [Indexed: 10/27/2022]
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22
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Mulatero P, Monticone S, Rainey WE, Veglio F, Williams TA. Role of KCNJ5 in familial and sporadic primary aldosteronism. Nat Rev Endocrinol 2013; 9:104-12. [PMID: 23229280 DOI: 10.1038/nrendo.2012.230] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Primary aldosteronism is characterised by the dysregulation of aldosterone production and comprises both sporadic forms, caused by an aldosterone-producing adenoma or bilateral adrenal hyperplasia, and familial forms (familial hyperaldosteronism types I, II and III). The two principal physiological regulators of aldosterone synthesis are angiotensin II and serum K(+), which reverse the high resting K(+) conductance and hyperpolarized membrane potential of adrenal glomerulosa cells. The resulting membrane depolarization causes the opening of voltage-gated Ca(2+) channels and an increase in intracellular Ca(2+) that stimulates aldosterone biosynthesis. Point mutations in the KCNJ5 gene, which encodes the G-protein-activated inward rectifier K(+) channel 4 (GIRK4), have been implicated in the pathogenesis of both sporadic and familial forms of primary aldosteronism. These mutations interfere with the selectivity filter of GIRK4 causing Na(+) entry, cell depolarization and Ca(2+) channel opening, resulting in constitutive aldosterone production. Seven families with familial hyperaldosteronism caused by KCNJ5 germline mutations have so far been described, and multicentre studies have reported KCNJ5 mutations in approximately 40% of sporadic aldosterone-producing adenomas. Herein, we review the role of GIRK4 in adrenal pathophysiology and provide an overview of the clinical and biochemical phenotypes resulting from KCNJ5 mutations in patients with sporadic and familial primary aldosteronism.
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Affiliation(s)
- Paolo Mulatero
- University of Torino, Department of Medical Sciences, Division of Internal Medicine and Hypertension, Italy. paolo.mulatero@ unito.it
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23
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Martinerie L, Munier M, Le Menuet D, Meduri G, Viengchareun S, Lombès M. The mineralocorticoid signaling pathway throughout development: expression, regulation and pathophysiological implications. Biochimie 2012; 95:148-57. [PMID: 23026756 DOI: 10.1016/j.biochi.2012.09.030] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Accepted: 09/23/2012] [Indexed: 10/27/2022]
Abstract
The mineralocorticoid signaling pathway has gained interest over the past few years, considering not only its implication in numerous pathologies but also its emerging role in physiological processes during kidney, brain, heart and lung development. This review aims at describing the setting and regulation of aldosterone biosynthesis and the expression of the mineralocorticoid receptor (MR), a nuclear receptor mediating aldosterone action in target tissues, during the perinatal period. Specificities concerning MR expression and regulation during the development of several major organs are highlighted. We provide evidence that MR expression is tightly controlled in a tissue-specific manner during development, which could have major pathophysiological implications in the neonatal period.
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24
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Zennaro MC, Jeunemaitre X, Boulkroun S. Integrating genetics and genomics in primary aldosteronism. Hypertension 2012; 60:580-8. [PMID: 22802222 DOI: 10.1161/hypertensionaha.111.188250] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Maria-Christina Zennaro
- Institut National de la Santé et de la Recherche Médicale, U970, Paris Cardiovascular Research Center-PARCC, 56 rue Leblanc, 75015 Paris, France.
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25
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Hattangady N, Olala L, Bollag WB, Rainey WE. Acute and chronic regulation of aldosterone production. Mol Cell Endocrinol 2012; 350:151-62. [PMID: 21839803 PMCID: PMC3253327 DOI: 10.1016/j.mce.2011.07.034] [Citation(s) in RCA: 206] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Revised: 07/11/2011] [Accepted: 07/17/2011] [Indexed: 11/28/2022]
Abstract
Aldosterone is the major mineralocorticoid synthesized by the adrenal and plays an important role in the regulation of systemic blood pressure through the absorption of sodium and water. Aldosterone production is regulated tightly by selective expression of aldosterone synthase (CYP11B2) in the adrenal outermost zone, the zona glomerulosa. Angiotensin II (Ang II), potassium (K(+)) and adrenocorticotropin (ACTH) are the main physiological agonists which regulate aldosterone secretion. Aldosterone production is regulated within minutes of stimulation (acutely) through increased expression and phosphorylation of the steroidogenic acute regulatory (StAR) protein and over hours to days (chronically) by increased expression of the enzymes involved in the synthesis of aldosterone, particularly CYP11B2. Imbalance in any of these processes may lead to several disorders of aldosterone excess. In this review we attempt to summarize the key molecular events involved in the acute and chronic phases of aldosterone secretion.
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Affiliation(s)
- Namita Hattangady
- Department of Physiology, Georgia Health Sciences University (formerly the Medical College of Georgia), 1120 15 Street, Augusta, GA 30912
| | - Lawrence Olala
- Department of Physiology, Georgia Health Sciences University (formerly the Medical College of Georgia), 1120 15 Street, Augusta, GA 30912
| | - Wendy B. Bollag
- Department of Physiology, Georgia Health Sciences University (formerly the Medical College of Georgia), 1120 15 Street, Augusta, GA 30912
- Charlie Norwood VA Medical Center, One Freedom Way, Augusta, GA 30904
| | - William E. Rainey
- Department of Physiology, Georgia Health Sciences University (formerly the Medical College of Georgia), 1120 15 Street, Augusta, GA 30912
- To whom correspondence should be addressed: William E. Rainey, Department of Physiology, Georgia Health Sciences University, 1120 15 Street, Augusta, GA 30912, , Tel: (706) 721-7665, Fax: (706) 721-7299
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26
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Stowasser M, Pimenta E, Gordon RD. Familial or genetic primary aldosteronism and Gordon syndrome. Endocrinol Metab Clin North Am 2011; 40:343-68, viii. [PMID: 21565671 DOI: 10.1016/j.ecl.2011.01.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Salt-sensitive forms of hypertension have received considerable renewed attention in recent years. This article focuses on 2 main forms of salt-sensitive hypertension (familial or genetic primary aldosteronism [PA] and Gordon syndrome) and the current state of knowledge regarding their genetic bases. The glucocorticoid-remediable form of familial PA (familial hyperaldosteronism type I) is dealt with only briefly because it is covered in depth elsewhere.
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Affiliation(s)
- Michael Stowasser
- Endocrine Hypertension Research Center, University of Queensland School of Medicine, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane 4102, Australia.
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27
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Abstract
PURPOSE OF REVIEW Inherited forms of mineralocorticoid hypertension are a group of monogenic disorders that, although rare, have enlightened our understanding of normal physiology, and subsequent processes implicated in the pathogenesis of 'essential' hypertension. They often present in early life and can be a cause of major morbidity and mortality that can be effectively treated with simple but targeted pharmacological therapy. Interestingly, all the conditions centre on the regulation of sodium transport through its epithelial channel, either directly or through mediators that act via the mineralocorticoid receptor. RECENT FINDINGS In recent years, molecular mechanisms of these conditions and their functional consequences have been elucidated. Diagnosis has been facilitated by plasma and urinary biomarkers. SUMMARY We provide an overview and diagnostic approach to apparent mineralocorticoid excess, glucocorticoid remediable aldosteronism, familial hyperaldosteronism type 2, Liddle's syndrome, Gordon's syndrome, activating mutations of the mineralocorticoid receptor, generalized glucocorticoid resistance and hypertensive forms of congenital adrenal hyperplasia.
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Affiliation(s)
- Zaki Hassan-Smith
- Centre for Endocrinology, Diabetes and Metabolism, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
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28
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Boulkroun S, Samson-Couterie B, Dzib JFG, Lefebvre H, Louiset E, Amar L, Plouin PF, Lalli E, Jeunemaitre X, Benecke A, Meatchi T, Zennaro MC. Adrenal Cortex Remodeling and Functional Zona Glomerulosa Hyperplasia in Primary Aldosteronism. Hypertension 2010; 56:885-92. [DOI: 10.1161/hypertensionaha.110.158543] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sheerazed Boulkroun
- From the Institut National de la Santé et de la Recherche Médicale (S.B., B.S.-C., L.A., P.-F.P., X.J., T.M., M.-C.Z.), U970, Paris Cardiovascular Research Center, Paris, France; University Paris Descartes (S.B., B.S.-C., L.A., P.-F.P., X.J., T.M., M.-C.Z.), Paris, France; Institut des Hautes Études Scientifiques (J.-F.G.D., A.B.), Bures sur Yvette, France; Institut National de la Santé et de la Recherche Médicale (H.L., E.Lo.), U982, Mont-Saint-Aignan, France; University of Rouen (H.L., E.Lo.)
| | - Benoit Samson-Couterie
- From the Institut National de la Santé et de la Recherche Médicale (S.B., B.S.-C., L.A., P.-F.P., X.J., T.M., M.-C.Z.), U970, Paris Cardiovascular Research Center, Paris, France; University Paris Descartes (S.B., B.S.-C., L.A., P.-F.P., X.J., T.M., M.-C.Z.), Paris, France; Institut des Hautes Études Scientifiques (J.-F.G.D., A.B.), Bures sur Yvette, France; Institut National de la Santé et de la Recherche Médicale (H.L., E.Lo.), U982, Mont-Saint-Aignan, France; University of Rouen (H.L., E.Lo.)
| | - José-Felipe Golib Dzib
- From the Institut National de la Santé et de la Recherche Médicale (S.B., B.S.-C., L.A., P.-F.P., X.J., T.M., M.-C.Z.), U970, Paris Cardiovascular Research Center, Paris, France; University Paris Descartes (S.B., B.S.-C., L.A., P.-F.P., X.J., T.M., M.-C.Z.), Paris, France; Institut des Hautes Études Scientifiques (J.-F.G.D., A.B.), Bures sur Yvette, France; Institut National de la Santé et de la Recherche Médicale (H.L., E.Lo.), U982, Mont-Saint-Aignan, France; University of Rouen (H.L., E.Lo.)
| | - Hervé Lefebvre
- From the Institut National de la Santé et de la Recherche Médicale (S.B., B.S.-C., L.A., P.-F.P., X.J., T.M., M.-C.Z.), U970, Paris Cardiovascular Research Center, Paris, France; University Paris Descartes (S.B., B.S.-C., L.A., P.-F.P., X.J., T.M., M.-C.Z.), Paris, France; Institut des Hautes Études Scientifiques (J.-F.G.D., A.B.), Bures sur Yvette, France; Institut National de la Santé et de la Recherche Médicale (H.L., E.Lo.), U982, Mont-Saint-Aignan, France; University of Rouen (H.L., E.Lo.)
| | - Estelle Louiset
- From the Institut National de la Santé et de la Recherche Médicale (S.B., B.S.-C., L.A., P.-F.P., X.J., T.M., M.-C.Z.), U970, Paris Cardiovascular Research Center, Paris, France; University Paris Descartes (S.B., B.S.-C., L.A., P.-F.P., X.J., T.M., M.-C.Z.), Paris, France; Institut des Hautes Études Scientifiques (J.-F.G.D., A.B.), Bures sur Yvette, France; Institut National de la Santé et de la Recherche Médicale (H.L., E.Lo.), U982, Mont-Saint-Aignan, France; University of Rouen (H.L., E.Lo.)
| | - Laurence Amar
- From the Institut National de la Santé et de la Recherche Médicale (S.B., B.S.-C., L.A., P.-F.P., X.J., T.M., M.-C.Z.), U970, Paris Cardiovascular Research Center, Paris, France; University Paris Descartes (S.B., B.S.-C., L.A., P.-F.P., X.J., T.M., M.-C.Z.), Paris, France; Institut des Hautes Études Scientifiques (J.-F.G.D., A.B.), Bures sur Yvette, France; Institut National de la Santé et de la Recherche Médicale (H.L., E.Lo.), U982, Mont-Saint-Aignan, France; University of Rouen (H.L., E.Lo.)
| | - Pierre-François Plouin
- From the Institut National de la Santé et de la Recherche Médicale (S.B., B.S.-C., L.A., P.-F.P., X.J., T.M., M.-C.Z.), U970, Paris Cardiovascular Research Center, Paris, France; University Paris Descartes (S.B., B.S.-C., L.A., P.-F.P., X.J., T.M., M.-C.Z.), Paris, France; Institut des Hautes Études Scientifiques (J.-F.G.D., A.B.), Bures sur Yvette, France; Institut National de la Santé et de la Recherche Médicale (H.L., E.Lo.), U982, Mont-Saint-Aignan, France; University of Rouen (H.L., E.Lo.)
| | - Enzo Lalli
- From the Institut National de la Santé et de la Recherche Médicale (S.B., B.S.-C., L.A., P.-F.P., X.J., T.M., M.-C.Z.), U970, Paris Cardiovascular Research Center, Paris, France; University Paris Descartes (S.B., B.S.-C., L.A., P.-F.P., X.J., T.M., M.-C.Z.), Paris, France; Institut des Hautes Études Scientifiques (J.-F.G.D., A.B.), Bures sur Yvette, France; Institut National de la Santé et de la Recherche Médicale (H.L., E.Lo.), U982, Mont-Saint-Aignan, France; University of Rouen (H.L., E.Lo.)
| | - Xavier Jeunemaitre
- From the Institut National de la Santé et de la Recherche Médicale (S.B., B.S.-C., L.A., P.-F.P., X.J., T.M., M.-C.Z.), U970, Paris Cardiovascular Research Center, Paris, France; University Paris Descartes (S.B., B.S.-C., L.A., P.-F.P., X.J., T.M., M.-C.Z.), Paris, France; Institut des Hautes Études Scientifiques (J.-F.G.D., A.B.), Bures sur Yvette, France; Institut National de la Santé et de la Recherche Médicale (H.L., E.Lo.), U982, Mont-Saint-Aignan, France; University of Rouen (H.L., E.Lo.)
| | - Arndt Benecke
- From the Institut National de la Santé et de la Recherche Médicale (S.B., B.S.-C., L.A., P.-F.P., X.J., T.M., M.-C.Z.), U970, Paris Cardiovascular Research Center, Paris, France; University Paris Descartes (S.B., B.S.-C., L.A., P.-F.P., X.J., T.M., M.-C.Z.), Paris, France; Institut des Hautes Études Scientifiques (J.-F.G.D., A.B.), Bures sur Yvette, France; Institut National de la Santé et de la Recherche Médicale (H.L., E.Lo.), U982, Mont-Saint-Aignan, France; University of Rouen (H.L., E.Lo.)
| | - Tchao Meatchi
- From the Institut National de la Santé et de la Recherche Médicale (S.B., B.S.-C., L.A., P.-F.P., X.J., T.M., M.-C.Z.), U970, Paris Cardiovascular Research Center, Paris, France; University Paris Descartes (S.B., B.S.-C., L.A., P.-F.P., X.J., T.M., M.-C.Z.), Paris, France; Institut des Hautes Études Scientifiques (J.-F.G.D., A.B.), Bures sur Yvette, France; Institut National de la Santé et de la Recherche Médicale (H.L., E.Lo.), U982, Mont-Saint-Aignan, France; University of Rouen (H.L., E.Lo.)
| | - Maria-Christina Zennaro
- From the Institut National de la Santé et de la Recherche Médicale (S.B., B.S.-C., L.A., P.-F.P., X.J., T.M., M.-C.Z.), U970, Paris Cardiovascular Research Center, Paris, France; University Paris Descartes (S.B., B.S.-C., L.A., P.-F.P., X.J., T.M., M.-C.Z.), Paris, France; Institut des Hautes Études Scientifiques (J.-F.G.D., A.B.), Bures sur Yvette, France; Institut National de la Santé et de la Recherche Médicale (H.L., E.Lo.), U982, Mont-Saint-Aignan, France; University of Rouen (H.L., E.Lo.)
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Amar L, Plouin PF, Steichen O. Aldosterone-producing adenoma and other surgically correctable forms of primary aldosteronism. Orphanet J Rare Dis 2010; 5:9. [PMID: 20482833 PMCID: PMC2889888 DOI: 10.1186/1750-1172-5-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Accepted: 05/19/2010] [Indexed: 01/20/2023] Open
Abstract
Surgically correctable forms of primary aldosteronism are characterized by unilateral aldosterone hypersecretion and renin suppression, associated with varying degrees of hypertension and hypokalemia. Unilateral aldosterone hypersecretion is caused by an aldosterone-producing adenoma (also known as Conn's adenoma and aldosteronoma), primary unilateral adrenal hyperplasia and rare cases of aldosterone-producing adrenocortical carcinoma. In these forms, unilateral adrenalectomy can cure aldosterone excess and hypokalemia, but not necessarily hypertension. The prevalence of primary aldosteronism in the general population is not known. Its prevalence in referred hypertensive populations is estimated to be between 6 and 13%, of which 1.5 to 5% have an aldosterone-producing adenoma or primary unilateral adrenal hyperplasia. Taking into account referral biases, the prevalence of surgically correctable primary aldosteronism is probably less than 1.5% in the hypertensive population and less than 0.3% in the general adult population. Surgically correctable primary aldosteronism is sought in patients with hypokalemic, severe or resistant forms of hypertension. Recent recommendations suggest screening for primary aldosteronism using the aldosterone to renin ratio. Patients with a raised ratio then undergo confirmatory suppression tests. The differential diagnosis of hypokalemic hypertension with low renin includes mineralocorticoid excess, with the mineralocorticoid being cortisol or 11-deoxycorticosterone, apparent mineralocorticoid excess, pseudo-hypermineralocorticoidism in Liddle syndrome or exposure to glycyrrhizic acid. Once the diagnosis is confirmed, adrenal computed tomography is performed for all patients. If surgery is considered, taking into consideration the clinical context and the desire of the patient, adrenal vein sampling is performed to detect whether or not aldosterone hypersecretion is unilateral. Laparoscopic surgery for unilateral aldosterone hypersecretion is associated with a morbidity of about 8%, with most complications being minor. It generally results in the normalization of aldosterone secretion and kalemia, and in a large decrease in blood pressure, but normotension without treatment is only achieved in half of all cases. Normotension following adrenalectomy is more frequent in young patients with recent hypertension than in patients with long-standing hypertension or a family history of hypertension.
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Affiliation(s)
- Laurence Amar
- Université Paris Descartes, Hôpitaux de Paris, France
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Nishimoto K, Nakagawa K, Li D, Kosaka T, Oya M, Mikami S, Shibata H, Itoh H, Mitani F, Yamazaki T, Ogishima T, Suematsu M, Mukai K. Adrenocortical zonation in humans under normal and pathological conditions. J Clin Endocrinol Metab 2010; 95:2296-305. [PMID: 20200334 DOI: 10.1210/jc.2009-2010] [Citation(s) in RCA: 219] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Aldosterone synthase (CYP11B2) and steroid 11 beta-hydroxylase (CYP11B1) catalyze the terminal steps for aldosterone and cortisol syntheses, respectively, thereby determining the functional differentiation of human adrenocortical cells. Little is known, however, about how the cells expressing the enzymes are actually distributed in the adrenals under normal and pathological conditions. OBJECTIVE The objective of the study was to determine the localization of CYP11B2 and -B1 in human adrenal specimens by using developed antibodies capable of distinguishing the two enzymes from each other. RESULTS Under normal conditions, CYP11B2 was sporadically detected in the zona glomerulosa, whereas CYP11B1 was entirely detected in the zonae fasciculata-reticularis. Adrenocortical cells lacking both enzymes were observed in the outer cortical regions. In addition to conventional zonation, we found a variegated zonation consisting of a subcapsular cell cluster expressing CYP11B2, which we termed aldosterone-producing cell cluster, and a CYP11B1-expressing area. Aldosterone-producing adenomas differed in cell populations expressing CYP11B2 from one another, whereas CYP11B1-expressing and double-negative cells were also intermingled. Adenomas from patients with Cushing's syndrome expressed CYP11B1 entirely but not CYP11B2, resulting in atrophic nontumor glands. The nontumor portions of both types of adenomas bore frequently one or more aldosterone-producing cell clusters, which sustained CYP11B2 expression markedly under the conditions of the suppressed renin-angiotensin system. CONCLUSION Immunohistochemistry of the human normal adrenal cortex for CYP11B2 and CYP11B1 revealed a variegated zonation with cell clusters constitutively expressing CYP11B2. This technique may provide a pathological confirmatory diagnosis of adrenocortical adenomas.
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Affiliation(s)
- Koshiro Nishimoto
- Department of Urology, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
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Expression of Genes Encoding Aldosterone Synthesis Pathway Enzymatic Proteins in Adrenocortical Adenomas in Patients With Conn Syndrome. POLISH JOURNAL OF SURGERY 2010. [DOI: 10.2478/v10035-010-0008-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Mulatero P, Caserta M, Bertello C, Schiavone D, Verhovez A, Giraudo G, Morello F, Veglio F. Aldosterone as an Independent Factor in Cerebrovascular Damage. Clin Exp Hypertens 2009; 30:785-97. [DOI: 10.1080/10641960802566017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Mourad JJ, Girerd X, Milliez P, Lopez-Sublet M, Lejeune S, Safar ME. Urinary aldosterone-to-active-renin ratio: a useful tool for predicting resolution of hypertension after adrenalectomy in patients with aldosterone-producing adenomas. Am J Hypertens 2008; 21:742-7. [PMID: 18443567 DOI: 10.1038/ajh.2008.175] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The purpose of this study was to determine the preoperative clinical and biological factors that predict the clinical outcomes after surgery, in subjects with aldosterone-producing adenomas (APAs). METHODS Fifty-eight patients (mean age 52 +/- 11 years) with APA were followed up for 43 +/- 13 months after they had undergone unilateral adrenalectomy. The subjects were classified as "cured" (n = 23) if the blood pressure (BP) was <140/90 mm Hg without postoperative medication, "normalized" (n = 20) if BP was <140/90 mm Hg with antihypertensive therapy, and "uncontrolled" (n = 15) if a BP of < or =140/90 mm Hg was not achieved despite intensive therapy. RESULTS The cured patients had a significantly lower mean preoperative age, cardiac mass, and serum creatinine (P < 0.001) than the other subjects. The main independent predictors of surgical curability were: age (P < 0.01), low serum potassium (P < 0.0001), and the urinary aldosterone-to-active-renin (UAAR) ratio (P < 0.008). Among the hormonal parameters, the UAAR ratio provided the best area under the receiver operating-characteristics curve (0.802 (confidence interval (CI) 95%: 0.676-0.944)). For a cutoff value of 15, the positive and negative predictive values of the UAAR ratio were 85 and 92%, respectively. In the study population as a whole, surgical treatment restored the age-systolic BP (SBP) relationship (P < 0.006), which was insignificant before surgery. CONCLUSIONS Although all the subjects showed lowering of BP after surgery, and the age-BP relationship was restored, the long-term cure rate of APA subjects was 40%. The UAAR ratio, by comparison with other classical hormonal features of primary aldosteronism, was the best independent predictor of the cure of hypertension after adrenalectomy.
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Médeau V, Moreau F, Trinquart L, Clemessy M, Wémeau JL, Vantyghem MC, Plouin PF, Reznik Y. Clinical and biochemical characteristics of normotensive patients with primary aldosteronism: a comparison with hypertensive cases. Clin Endocrinol (Oxf) 2008; 69:20-8. [PMID: 18284637 DOI: 10.1111/j.1365-2265.2008.03213.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE It is unknown why some patients with biochemical evidence of primary aldosteronism (PA) do not develop hypertension. We aimed to compare clinical and biochemical characteristics of normotensive and hypertensive patients with PA. DESIGN AND PATIENTS Retrospective comparison of 10 normotensive and 168 hypertensive patients with PA for office or ambulatory blood pressure, serum potassium, plasma aldosterone and renin concentrations; the aldosterone:renin ratio, and tumour size. Comparison of initial hormonal pattern and drop in blood pressure following adrenalectomy in five normotensive and nine hypertensive patients matched for age, sex and body mass index. RESULTS The 10 normotensive patients were women and presented with hypokalemia or an adrenal mass. Age, plasma aldosterone and renin concentrations were similar in normotensive and hypertensive cases, but kalemia and body mass index were significantly lower in the normotensive patients. Mean tumour diameter was larger in the normotensive patients than in the hypertensive matched patients with an adenoma (P < 0.01). In normotensive patients, diastolic blood pressure and upright aldosterone correlated negatively with kalemia. Blood pressure was lowered similarly after adrenalectomy in five normotensive PA patients and in their matched hypertensive counterparts. Aldosterone synthase expression was detected in four out of five adrenal tumours. CONCLUSIONS Blood pressure may be normal in patients with well-documented PA. The occurrence of hypokalemia, despite a normal blood pressure profile, suggests that protective mechanisms against hypertension are present in normotensive patients.
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Affiliation(s)
- Virginie Médeau
- Département d'Hypertension, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
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Quack I, Vonend O, Sellin L, Stegbauer J, Dekomien G, Rump LC. A Tale of Two Patients With Mendelian Hypertension. Hypertension 2008; 51:609-14. [DOI: 10.1161/hypertensionaha.107.101915] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ivo Quack
- From the Department of Nephrology, Heinrich-Heine-University (I.Q., L.S., J.S., L.C.R.), Düsseldorf, Germany; the Department of Internal Medicine I (O.V.), Ruhr University, Bochum, Germany; Marienhospital (G.D.), Herne, Germany; and the Department of Human Genetics (G.D.), Ruhr University, Bochum, Germany
| | - Oliver Vonend
- From the Department of Nephrology, Heinrich-Heine-University (I.Q., L.S., J.S., L.C.R.), Düsseldorf, Germany; the Department of Internal Medicine I (O.V.), Ruhr University, Bochum, Germany; Marienhospital (G.D.), Herne, Germany; and the Department of Human Genetics (G.D.), Ruhr University, Bochum, Germany
| | - Lorenz Sellin
- From the Department of Nephrology, Heinrich-Heine-University (I.Q., L.S., J.S., L.C.R.), Düsseldorf, Germany; the Department of Internal Medicine I (O.V.), Ruhr University, Bochum, Germany; Marienhospital (G.D.), Herne, Germany; and the Department of Human Genetics (G.D.), Ruhr University, Bochum, Germany
| | - Johannes Stegbauer
- From the Department of Nephrology, Heinrich-Heine-University (I.Q., L.S., J.S., L.C.R.), Düsseldorf, Germany; the Department of Internal Medicine I (O.V.), Ruhr University, Bochum, Germany; Marienhospital (G.D.), Herne, Germany; and the Department of Human Genetics (G.D.), Ruhr University, Bochum, Germany
| | - Gabriele Dekomien
- From the Department of Nephrology, Heinrich-Heine-University (I.Q., L.S., J.S., L.C.R.), Düsseldorf, Germany; the Department of Internal Medicine I (O.V.), Ruhr University, Bochum, Germany; Marienhospital (G.D.), Herne, Germany; and the Department of Human Genetics (G.D.), Ruhr University, Bochum, Germany
| | - Lars Christian Rump
- From the Department of Nephrology, Heinrich-Heine-University (I.Q., L.S., J.S., L.C.R.), Düsseldorf, Germany; the Department of Internal Medicine I (O.V.), Ruhr University, Bochum, Germany; Marienhospital (G.D.), Herne, Germany; and the Department of Human Genetics (G.D.), Ruhr University, Bochum, Germany
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Lenzini L, Seccia TM, Aldighieri E, Belloni AS, Bernante P, Giuliani L, Nussdorfer GG, Pessina AC, Rossi GP. Heterogeneity of Aldosterone-Producing Adenomas Revealed by a Whole Transcriptome Analysis. Hypertension 2007; 50:1106-13. [DOI: 10.1161/hypertensionaha.107.100438] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Livia Lenzini
- From the Department of Experimental and Clinical Medicine (DMCS-Internal Medicine 4) (L.L., T.M.S., E.A., L.G., A.C.P., G.P.R.), Section of Anatomy, Department of Human Anatomy and Physiology (A.S.B., G.G.N.), and Department of Medical and Surgical Sciences (Surgical Pathology) (P.B.), School of Medicine, University of Padua, Padua, Italy
| | - Teresa M. Seccia
- From the Department of Experimental and Clinical Medicine (DMCS-Internal Medicine 4) (L.L., T.M.S., E.A., L.G., A.C.P., G.P.R.), Section of Anatomy, Department of Human Anatomy and Physiology (A.S.B., G.G.N.), and Department of Medical and Surgical Sciences (Surgical Pathology) (P.B.), School of Medicine, University of Padua, Padua, Italy
| | - Enrico Aldighieri
- From the Department of Experimental and Clinical Medicine (DMCS-Internal Medicine 4) (L.L., T.M.S., E.A., L.G., A.C.P., G.P.R.), Section of Anatomy, Department of Human Anatomy and Physiology (A.S.B., G.G.N.), and Department of Medical and Surgical Sciences (Surgical Pathology) (P.B.), School of Medicine, University of Padua, Padua, Italy
| | - Anna S. Belloni
- From the Department of Experimental and Clinical Medicine (DMCS-Internal Medicine 4) (L.L., T.M.S., E.A., L.G., A.C.P., G.P.R.), Section of Anatomy, Department of Human Anatomy and Physiology (A.S.B., G.G.N.), and Department of Medical and Surgical Sciences (Surgical Pathology) (P.B.), School of Medicine, University of Padua, Padua, Italy
| | - Paolo Bernante
- From the Department of Experimental and Clinical Medicine (DMCS-Internal Medicine 4) (L.L., T.M.S., E.A., L.G., A.C.P., G.P.R.), Section of Anatomy, Department of Human Anatomy and Physiology (A.S.B., G.G.N.), and Department of Medical and Surgical Sciences (Surgical Pathology) (P.B.), School of Medicine, University of Padua, Padua, Italy
| | - Luisa Giuliani
- From the Department of Experimental and Clinical Medicine (DMCS-Internal Medicine 4) (L.L., T.M.S., E.A., L.G., A.C.P., G.P.R.), Section of Anatomy, Department of Human Anatomy and Physiology (A.S.B., G.G.N.), and Department of Medical and Surgical Sciences (Surgical Pathology) (P.B.), School of Medicine, University of Padua, Padua, Italy
| | - Gastone G. Nussdorfer
- From the Department of Experimental and Clinical Medicine (DMCS-Internal Medicine 4) (L.L., T.M.S., E.A., L.G., A.C.P., G.P.R.), Section of Anatomy, Department of Human Anatomy and Physiology (A.S.B., G.G.N.), and Department of Medical and Surgical Sciences (Surgical Pathology) (P.B.), School of Medicine, University of Padua, Padua, Italy
| | - Achille C. Pessina
- From the Department of Experimental and Clinical Medicine (DMCS-Internal Medicine 4) (L.L., T.M.S., E.A., L.G., A.C.P., G.P.R.), Section of Anatomy, Department of Human Anatomy and Physiology (A.S.B., G.G.N.), and Department of Medical and Surgical Sciences (Surgical Pathology) (P.B.), School of Medicine, University of Padua, Padua, Italy
| | - Gian Paolo Rossi
- From the Department of Experimental and Clinical Medicine (DMCS-Internal Medicine 4) (L.L., T.M.S., E.A., L.G., A.C.P., G.P.R.), Section of Anatomy, Department of Human Anatomy and Physiology (A.S.B., G.G.N.), and Department of Medical and Surgical Sciences (Surgical Pathology) (P.B.), School of Medicine, University of Padua, Padua, Italy
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Heitzmann D, Derand R, Jungbauer S, Bandulik S, Sterner C, Schweda F, El Wakil A, Lalli E, Guy N, Mengual R, Reichold M, Tegtmeier I, Bendahhou S, Gomez-Sanchez CE, Aller MI, Wisden W, Weber A, Lesage F, Warth R, Barhanin J. Invalidation of TASK1 potassium channels disrupts adrenal gland zonation and mineralocorticoid homeostasis. EMBO J 2007; 27:179-87. [PMID: 18034154 DOI: 10.1038/sj.emboj.7601934] [Citation(s) in RCA: 153] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2007] [Accepted: 11/02/2007] [Indexed: 01/18/2023] Open
Abstract
TASK1 (KCNK3) and TASK3 (KCNK9) are two-pore domain potassium channels highly expressed in adrenal glands. TASK1/TASK3 heterodimers are believed to contribute to the background conductance whose inhibition by angiotensin II stimulates aldosterone secretion. We used task1-/- mice to analyze the role of this channel in adrenal gland function. Task1-/- exhibited severe hyperaldosteronism independent of salt intake, hypokalemia, and arterial 'low-renin' hypertension. The hyperaldosteronism was fully remediable by glucocorticoids. The aldosterone phenotype was caused by an adrenocortical zonation defect. Aldosterone synthase was absent in the outer cortex normally corresponding to the zona glomerulosa, but abundant in the reticulo-fasciculata zone. The impaired mineralocorticoid homeostasis and zonation were independent of the sex in young mice, but were restricted to females in adults. Patch-clamp experiments on adrenal cells suggest that task3 and other K+ channels compensate for the task1 absence. Adrenal zonation appears as a dynamic process that even can take place in adulthood. The striking changes in the adrenocortical architecture in task1-/- mice are the first demonstration of the causative role of a potassium channel in development/differentiation.
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Affiliation(s)
- Dirk Heitzmann
- Institute of Physiology, University of Regensburg, Regensburg, Germany
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Rossi GP. New concepts in adrenal vein sampling for aldosterone in the diagnosis of primary aldosteronism. Curr Hypertens Rep 2007; 9:90-7. [PMID: 17442218 DOI: 10.1007/s11906-007-0017-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Improved diagnostic techniques and adoption of a systematic and thorough diagnostic workup can lead to identification of the surgically correctable forms of primary aldosteronism (PA) far more frequently than expected. Adrenalectomy can provide long-term normalization of blood pressure and correction of PA in most patients with an aldosterone-producing adenoma. Forms needing surgical correction are generally held to be less common than forms requiring medical therapy; however, this can be a misconception arising from the lack of systematic use of adrenal vein sampling (AVS). Currently AVS still remains the "gold standard" for identifying unilateral causes of PA that are surgically curable. The criteria for selecting patients to undergo AVS, the technique for performing AVS, and the criteria for analyzing and interpreting its results are summarized here.
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Affiliation(s)
- Gian Paolo Rossi
- Department of Clinical and Experimental Medicine, Internal Medicine 4, University Hospital, Via Giustiniani, 2, Padova, Italy.
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Lehoux JG, Lefebvre A. Angiotensin II activates p44/42 MAP kinase partly through PKCepsilon in H295R cells. Mol Cell Endocrinol 2007; 265-266:121-5. [PMID: 17215072 DOI: 10.1016/j.mce.2006.12.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Using pharmaceutical and overexpression approaches we have previously reported that in H295R cells, (a) angiotensin II (AII) activates PKCepsilon, PKCalpha and p44/42 MAPK pathway, (b) PKCepsilon, PKCalpha and p44/42 MAPK overexpression inhibits AII-induced CYP11B2 gene transcription and (c) overexpression of PKCepsilon inhibits CYP11B2 gene transcription through p44/42 MAPK activation [LeHoux, J.G., Dupuis, G., Lefebvre, A., 2001. Control of CYP11B2 gene expression through differential regulation of its promoter by atypical and conventional protein kinase C isoforms. J. Biol. Chem. 276 (11), 8021-8028; LeHoux, J.G., Lefebvre, A., 2006. Novel protein kinase C-epsilon inhibits human CYP11B2 gene expression through ERK1/2 signalling pathway and JunB. J. Mol. Endocrinol. 36 (1), 51-64]. The aim of the present work was to evaluate the physiological role of endogenous PKCepsilon and PKCalpha isoforms in the activation of p44/42 MAPK by AII. A 50% reduction of PKCepsilon protein by siRNA-PKCepsilon resulted in 35% inhibition of AII-induced p44/42 MAPK activation. Knockdown of PKCepsilon stimulated AII-induced CYP11B2 transcription indicating that the PKCepsilon is not involved in the activation of CYP11B2 gene expression by AII. Furthermore, knockdown of PKCalpha enhanced AII-stimulated CYP11B2 transcription without altering p44/42 MAPK indicating that inhibition of AII-stimulated CYP11B2 gene by PKCalpha does not involve the p44/42 MAPK signalling pathway. These results thus establish that physiologically, PKCepsilon and PKCalpha act through different signalling pathways to inhibit AII-stimulated CYP11B2 gene expression.
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Affiliation(s)
- Jean-Guy Lehoux
- Department of Biochemistry, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada J1H 5N4.
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Stowasser M, Fallo F, So A, Jeske Y, Kelemen L, Pilon C, Gordon R. Genetic Forms of Primary Aldosteronism. High Blood Press Cardiovasc Prev 2007. [DOI: 10.2165/00151642-200714020-00004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Abstract
Surgically correctable forms of primary aldosteronism are generally held to be less common than forms requiring medical therapy. However, with the availability of improved diagnostic techniques and the adoption of a systematic and thorough diagnostic work-up they can be identified more commonly than expected. Adrenal vein sampling (AVS) for measurement of cortisol and aldosterone has emerged as the 'gold standard' diagnostic test for identifying unilateral causes of primary aldosteronism that are amenable to surgical cure. Adrenalectomy can provide long-term normalisation of blood pressure and correction of primary aldosteronism in about 55% of patients with an aldosterone-producing adenoma and can markedly ameliorate blood pressure control in the rest. This chapter summarises the diagnostic work-up suggested for identifying these forms and examines the other diseases mimicking mineralocorticoid excess that enter into the differential diagnosis of surgically curable primary aldosteronism.
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Affiliation(s)
- Gian Paolo Rossi
- Department of Clinical & Experimental Medicine, Clinica Medica 4, University Hospital, University of Padova, Via Giustiniani 2, 35126 Padova, Italy.
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Sanderson JT. The Steroid Hormone Biosynthesis Pathway as a Target for Endocrine-Disrupting Chemicals. Toxicol Sci 2006; 94:3-21. [PMID: 16807284 DOI: 10.1093/toxsci/kfl051] [Citation(s) in RCA: 342] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Various chemicals found in the human and wildlife environments have the potential to disrupt endocrine functions in exposed organisms. Increasingly, the enzymes involved in the steroid biosynthesis pathway are being recognized as important targets for the actions of various endocrine-disrupting chemicals. Interferences with steroid biosynthesis may result in impaired reproduction, alterations in (sexual) differentiation, growth, and development and the development of certain cancers. Steroid hormone synthesis is controlled by the activity of several highly substrate-selective cytochrome P450 enzymes and a number of steroid dehydrogenases and reductases. Particularly aromatase (CYP19), the enzyme that converts androgens to estrogens, has been the subject of studies into the mechanisms by which chemicals interfere with sex steroid hormone homeostasis and function, often related to (de)feminization and (de)masculinazation processes. Studies in vivo and in vitro have focussed on ovarian and testicular function, with less attention given to other steroidogenic organs, such as the adrenal cortex. This review aims to provide a comprehensive overview of the state of knowledge regarding the mechanisms by which chemicals interfere with the function of steroidogenic enzymes in various tissues and organisms. The endocrine toxicities and mechanisms of action related to steroidogenesis of a number of classes of drugs and environmental contaminants are discussed. In addition, several potential in vitro bioassays are reviewed for their usefulness as screening tools for the detection of chemicals that can interfere with steroidogenesis. Analysis of the currently scattered state of knowledge indicates that still relatively little is known about the underlying mechanisms of interference of chemicals with steroidogenesis and their potential toxicity in steroidogenic tissues, neither in humans nor in wildlife. Considerably more detailed and systematic research in this area of (endocrine) toxicology is required for a better understanding of risks to humans and wildlife.
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Affiliation(s)
- J Thomas Sanderson
- INRS-Institut Armand-Frappier, Université du Québec, 245 Hymus Boulevard (Pointe-Claire), Montréal, Québec, Canada H9R 1G6.
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Hakki T, Bernhardt R. CYP17- and CYP11B-dependent steroid hydroxylases as drug development targets. Pharmacol Ther 2006; 111:27-52. [PMID: 16426683 DOI: 10.1016/j.pharmthera.2005.07.006] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2005] [Accepted: 07/22/2005] [Indexed: 01/03/2023]
Abstract
Steroid hormone biosynthesis is catalyzed by the action of a series of cytochrome P450 enzymes as well as reductases. Defects in steroid hydroxylating P450s are the cause of several severe defects such as the adrenogenital syndrome (AGS), corticosterone methyl oxidase (CMO) I or II deficiencies, or pseudohermaphroditism. In contrast, overproduction of steroid hormones can be involved in breast or prostate cancer, in hypertension, and heart fibrosis. Besides inhibiting the action of the steroid hormones on the level of steroid hormone receptors by using antihormones, which often is connected with severe side effects, more recently the steroid hydroxylases themselves turned out to be promising new targets for drug development. Since the 3-dimensional structures of steroid hydroxylases are not yet available, computer models of the corresponding CYPs may help to develop new inhibitors of these enzymes. During the past years, the necessary test systems have been developed and new compounds have been synthesized, which displayed selective and specific inhibition of CYP17, CYP11B2, and CYP11B1. With some of these potential new drugs, clinical trials are under way. It can be expected that in the near future some of these compounds will contribute to our arsenal of new and selective drugs.
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Affiliation(s)
- Tarek Hakki
- Institute of Biochemistry, P.O. Box 151150, Saarland University, D-66041 Saarbrücken, Germany
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Assié G, Auzan C, Gasc JM, Baviera E, Balaton A, Elalouf JM, Jeunemaitre X, Plouin PF, Corvol P, Clauser E. Steroidogenesis in aldosterone-producing adenoma revisited by transcriptome analysis. J Clin Endocrinol Metab 2005; 90:6638-49. [PMID: 16204365 DOI: 10.1210/jc.2005-1309] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Primary aldosteronism (PAL) is the most frequent cause of secondary arterial hypertension. In PAL, aldosterone production is chronic, excessive, and autonomous. OBJECTIVE The objective of this study was to identify the angiotensin-II independent alterations of steroidogenesis responsible for PAL. DESIGN Genomewide gene expression was compared in two tissues differentiated for aldosterone production, both nonstimulated by circulating angiotensin II and differing in their autonomy to produce aldosterone: aldosterone-producing adenoma (APA) and its adjacent dissected zona glomerulosa (ZG). SETTING The setting of this study was the Comete Network. PATIENTS Patients with APA were studied. INTERVENTION Transcriptome comparison was made of one APA and its adjacent ZG by serial analysis of gene expression; validation by in situ hybridization was performed for 19 genes in 11 samples. OUTCOME The study outcome was genes differentially expressed in APA and adjacent ZG. RESULTS Activation of steroidogenesis in PAL is restricted to the overexpression of the enzymes producing aldosterone-specific steroids, aldosterone synthase and also 21-hydroxylase, suggesting that upstream precursor production is not limiting. Increased expression of high-density lipoprotein receptor, adrenodoxin and P450 oxidoreductase suggests that these systems provide cholesterol and electrons to the mitochondrial steroidogenic enzymes. As for acute stimulation of aldosterone production, an activation of calcium signaling is suggested by concordant overexpression of calcium-binding proteins or effectors. Calcium activation may result from an abnormal activity of G(q) protein-coupled receptors. This calcium activation may be the starting point of the other gene expression changes observed in APA. Finally, other differentially expressed genes include three genes encoding unidentified proteins. CONCLUSION This work provides an original and integrated view of the mechanisms of aldosterone production in PAL.
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Affiliation(s)
- Guillaume Assié
- Institut National de la Santé et de la Recherche Médicale, Unité 567, Centre National de la Recherche Scientifique 8104, Université Paris 5, Institut Cochin, 24 rue du Fg Saint Jacques, 75014 Paris, France
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Médeau V, Assié G, Zennaro MC, Clauser E, Plouin PF, Jeunemaitre X. Aspect familial de l’hyperaldostéronisme primaire : analyse de familles compatibles avec un hyperaldostéronisme primaire de type 2. ANNALES D'ENDOCRINOLOGIE 2005; 66:240-6. [PMID: 15988385 DOI: 10.1016/s0003-4266(05)81756-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- V Médeau
- Département de Génétique, Hôpital européen Georges Pompidou, 20-40, rue Leblanc, 75015 Paris, France
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Milliez P, Girerd X, Plouin PF, Blacher J, Safar ME, Mourad JJ. Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism. J Am Coll Cardiol 2005; 45:1243-8. [PMID: 15837256 DOI: 10.1016/j.jacc.2005.01.015] [Citation(s) in RCA: 1048] [Impact Index Per Article: 55.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2004] [Revised: 12/20/2004] [Accepted: 01/04/2005] [Indexed: 12/18/2022]
Abstract
OBJECTIVES The aim of this report was to show that the rate of cardiovascular events is increased in patients with either subtype of primary aldosteronism (PA). BACKGROUND Primary aldosteronism involves hypertension (HTN), hypokalemia, and low plasma renin. The two major PA subtypes are unilateral aldosterone-producing adenoma (APA) and bilateral adrenal hyperplasia. METHODS During a three-year period, the diagnosis of PA was made in 124 of 5,500 patients referred for comprehensive evaluation and management. Adenomas were diagnosed in 65 patients and idiopathic hyperaldosteronism in 59 patients. During the same period, clinical characteristics and cardiovascular events of this group were compared with those of 465 patients with essential hypertension (EHT) randomly matched for age, gender, and systolic and diastolic blood pressure. RESULTS A history of stroke was found in 12.9% of patients with PA and 3.4% of patients with EHT (odds ratio [OR] = 4.2; 95% confidence interval [CI] 2.0 to 8.6]). Non-fatal myocardial infarction was diagnosed in 4.0% of patients with PA and in 0.6% of patients with EHT (OR = 6.5; 95% CI 1.5 to 27.4). A history of atrial fibrillation was diagnosed in 7.3% of patients with PA and 0.6% of patients with EHT (OR = 12.1; 95% CI 3.2 to 45.2). The occurrence of cardiovascular complications was comparable in both subtypes of PA. CONCLUSIONS Patients presenting with PA experienced more cardiovascular events than did EHT patients independent of blood pressure. The presence of PA should be detected, not only to determine the cause of HTN, but also to prevent such complications.
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Affiliation(s)
- Paul Milliez
- Department of Cardiology, Lariboisière Hospital, Paris, France
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Abstract
During the past 15 years, considerable progress has been made in our understanding of the genetic basis of adrenal development and function. More than 30 single gene disorders have now been identified that can affect the hypothalamic-pituitary-adrenal axis in humans (fig. 1, 2; table 1). This review highlights recent advances in the molecular pathology of: (1) adrenal hypoplasia, (2) adrenal destruction, (3) disorders of adrenal steroidogenesis, (4) adrenal steroid resistance and (5) activation of the adrenal axis/tumorigenesis. Characterizing the molecular basis and natural history of these conditions is providing fascinating insight into adrenal development and function and can help to focus treatment and counselling of patients appropriately. However, ongoing translation of research findings into clinical practice is needed if patient care is to be influenced significantly.
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Affiliation(s)
- Lin Lin
- Department of Medicine and Institute of Child Health, University College London, London, UK
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Abstract
The three zones of the human adrenal cortex are functionally distinct with the glomerulosa producing aldosterone, the fasciculata producing cortisol, and the reticularis producing DHEA/DHEAS. This functional zonation is largely due to the zone-specific expression of steroidogenic enzymes. Recent evidence suggests a role for the NGFI-B family of orphan nuclear receptors (particularly NURR1 and NGFI-B) in the zone-specific expression of two key steroidogenic enzymes, aldosterone synthase (CYP11B2) and 3beta-hydroxysteroid dehydrogenase (HSD3B2). Herein we discuss the evidence that suggests a role for NURR1 (NR4A2) in the expression of CYP11B2 in the glomerulosa as well as in the dysregulation of CYP11B2 gene expression as is seen in aldosterone-producing adenoma (APA), a major cause of endocrine hypertension. NURR1 appears to be important for CYP11B2 transcription and is found at higher levels in glomerulosa and in APA. Its expression in adrenal cells is also readily increased by angiotensin II treatment. HSD3B2 is a steroid-metabolizing enzyme that is essential for adrenal production of mineralocorticoids and glucocorticoids. Thus, HSD3B2 is expressed at high levels in the glomerulosa and fasciculata where these steroids are produced but at low levels in the adrenal reticularis, which produces mainly DHEA. We recently demonstrated that NGFI-B (nur77 or NR4A1) plays an important role in the regulation of HSD3B2 transcription and may play an important role in the functional zonation of the adrenal gland. Immunohistochemistry confirmed that, within adult and fetal adrenal gland, NGFI-B expression paralleled expression of HSD3B2. Transient transfections demonstrated that NGFI-B family members enhanced HSD3B2 reporter activity but had no effect on a 17alpha-hydroxylase (CYP17) promoter construct. Taken together these results suggest that the NGFI-B family of transcription factors plays a role in establishing the functional zonation of the human adrenal by regulating CYP11B2 and HSD3B2 gene transcription.
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Affiliation(s)
- Mary H Bassett
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology University of Texas Southwestern Medical Center, Dallas, Texas 75390-9073, USA
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Abstract
A hiperplasia congênita da adrenal devido à deficiência da enzima 11beta-hidroxilase é resultado de uma falha na conversão do 11-desoxicortisol em cortisol na última etapa da via sintética dos glicocorticóides. Em geral, esta forma da doença é responsável por cerca de 5% dos casos. A manifestação clínica do excesso de andrógenos em pacientes do sexo feminino inclui graus de ambigüidade genital que podem variar entre uma clitoromegalia até a virilização completa da genitália. Devido ao acúmulo de mineralocorticóides, aproximadamente 50% dos pacientes desenvolvem hipertensão arterial. Mutações no gene CYP11B1, que codifica a enzima 11beta-hidroxilase, são responsáveis pela doença. As características bioquímicas e moleculares da enzima e suas implicações na apresentação clínica da deficiência da 11beta-hidroxilase são abordadas no presente trabalho de revisão.
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Affiliation(s)
- Maricilda Palandi Mello
- Centro de Biologia Molecular e Engenharia Genética, Universidade Estadual de Campinas, Campinas, SP.
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Zettinig G, Mitterhauser M, Wadsak W, Becherer A, Pirich C, Vierhapper H, Niederle B, Dudczak R, Kletter K. Positron emission tomography imaging of adrenal masses: (18)F-fluorodeoxyglucose and the 11beta-hydroxylase tracer (11)C-metomidate. Eur J Nucl Med Mol Imaging 2004; 31:1224-30. [PMID: 15197504 DOI: 10.1007/s00259-004-1575-0] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2004] [Accepted: 04/13/2004] [Indexed: 11/24/2022]
Abstract
PURPOSE (11)C-metomidate (MTO), a marker of 11beta-hydroxylase, has been suggested as a novel positron emission tomography (PET) tracer for adrenocortical imaging. Up to now, experience with this very new tracer is limited. The aims of this study were (1) to evaluate this novel tracer, (2) to point out possible advantages in comparison with( 18)F-fluorodeoxyglucose (FDG) and (3) to investigate in vivo the expression of 11beta-hydroxylase in patients with primary aldosteronism. METHODS Sixteen patients with adrenal masses were investigated using both MTO and FDG PET imaging. All patients except one were operated on. Five patients had non-functioning adrenal masses, while 11 had functioning tumours(Cushing's syndrome, n=4; Conn's syndrome, n=5; phaeochromocytoma, n=2). Thirteen patients had benign disease, whereas in three cases the adrenal mass was malignant (adrenocortical cancer, n=1; malignant phaeochromocytoma, n=1; adrenal metastasis of renal cancer, n=1). RESULTS MTO imaging clearly distinguished cortical from non-cortical adrenal masses (median standardised uptake values of 18.6 and 1.9, respectively, p<0.01). MTO uptake was slightly lower in patients with Cushing's syndrome than in those with Conn's syndrome, but the difference did not reach statistical significance. The expression of 11beta-hydroxylase was not suppressed in the contralateral gland of patients with Conn's syndrome, whereas in Cushing's syndrome this was clearly the case. The single patient with adrenocortical carcinoma had MTO uptake in the lower range. CONCLUSION MTO could not definitely distinguish between benign and malignant disease. FDG PET, however, identified clearly all three study patients with malignant adrenal lesions. We conclude: (1) MTO is an excellent imaging tool to distinguish adrenocortical and non-cortical lesions; (2) the in vivo expression of 11beta-hydroxylase is lower in Cushing's syndrome than in Conn's syndrome, and there is no suppression of the contralateral gland in primary aldosteronism; (3) for the purpose of discriminating between benign and malignant lesions, FDG is the tracer of choice.
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Affiliation(s)
- Georg Zettinig
- Department of Nuclear Medicine, University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria,
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