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1.
Nihon Shokakibyo Gakkai Zasshi ; 118(11): 1071-1078, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-34759104

RESUMO

A 77-year-old woman with a history of hypertension underwent upper gastrointestinal endoscopy for hematemesis, and vasodilation with erosion was detected. Contrast-enhanced computed tomography and abdominal angiography revealed a gastric aneurysm penetrating the stomach wall. Endoscopic hemostasis was thought to be not applicable to a ruptured aneurysm. Transcatheter arterial embolization was not performed because of technical difficulties. Therefore, local gastric resection was performed. It was later determined that the cause of the persistent hypertension was primary aldosteronism, which was thought to cause arteriosclerotic obstruction of the celiac, common hepatic, and splenic arteries, resulting in the formation of the gastric arterial aneurysm. In the case of upper gastrointestinal bleeding, keeping primary aldosteronism in mind as a differential diagnosis is important to make a precise diagnosis and suitable treatment selection.


Assuntos
Aneurisma Roto , Arteriosclerose , Embolização Terapêutica , Hiperaldosteronismo , Hipertensão , Idoso , Aneurisma Roto/complicações , Aneurisma Roto/diagnóstico por imagem , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Hipertensão/complicações , Estômago
2.
Diagn Interv Radiol ; 27(6): 754-761, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34792030

RESUMO

PURPOSE: We aimed to analyze the prevalence and radiological characteristics of duplicated right adrenal veins (DRAVs) and evaluate the diagnostic impact of adrenal venous sampling (AVS) in primary aldosteronism. METHODS: DRAVs were retrospectively identified among patients who underwent segmental AVS between April 2017 and March 2020. DRAVs were defined as main or accessory according to the drainage area. The diameter, position, hormone levels, and treatment plan based on AVS were compared between main and accessory RAVs, using the Wilcoxon rank-sum test. RESULTS: Fourteen of 432 patients (3.2%) were diagnosed with DRAVs. On venography, the mean diameters of the main and accessory side were 3±0.63 mm and 2.1±0.41 mm, respectively, and were significantly different (p < 0.001). The mean relative position in craniocaudal direction of main and accessory veins from the adrenal caudal edge on computed tomography was 65.5%±16.0%, and 48.1%±16.8%, respectively, which was significantly different (p = 0.007). The left-right positions and hormone levels were not significantly different. Based on conventional AVS, the treatment plan between DRAVs was not changed in six of eight patients, but changed from surgery to medication in two patients with right aldosterone-producing adenoma (APA)/microadenoma based on segmental AVS findings. CONCLUSION: DRAVs, in which the main RAV was thicker and more cranially located than the accessory RAV were rare. Depending on blood sampled from either of DRAVs, the diagnosis made through conventional AVS might change treatment approach from surgery to medication, especially with right APA. Hence, their identification is important to make an accurate subtyping by AVS.


Assuntos
Adenoma Adrenocortical , Hiperaldosteronismo , Glândulas Suprarrenais/diagnóstico por imagem , Aldosterona , Humanos , Hiperaldosteronismo/diagnóstico por imagem , Estudos Retrospectivos
3.
Clin Ter ; 172(5): 407-409, 2021 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-34625768

RESUMO

Abstract: Hypokalemia is a common electrolyte abnormality. Generally being asymptomatic, muscular fatigue, paresis and arrhythmia can be seen as the severity of hypokalemia increases. Severe rhabdomyolysis and neuromuscular findings can be seen in severe hypokalemia cases. Presence of hypokalemia can be a precursor of secondary hypertension in hypertensive patients, and also should bring hyperaldosteronism into consideration. Mild hypokalemia is usually seen in primary hype-raldosteronism. However, deficient potassium levels are also seen in some cases. We have shared the case of a hypertensive patient, who presented to the emergency department with findings of rhabdomyo-lysis and neuromuscular findings secondary to severe hypokalemia. The potassium level of our patient was 1.3 mmol, and it was one of the lowest potassium levels reported up to today.


Assuntos
Hiperaldosteronismo , Hipertensão , Hipopotassemia , Rabdomiólise , Arritmias Cardíacas , Humanos , Hipertensão/complicações , Hipopotassemia/complicações , Rabdomiólise/complicações
4.
Med Clin North Am ; 105(6): 1047-1063, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34688414

RESUMO

Adrenal masses are frequently incidentally identified from cross-sectional imaging studies, which are performed for other reasons. The intensity of the approach to the patient with such a mass is tailored to the clinical situation, ranging from a quick evaluation to a detailed work-up. In all cases, the three components of the evaluation are clinical assessment, review of the images, and biochemical testing with the goal of ruling out malignancy and identifying hormonally active lesions. This article incorporates recent information to produce a logical, systematic assessment of these patients with risk stratification and proportionate follow-up.


Assuntos
Doenças das Glândulas Suprarrenais/diagnóstico , Doenças das Glândulas Suprarrenais/patologia , Adenoma/diagnóstico por imagem , Adenoma/patologia , Doenças das Glândulas Suprarrenais/sangue , Doenças das Glândulas Suprarrenais/diagnóstico por imagem , Neoplasias das Glândulas Suprarrenais/diagnóstico , Neoplasias das Glândulas Suprarrenais/patologia , Aldosterona/biossíntese , Catecolaminas/biossíntese , Diagnóstico Diferencial , Humanos , Hiperaldosteronismo/diagnóstico , Hiperaldosteronismo/patologia , Achados Incidentais , Feocromocitoma/diagnóstico , Feocromocitoma/patologia
5.
Med Clin North Am ; 105(6): 1065-1080, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34688415

RESUMO

Hyperaldosteronism is a relatively more common disorder than previously recognized. Patients with hyperaldosteronism are at high risk for cardiovascular events. Patients suspected of having hyperaldosteronism should undergo initial screening and subsequent confirmatory testing to establish a biochemical diagnosis. Although adrenal computed tomography/magnetic resonance imaging scans often define a disease's subtype, adrenal vein sampling, in order to determine lateralization, may be necessary in some patients who are surgical candidates. Medical therapy using optimal doses of mineralocorticoid receptor antagonists can control symptoms and normalize plasma renin activity. The long-term outcome of patients treated with either surgical or optimal medical therapy appears similar.


Assuntos
Aldosterona/metabolismo , Hiperaldosteronismo/tratamento farmacológico , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Aldosterona/sangue , Humanos , Hiperaldosteronismo/sangue , Hiperaldosteronismo/diagnóstico , Hiperaldosteronismo/cirurgia , Renina/metabolismo , Sistema Renina-Angiotensina/fisiologia
7.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 46(9): 996-1002, 2021.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-34707010

RESUMO

OBJECTIVES: Adrenal venous sampling (AVS) is one of the recognized effective methods for the identification of primary aldosteronism, and the success rate is related to the skill level of the operator. This study aims to analyze the learning curve of AVS and to determine the number of staged cases of AVS procedure success rate, and to provide a reference for the standardized use of AVS. METHODS: The age, gender, blood pressure, surgery success rate, operation time, radiation dose, and operation-related complications of 120 patients with primary aldosteronism who underwent continuous AVS in the Second Xiangya Hospital from August 2015 to February 2021 were retrospectively collected. The cumulative sum analysis was used to analyze the learning curve of the operator. The minimum cases who were proficient in the operation was determined according to the learning curve, and the patients were divided into 4 groups a, b, c, and d according to the time sequence of receiving AVS based on the cut-off point. The AVS success rate, radiation dose, operation time, and complications of each group were analyzed. RESULTS: The cumulative sum analysis showed that the learning curves were divided into a learning stage and a mastery stage with 30 cases as the cut-off point, and the operation experience of the surgeon was from raw to mature. The success rates of the a, b, c, and d groups were 66.7%, 86.7%, 93.3%, and 96.7%, respectively. Compared with b, c, and d groups, the success rate in group a was significant decreased (all P<0.05), the operative time in group a was significantly lengthened (all P<0.05), and the radiation dose in group a was significantly increased (all P<0.05). CONCLUSIONS: After accumulating the AVS experience of 30 cases of primary aldosteronism, the operation time is obviously shortened, the radiation dose is significantly decreased, the operative complications are significantly reduced, and the learning curve enters a plateau. In the future, the success rate of AVS procedure may be improved through further standardized training.


Assuntos
Hiperaldosteronismo , Curva de Aprendizado , Glândulas Suprarrenais , Aldosterona , Humanos , Hiperaldosteronismo/diagnóstico , Hiperaldosteronismo/cirurgia , Estudos Retrospectivos
9.
J Vet Intern Med ; 35(5): 2159-2166, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34473866

RESUMO

BACKGROUND: Primary hyperaldosteronism caused by adrenal neoplasia has been well described in cats. Multiple corticosteroid abnormalities occur in a subset of affected cats, but characterizations of this syndrome are limited to several case reports. OBJECTIVES: To describe a series of cats with adrenal tumors secreting aldosterone and additional corticosteroids. ANIMALS: Ten cats with multiple corticosteroid secreting adrenocortical tumors. METHODS: Retrospective case series. Medical records of cats with adrenal tumors secreting both aldosterone and progesterone were identified. Data concerning historical findings, clinicopathologic features, treatments, and outcomes were retrieved from medical records. RESULTS: All 10 cats had diabetes mellitus in addition to biochemical features of hyperaldosteronism such as hypokalemia. High corticosterone concentrations were observed in all 3 cats in which this corticosteroid was measured. Ultrasound examinations revealed unilateral adrenal tumors in all 10 cases, and the contralateral adrenal gland was either atrophied or not identified in 5 cats. Three of 4 cats developed hypoadrenocorticism after surgical adrenalectomy. Three cats achieved diabetic remission after adrenalectomy. Two cats treated with adrenalectomy survived >1 year, 1 cat survived 6.5 months, and 1 cat was alive 5.5 months after diagnosis. Survival >1 year occurred in 2 of 4 cats treated with medical management alone. Two cats were not treated. CONCLUSIONS AND CLINICAL IMPORTANCE: The presence of multiple corticosteroid abnormalities should be considered in cats with aldosterone secreting adrenal tumors, especially those with concurrent diabetes mellitus. Both surgical and medical management can result in long-term survival, although diabetic remission was documented only in cats undergoing adrenalectomy.


Assuntos
Neoplasias das Glândulas Suprarrenais , Doenças do Gato , Hiperaldosteronismo , Neoplasias das Glândulas Suprarrenais/cirurgia , Neoplasias das Glândulas Suprarrenais/veterinária , Glândulas Suprarrenais/diagnóstico por imagem , Adrenalectomia/veterinária , Aldosterona , Animais , Gatos , Hiperaldosteronismo/cirurgia , Hiperaldosteronismo/veterinária , Progesterona , Estudos Retrospectivos
10.
S Afr J Surg ; 59(3): 131a-131c, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34515436

RESUMO

SUMMARY: Primary aldosteronism, eponymously known as Conn's syndrome, has recently gained recognition as the most common cause of endocrine hypertension. Unilateral subtypes, such as aldosterone secreting adenomas, are managed surgically and are potentially curable. The background of refractory hypertension and hypokalaemia in a forty-year-old man raised suspicions of Conn's syndrome which was localised to an aldosterone secreting adenoma in the right adrenal gland. The patient underwent a laparoscopic intraperitoneal right adrenalectomy which resulted in normalisation of his plasma aldosterone concentration as well as improved blood pressure control.


Assuntos
Adenoma , Hiperaldosteronismo , Hipertensão , Adenoma/complicações , Adenoma/diagnóstico , Adenoma/cirurgia , Adrenalectomia , Adulto , Aldosterona , Humanos , Hiperaldosteronismo/diagnóstico , Hiperaldosteronismo/etiologia , Hiperaldosteronismo/cirurgia , Hipertensão/diagnóstico , Hipertensão/etiologia , Masculino
11.
Eur J Endocrinol ; 185(5): 663-672, 2021 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-34468397

RESUMO

Context: Primary aldosteronism (PA) causes left ventricular hypertrophy (LVH) via hemodynamic factors and directly by aldosterone effects. Specific treatment by mineralocorticoid receptor antagonists (MRA) or adrenalectomy (ADX) has been reported to improve LVH. However, the cardiovascular benefit could depend on plasma renin concentration (PRC) in patients on MRA. Patients and objective: We analyzed data from 184 patients from the Munich center of the German Conn's Registry, who underwent echocardiography at the time of diagnosis and 1 year after treatment. To assess the effect of PRC on cardiac recovery, we stratified patients on MRA according to suppression (n = 46) or non-suppression of PRC (n = 59) at follow-up and compared them to PA patients after ADX (n = 79). Results: At baseline, patients treated by ADX or MRA had comparable left ventricular mass index (LVMI, 61.7 vs 58.9 g/m2.7, P = 0.591). Likewise, patients on MRA had similar LVMI at baseline, when stratified into treatment groups with suppressed and unsuppressed PRC during follow-up (60.0 vs 58.1 g/m2.7, P = 0.576). In all three groups, we observed a significant reduction in LVMI following treatment (P < 0.001). However, patients with suppressed PRC had no decrease in pro-BNP levels, and the reduction of LVMI was less intense than in patients with unsuppressed PRC (4.1 vs 8.2 g/m2.7, P = 0.033) or after ADX (9.3 g/m2.7, P = 0.019). Similarly, in multivariate analysis, higher PRC was correlated with the regression of LVH. Conclusion: PA patients with suppressed PRC on MRA show impaired regression of LVH. Therefore, dosing of MRA according to PRC could improve their cardiovascular benefit.


Assuntos
Hiperaldosteronismo/sangue , Hiperaldosteronismo/complicações , Hipertrofia Ventricular Esquerda/sangue , Hipertrofia Ventricular Esquerda/etiologia , Renina/sangue , Adrenalectomia , Adulto , Biomarcadores , Estudos de Coortes , Ecocardiografia , Eletrocardiografia , Feminino , Alemanha , Humanos , Hiperaldosteronismo/terapia , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Estudos Prospectivos , Sistema de Registros , Resultado do Tratamento
12.
Zhonghua Yi Xue Za Zhi ; 101(34): 2662-2666, 2021 Sep 14.
Artigo em Chinês | MEDLINE | ID: mdl-34510871

RESUMO

Primary aldosteronism (PA) patients diagnosed with aldosterone-producing adenoma and unilateral adrenal hyperplasia are preferred for surgical treatment.The aim of the operation is to remove the hypersecretory aldosterone tissue of adrenal and to improve the prognosis.Current studies have shown that both partial adrenalectomy and total adrenalectomy can achieve clinical cure for PA, but the choice of surgical methods is still controversial. This paper discusses the efficacy and safety, postoperative changes in cortisol level, postoperative recurrence and surgical techniques of different surgical methods in the treatment of different PA subtypes, so as to find the best surgical methods for different PA subtypes and to maximize the benefits for patients.


Assuntos
Adenoma , Hiperaldosteronismo , Adenoma/cirurgia , Glândulas Suprarrenais , Adrenalectomia , Aldosterona , Humanos , Hiperaldosteronismo/cirurgia , Recidiva Local de Neoplasia
13.
Zhonghua Yi Xue Za Zhi ; 101(34): 2674-2680, 2021 Sep 14.
Artigo em Chinês | MEDLINE | ID: mdl-34510873

RESUMO

Objective: To explore the value of serum parathyroid hormone (PTH) in the diagnosis of primary aldosteronism (PA) and to investigate an optimal cut-off of serum PTH to distinguish PA from nonfunctional adrenal tumor (NFA). Methods: The clinical data of patients with adrenal incidentaloma in Chinese PLA General Hospital from January 1, 2017 to December 31, 2019 were collected. The data of PA and NFA by clinical characteristics and evaluation on endocrine function were retrospectively analyzed. The logistic regression model was used to find the potential risk factors of elevated PTH. The receiver operating characteristic(ROC) curve was used to evaluate the efficacy of PTH in diagnosis of PA and to explore the best cut-off value. Results: A total of 773 patients were included. There were 356 PA patients (203 males, 57.0%), aged (50±11) years and 417 NFA patients (219 males, 52.5%), aged (51±12) years. The serum PTH level in patients with PA was significantly higher than that in patients with NFA [63.1 (48.4, 80.3) ng/L vs 41.7 (34.1, 51.7) ng/L, P<0.05], as well as the proportion of patients with elevated PTH level (47.8% vs 7.2%, P<0.05). Logistic regression analysis showed that having PA and deficiency of Vitamin D were risk factors for PTH elevation (both P<0.05). The ROC curve showed that the best cut-off value of PTH for the diagnosis of PA in patients with vitamin D deficiency was 56.44 ng/L, with a sensitivity of 66.5% and a specificity of 83.0%, and that in patients with normal vitamin D was 48.81 ng/L, with a sensitivity of 70.5% and a specificity of 72.6%. Conclusions: Patients with PA tend to show increased levels of serum PTH compared with NFA patients. The level of serum PTH can be used as one of the valuable indexes in screening of PA.


Assuntos
Neoplasias das Glândulas Suprarrenais , Hiperaldosteronismo , Humanos , Hiperaldosteronismo/diagnóstico , Masculino , Hormônio Paratireóideo , Curva ROC , Estudos Retrospectivos
14.
Zhonghua Yi Xue Za Zhi ; 101(34): 2667-2673, 2021 Sep 14.
Artigo em Chinês | MEDLINE | ID: mdl-34510872

RESUMO

Objective: To explore related factors associated with unilateral aldosterone secretion of patients with primary aldosteronism (PA) and construct a predictive model. Methods: The clinical data of patients who were diagnosed as PA in West China Hospital from April 2016 to September 2020 was analyzed retrospectively. According to the results of the adrenal enhancement CT, patients were divided into 3 groups, namely non-nodular group with no bilateral adrenal glands lesions, only with unilateral adrenal hyperplasia or bilateral adrenal hyperplasia, unilateral nodule group with unilateral adrenal nodules and the contralateral adrenal glands with hyperplasia or not, and bilateral nodules group with nodules in both adrenal glands. Regarding the related factors of dominant side of aldosterone secretion, univariate analysis and binary logistic regression were used. Receiver operating characteristic curve and nomogram were used to evaluate the diagnostic performance of regression models. Results: A total of 237 patients with PA were included, of which, 118 males and 119 females, the median age was 39 years, and the body mass index (BMI) was (25.2±3.5) kg/m2. There were 157 (66.2%) of 237 patients with typical imaging findings. There were 32 cases in no-nodular group, 183 cases in unilateral nodule group, and 22 cases in bilateral nodules group. Multivariate analysis showed that age (OR=0.876, P<0.001), blood potassium concentration (OR=0.430, P=0.004), and typical imaging findings (OR=2.202, P=0.035) were associated with unilateral aldosterone secretion. As for unilateral nodule group, multivariate analysis showed that age (OR=0.900, P<0.001), plasma aldosteronism concentration (PAC) (OR=1.050, P=0.018), and typical imaging findings (OR=2.637, P=0.025) were associated with unilateral aldosterone secretion. The agreement rate between the dominant side of the adrenal CT and AVS was only 50.2%. Multivariate analysis showed that age (OR=0.954, P=0.001), BMI (OR=0.893, P=0.024) and PAC (OR=1.043, P=0.011) were independently associated with concordance between AVS and CT. The cut-off value of the ROC curve was 0.43; the model sensitivity was 56.3%; the specificity was 86.7% and the area under the ROC curve was 0.742. Conclusions: Age is an important predictor in the diagnosis of PA subtypes. It is recommended to refer to subgroup based on imaging results for clinical decision. For patients with no obvious lesions or bilateral lesions on CT, AVS should be performed as far as possible to confirm the subtypes in diagnosis of PA.


Assuntos
Aldosterona , Hiperaldosteronismo , Glândulas Suprarrenais , Adulto , Feminino , Humanos , Hiperaldosteronismo/diagnóstico , Masculino , Curva ROC , Estudos Retrospectivos
15.
Zhonghua Yi Xue Za Zhi ; 101(34): 2681-2685, 2021 Sep 14.
Artigo em Chinês | MEDLINE | ID: mdl-34510874

RESUMO

Objective: To explore the potential application of a three-dimensional visualization technique in adrenal vein sampling (AVS). Methods: The clinical data were retrospectively analyzed, which included 76 patients with primary aldosteronism (PA) who have undergone AVS in Guizhou Provincial People's Hospital from December 2017 to May 2020. All cases were examined by adrenal thin-section enhanced CT and blood was drawn by bilateral AVS. Among them, the adrenal vein blood of 46 cases was sampled with the help of three-dimensional (3D) visualization processing of CT data, while that of 30 cases was without 3D visualization processing. The rate of the catheter in place, the successful rate of AVS, the time of blood collection, the dosage of the contrast agent, and surgical complications were compared between the two groups. Results: There were 76 cases included, while 38 were male and 38 were female. The average age was 45 (25-57) years. Compared with the patients without the aid of 3D visualization, the success rate of right AVS of the patients with the aid of 3D visualization technology increased from 43% to 78% (P<0.05). The success rate of adrenal vein blood collection increased from 53% to 83%. The dose of contrast agent decreased [the M(Q1,Q3) were78 (59, 89) ml vs 28 (16, 51) ml, P<0.05], and the time of blood sampling from the right adrenal vein approximately decreased [the M(Q1,Q3) were 70 (66, 88) min vs 44 (22, 61) min, P<0.05]. Compared with the case without the aid of 3D visualization, the left adrenal vein catheterization rate of patients in the 3D visualization group increased from 97% to 98%, the success rate of adrenal vein blood collection increased from 97% to 98%, and the differences of the time of blood sampling and the dosage of the contrast were not statistically significant between the two groups. Among all the cases experienced bilateral AVS, only one patient without 3D reconstruction had contrast extravasation, and the others had no obvious complications. Conclusions: Before AVS, 3D visualization processing of adrenal vein from CT data is capable of increasing the success rate of blood sampling from the right adrenal vein, as well as reducing the dosage of contrast agent and the time of adrenal vein blood sampling. Therefore, it has a potential clinical value of the application.


Assuntos
Hiperaldosteronismo , Imageamento Tridimensional , Glândulas Suprarrenais/diagnóstico por imagem , Aldosterona , Coleta de Amostras Sanguíneas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
16.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 43(4): 653-658, 2021 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-34494540

RESUMO

Primary aldosteronism is the most common cause of secondary hypertension.This review focuses on the procedures related to surgical treatment and summarizes the available evidence.We analyzed the impact of primary aldosteronism on the body,the advantages of surgical treatment,the choice of patients and surgical methods,perioperative management,and surgical efficacy evaluation.Finally,we put forward the prospect of scientific research in this field,with a view to providing reference for clinical work.


Assuntos
Hiperaldosteronismo , Hipertensão , Adrenalectomia , Humanos , Hiperaldosteronismo/cirurgia
17.
Nat Genet ; 53(9): 1360-1372, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34385710

RESUMO

Most aldosterone-producing adenomas (APAs) have gain-of-function somatic mutations of ion channels or transporters. However, their frequency in aldosterone-producing cell clusters of normal adrenal gland suggests a requirement for codriver mutations in APAs. Here we identified gain-of-function mutations in both CTNNB1 and GNA11 by whole-exome sequencing of 3/41 APAs. Further sequencing of known CTNNB1-mutant APAs led to a total of 16 of 27 (59%) with a somatic p.Gln209His, p.Gln209Pro or p.Gln209Leu mutation of GNA11 or GNAQ. Solitary GNA11 mutations were found in hyperplastic zona glomerulosa adjacent to double-mutant APAs. Nine of ten patients in our UK/Irish cohort presented in puberty, pregnancy or menopause. Among multiple transcripts upregulated more than tenfold in double-mutant APAs was LHCGR, the receptor for luteinizing or pregnancy hormone (human chorionic gonadotropin). Transfections of adrenocortical cells demonstrated additive effects of GNA11 and CTNNB1 mutations on aldosterone secretion and expression of genes upregulated in double-mutant APAs. In adrenal cortex, GNA11/Q mutations appear clinically silent without a codriver mutation of CTNNB1.


Assuntos
Neoplasias do Córtex Suprarrenal/genética , Adenoma Adrenocortical/genética , Aldosterona/biossíntese , Subunidades alfa de Proteínas de Ligação ao GTP/genética , beta Catenina/genética , Adolescente , Neoplasias do Córtex Suprarrenal/patologia , Adenoma Adrenocortical/patologia , Adulto , Feminino , Subunidades alfa Gq-G11 de Proteínas de Ligação ao GTP/genética , Humanos , Hiperaldosteronismo/patologia , Masculino , Menopausa/metabolismo , Pessoa de Meia-Idade , Gravidez , Puberdade/metabolismo
18.
BMC Cardiovasc Disord ; 21(1): 350, 2021 07 22.
Artigo em Inglês | MEDLINE | ID: mdl-34294029

RESUMO

BACKGROUND: Primary aldosteronism (PA), as a cause of secondary hypertension, can cause more serious cardiovascular damage than essential hypertension. The aldosterone-to-renin ratio (ARR) is recommended as the most reliable screening method for PA, but ARR screening is often influenced by many factors. PA cannot be easily excluded when negative ARR. CASE PRESENTATION: We report the case of a 45-year-old Chinese man with resistant hypertension. Three years ago, he underwent a comprehensive screening for secondary hypertension, including the ARR, and the result was negative. After that, the patient's blood pressure was still poorly controlled with four kinds of antihypertensive drugs, the target organ damage of hypertension progressed, and hypokalaemia was difficult to correct. When the patient was hospitalized again for comprehensive examination, we found that aldosterone levels had significantly increased, although the ARR was negative. An inhibitory test with saline was further carried out, and the results suggested that aldosterone was not inhibited; therefore, PA was diagnosed. We performed a unilateral adenoma resection for this patient, and spironolactone was continued to control blood pressure. After the operation, blood pressure is well controlled, and hypokalaemia is corrected. CONCLUSION: When the ARR is negative, PA cannot be easily excluded. Comprehensive analysis and diagnosis should be based on the medication and clinical conditions of patients.


Assuntos
Adenoma/complicações , Neoplasias das Glândulas Suprarrenais/complicações , Aldosterona/sangue , Hiperaldosteronismo/sangue , Hipertensão/etiologia , Renina/sangue , Adenoma/sangue , Adenoma/diagnóstico , Adenoma/cirurgia , Neoplasias das Glândulas Suprarrenais/sangue , Neoplasias das Glândulas Suprarrenais/diagnóstico , Neoplasias das Glândulas Suprarrenais/cirurgia , Adrenalectomia , Anti-Hipertensivos/uso terapêutico , Biomarcadores/sangue , Pressão Sanguínea/efeitos dos fármacos , Humanos , Hiperaldosteronismo/diagnóstico , Hiperaldosteronismo/etiologia , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
19.
J Vet Intern Med ; 35(5): 2152-2158, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34331479

RESUMO

BACKGROUND: The frequency with which multiple corticosteroid abnormalities occur in cats with aldosterone secreting adrenocortical tumors is unknown. OBJECTIVES: To evaluate adrenal-derived corticosteroids in cats in which blood samples were submitted for measure of aldosterone. ANIMALS: Two hundred ninety-seven cats. METHODS: Retrospective study. Analysis of a convenience sample of previously submitted serum or plasma. Progesterone, corticosterone, and cortisol were measured in feline serum or plasma samples submitted to an endocrinology laboratory for aldosterone measurements. Demographics and clinical history were retrieved from submittal forms when provided. Statistical testing was performed to investigate associations among the adrenal corticosteroids. RESULTS: Progesterone and corticosterone concentrations were strongly correlated (ρ = 0.74; P < .001). Progesterone (median, 5 nmol/L; interquartile range, 3-10 nmol/L) and corticosterone (113 nmol/L, 38-250 nmol/L) in cats with markedly increased aldosterone concentrations (≥3000 pmol/L) were higher than progesterone (1 nmol/L, 1-2 nmol/L) and corticosterone (12 nmol/L, 3-25 nmol/L) in cats with normal aldosterone concentrations (P < .001 for both comparisons). Progesterone concentrations ≥10 nmol/L (normal, ≤2 nmol//L) occurred in 24 of 76 (32%) cats with aldosterone concentrations ≥3000 pmol/L. Cortisol was lower in cats with aldosterone concentrations ≥3000 pmol/L as compared to those with aldosterone concentrations <500 pmol/L (59 nmol/L, 27-103 nmol/L vs 103 nmol/L, 49-182 nmol/L; P = .002). CONCLUSIONS AND CLINICAL IMPORTANCE: Multiple corticosteroid abnormalities occur in a subset of cats with hyperaldosteronism. The magnitude of increases in progesterone and corticosterone in some cats with hyperaldosteronism is likely to be clinically relevant.


Assuntos
Doenças do Gato , Hiperaldosteronismo , Hormônio Adrenocorticotrópico , Aldosterona , Animais , Gatos , Corticosterona , Hidrocortisona , Hiperaldosteronismo/veterinária , Estudos Retrospectivos
20.
J Hypertens ; 39(11): 2325-2332, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34224538

RESUMO

OBJECTIVE: Primary aldosteronism has two main clinically and biologically distinct subtypes: unilateral aldosterone-producing adenoma (APA) and bilateral adrenal hyperplasia (BAH). We aimed to evaluate the changes of each subtype's clinical characteristics over a 13-year period. METHODS: This retrospective study involved time-trend analyses to identify changes in the clinical features of APA and BAH at diagnosis (2006-2018). A nationwide database from 41 Japanese referral centers was searched, which identified 2804 primary aldosteronism patients with complete baseline information and adrenal venous sampling (AVS) data. RESULTS: The proportion of patients with APA decreased from 51% in 2006-2009 to 22% in 2016-2018. Among the 1634 patients with BAH, trend analyses revealed decreases in hypertension duration (median 7--3 years; P < 0.01) and hypokalemia prevalence (18--11%; P < 0.01). However, among the 952 patients with APA, there were no significant changes in hypertension duration (median 8 years) and hypokalemia prevalence (overall 70%). Furthermore, the APA group had a trend towards increased use of multiple hypertensive drugs at diagnosis (30--43%; P < 0.01). When subtypes were reclassified according to the precosyntropin stimulation AVS data, APA patients tended to be diagnosed earlier and at milder forms, consistent with the trend in overall primary aldosteronism patients. CONCLUSION: During 2006-2018, we identified marked subtype-specific trends in the clinical findings at the diagnosis of primary aldosteronism. Our results suggested that the emphasis on the implementing cosyntropin stimulation during AVS might lead to under-identification of APA, especially in patients with mild or early cases.


Assuntos
Adenoma Adrenocortical , Hiperaldosteronismo , Hipertensão , Glândulas Suprarrenais , Aldosterona , Humanos , Hiperaldosteronismo/complicações , Hiperaldosteronismo/diagnóstico , Hiperaldosteronismo/epidemiologia , Hipertensão/epidemiologia , Estudos Retrospectivos
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