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J Am Heart Assoc 2022 Jun 29:e023813. Epub 2022 Jun 29.

Endocrinology and Diabetes Center Yokohama Rosai Hospital Yokohama Japan.

Background Primary aldosteronism can cause cardiac dysfunction, including left ventricular hypertrophy, left ventricular diastolic dysfunction, and left atrial enlargement. A few studies have compared the cardioprotective effects between surgery and medication for primary aldosteronism, although most have not adjusted for baseline disease status. In this study, we investigated the difference in cardiovascular outcomes between surgery and medication treatment for primary aldosteronism after adjusting for baseline clinical characteristics, including aldosterone level and pretreatment echocardiographic information. Read More

Front Endocrinol (Lausanne) 2022 9;13:816476. Epub 2022 Jun 9.

Department of Urology, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.

Background: Somatic mutations for excess aldosterone production have been frequently identified as important roles in the pathogenesis of unilateral primary hyperaldosteronism (uPA). Although mutation represents a minor etiology in primary aldosteronism, it plays a significant role in causing uPAs in sporadic cases.

Objective: To identify novel somatic mutation in patients with uPA and investigate the pathophysiological, immunohistological, and clinical characteristics of the variant. Read More

Rev Med Chil 2021 Nov;149(11):1539-1543

Departamento de Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.

Background: Familial hyperaldosteronism type I is caused by the generation of a chimeric aldosterone synthase enzyme (ASCE) which is regulated by ACTH instead of angiotensin II. We have reported that in vitro, the wild-type (ASWT) and chimeric aldosterone synthase (ASCE) enzymes are inhibited by progesterone and estradiol does not affect their activity.

Aim: To explore the direct action of testosterone on ASWT and ASCE enzymes. Read More

J Endocr Soc 2022 Aug 29;6(8):bvac085. Epub 2022 May 29.

Department of Endocrinology and Hypertension, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.

During pregnancy, there is no established treatment for idiopathic hyperaldosteronism (IHA), the most common form of primary aldosteronism due to bilateral adrenal hyperplasia. Here, we report the case of a pregnant patient with IHA who was successfully treated with esaxerenone, a nonsteroidal mineralocorticoid receptor (MR) antagonist. A 39-year-old woman was diagnosed with IHA and commenced on nifedipine 20 mg daily because she desired to be pregnant. Read More

Blood Press 2022 12;31(1):139-145

Department of Endocrinology, Shanghai Public Health Clinical Center, Shanghai, China.

Purpose: Through describing the confusing misdiagnosis process of Liddle syndrome, we try to reveal the importance of accurate aldosterone-renin detection and a genetic test for Liddle syndrome.

Methods: We found a family of hypertension and hypokalaemia with the proband of a 21-year-old female who had been misdiagnosed as primary aldosteronism (PA). She presented with high aldosterone and low renin levels. Read More

Curr Issues Mol Biol 2021 Dec 28;44(1):128-138. Epub 2021 Dec 28.

Department of Urology and Andrology, Kansai Medical University, Osaka 573-1191, Japan.

Primary aldosteronism is most often caused by aldosterone-producing adenoma (APA) and bi-lateral adrenal hyperplasia. Most APAs are caused by somatic mutations of various ion channels and pumps, the most common being the inward-rectifying potassium channel . Germ line mutations of cause familial hyperaldosteronism type 3 (FH3), which is associated with severe hyperaldosteronism and hypertension. Read More

Iran J Kidney Dis 2022 May;16(3):162-170

1Intrdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Brazil.

Introduction: Bartter syndrome (BS) is a salt losing tubulopathy due to impairment of the transport mechanisms at the thick ascending limb of the Henle's loop. The aim of this study was to report the clinical course of patients with BS.

Methods: Patients with BS were followed from 1996 to 2020 and enrolled to a systematic protocol to confirm primary BS by evaluating the metabolic derangements, nephrolithiasis and nephrocalcinosis. Read More

J Hypertens 2022 Jun;40(6):1179-1188

Yong Loo Lin School of Medicine, National University of Singapore (NUS).

Objective: Adrenal vein sampling (AVS) is recommended to subtype primary aldosteronism, but it is technically challenging. We compared 11C-Metomidate-PET-computed tomography (PET-CT) and AVS for subtyping of primary aldosteronism.

Methods: Patients with confirmed primary aldosteronism underwent both AVS and 11C-Metomidate PET-CT (post-dexamethasone). Read More

Cureus 2022 May 10;14(5):e24880. Epub 2022 May 10.

Internal Medicine, Hospital Beatriz Ângelo, Loures, PRT.

Primary hyperaldosteronism, also known as Conn's syndrome, is characterized by an independent and excessive aldosterone production in the adrenal cortex, causing hypernatremia, arterial hypertension, and, in some cases, potentially severe hypokalemia can occur. We report a case of a 45-year-old Caucasian woman, with a history of obesity and hypertension, who presented to the emergency room with a four-week evolution history of myalgia and ascending muscle weakness eventually resulting in tetraparesis. The initial blood analysis showed severe hypokalemia (1. Read More

BMJ Open 2022 Jun 13;12(6):e061671. Epub 2022 Jun 13.

Department of General Practice, Monash University, Clayton, Victoria, Australia

Objective: We sought to understand the factors that influence a general practitioner's (GP's) experience of screening for primary aldosteronism (PA) in hypertensive patients.

Design: A qualitative study, framed by phenomenology, using semistructured interviews that were audiorecorded, transcribed verbatim, entered into NVivo V.12. Read More

Hypertension 2022 Jun 10:101161HYPERTENSIONAHA12118858. Epub 2022 Jun 10.

Hypertension and Emergency Unit, Department of Medicine - DIMED, University of Padua, Italy. (V.S., T.M.S., G.P.R.).

Primary aldosteronism (PA) in pregnancy (PAP) can be a serious condition and is challenging to diagnose. This study was conceived to help in the diagnosis of PAP and provide suggestions on management of PAP based on evidence retrieved using a Population, Intervention, Comparison, and Outcome search strategy. Based on the changes of aldosterone and renin occurring in normal pregnancies, we developed a nomogram that will allow to identify PAP cases. Read More

Front Cardiovasc Med 2022 23;9:882330. Epub 2022 May 23.

Department of Cardiology, Einstein Medical Center, Philadelphia, PA, United States.

Cardiovascular disease, in particular ischemic heart disease is a major cause of morbidity and mortality worldwide. Primary aldosteronism is the leading cause of secondary hypertension, yet commonly under diagnosed, and represents a major preventable risk factor. In contrast to historical teaching, recent studies have shown that excess aldosterone production is associated with increased burden of ischemic heart disease disproportionate to the effects caused by hypertension alone. Read More

Biomedicines 2022 Apr 30;10(5). Epub 2022 Apr 30.

Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA.

The genetic basis of most types of adrenal adenomas has been elucidated over the past decade, leading to the association of adrenal gland pathologies with specific molecular defects. Various genetic studies have established links between variants affecting the protein kinase A (PKA) signaling pathway and benign cortisol-producing adrenal lesions. Specifically, genetic alterations in , , , , , and have been identified. Read More

Curr Opin Endocrinol Diabetes Obes 2022 06;29(3):233-242

Department of Molecular and Integrative Physiology.

Purpose Of Review: Renin-independent aldosterone production from one or both affected adrenal(s), a condition known as primary aldosteronism (PA), is a common cause of secondary hypertension. In this review, we aimed to summarize recent findings regarding pathophysiology of bilateral forms of PA, including sporadic bilateral hyperaldosteronism (BHA) and rare familial hyperaldosteronism.

Recent Findings: The presence of subcapsular aldosterone synthase (CYP11B2)-expressing aldosterone-producing micronodules, also called aldosterone-producing cell clusters, appears to be a common histologic feature of adrenals with sporadic BHA. Read More

Front Immunol 2022 10;13:853403. Epub 2022 May 10.

Master Program in Clinical Pharmacogenomics and Pharmacoproteomics, School of Pharmacy, Taipei Medical University, Taipei, Taiwan.

Aldosterone-producing adenoma (APA) is a benign adrenal tumor that results in persistent hyperaldosteronism. As one major subtype of primary aldosteronism, APA leads to secondary hypertension that is associated with immune dysregulation. However, how the adaptive immune system, particularly the T-cell population, is altered in APA patients remains largely unknown. Read More

Sci Rep 2022 May 25;12(1):8892. Epub 2022 May 25.

Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.

We performed the present study to investigate the role of computed tomography (CT) radiomics in differentiating nonfunctional adenoma and aldosterone-producing adenoma (APA) and outcome prediction in patients with clinically suspected primary aldosteronism (PA). This study included 60 patients diagnosed with essential hypertension (EH) with nonfunctional adenoma on CT and 91 patients with unilateral surgically proven APA. Each whole nodule on unenhanced and venous phase CT images was segmented manually and randomly split into training and test sets at a ratio of 8:2. Read More

Cardiovasc Intervent Radiol 2022 May 23. Epub 2022 May 23.

Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-0872, Japan.

Purpose: The aim was to evaluate a flexible device for transvenous adrenal gland radiofrequency ablation in vitro and in an in vivo animal model.

Materials And Methods: A flexible radiofrequency-tip catheter with an inner-cooling mechanism and a guidewire lumen was made. Then, using a polyvinyl alcohol gel model, the ablation diameter was evaluated and how much energy to deliver in vivo was determined. Read More

J Clin Endocrinol Metab 2022 May 15. Epub 2022 May 15.

Department of Renal Medicine, South Western Sydney Local Health District (SWSLHD), New South Wales (NSW), Australia.

Context: Primary aldosteronism (PA) is a common secondary cause of hypertension. Literature regarding PA in pregnancy has demonstrated poor outcomes.

Objective: Compare the management and outcomes of PA in pregnancy to both high and low-risk matched controls. Read More

Int J Mol Sci 2022 Apr 27;23(9). Epub 2022 Apr 27.

Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126 Turin, Italy.

Primary aldosteronism (PA) is a pathological condition characterized by an excessive aldosterone secretion; once thought to be rare, PA is now recognized as the most common cause of secondary hypertension. Its prevalence increases with the severity of hypertension, reaching up to 29.1% in patients with resistant hypertension (RH). Read More

Front Physiol 2022 26;13:800055. Epub 2022 Apr 26.

Department of Biomedicine, Aarhus University, Aarhus, Denmark.

Primary hyperaldosteronism (PA) is characterized by aldosterone excess and hypertension. This may be linked to increased renal Na reabsorption the epithelial Na channel (ENaC) and the NaCl cotransporter (NCC). The majority of PA patients have normal plasma K levels, but a subset of cases are associated with hypokalemia. Read More

Front Endocrinol (Lausanne) 2022 26;13:861581. Epub 2022 Apr 26.

Department of Medicine (Division of Nephrology) and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.

Primary aldosteronism is the most common and modifiable form of secondary hypertension. Left untreated, primary aldosteronism leads high rates of cardiovascular, metabolic, and kidney disease. Therefore, early diagnosis and targeted therapy are crucial to improve long-term patient outcomes. Read More

Eur J Endocrinol 2022 Jun 7;187(1):197-208. Epub 2022 Jun 7.

Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.

Objective: The presence of autonomous cortisol secretion (ACS) in patients with primary aldosteronism (PA) is common and potentially associated with poor outcomes. The aim of this study was to investigate the association between ACS and vascular remodeling in PA patients.

Design And Methods: We prospectively enrolled 436 PA patients from October 2006 to November 2019. Read More

BMC Nephrol 2022 May 12;23(1):182. Epub 2022 May 12.

Nephrology Department, Heraklion University Hospital, Voutes, 71500, Heraklion, Crete, Greece.

Background: Dent disease is an X-linked disorder characterized by low molecular weight proteinuria (LMWP), hypercalciuria, nephrolithiasis and chronic kidney disease (CKD). It is caused by mutations in the chloride voltage-gated channel 5 (CLCN5) gene (Dent disease-1), or in the OCRL gene (Dent disease-2). It is associated with chronic metabolic acidosis; however metabolic alkalosis has rarely been reported. Read More

J Steroid Biochem Mol Biol 2022 Jul 6;221:106116. Epub 2022 May 6.

Department of Pathology, Tohoku Graduate School of Medicine, Tohoku University, Sendai, Japan.

Aldosterone-producing adenoma (APA) is histologically composed of clear and compact tumor cells. KCNJ5- mutated APAs were reported to be associated with higher plasma aldosterone concentration and more abundant clear tumor cells containing lipid droplets than non-KCNJ5- mutated APAs. However, the association among cholesterol uptake and/or synthesis, cellular morphology and genotypes has remained unknown. Read More

Clin Exp Hypertens 2022 Jul 8;44(5):459-463. Epub 2022 May 8.

Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.

Objective: The role of hypertension in COVID-19 has not been clearly elucidated yet. The aim of this study was to evaluate the incidence and severity of COVID-19 in a hypertensive population and assess whether there is a link between blood pressure control and SARS-CoV-2 infection outcomes.

Methods: This was a single-center retrospective observational study that evaluated the incidence and severity of COVID-19 in a chronic hypertensive population (n=1,637) from a specialized consultation of Hypertension and Cardiovascular Risk of Internal Medicine in a tertiary hospital in Madrid (Spain). Read More

Endocr Connect 2022 May 11;11(5). Epub 2022 May 11.

Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.

The 20-point clinical prediction SPACE score, the aldosterone-to-lowest potassium ratio (APR), aldosterone concentration (AC) and the AC relative reduction rate after saline infusion test (SIT) have recently been proposed for primary aldosteronism (PA) subtyping prior to adrenal vein sampling (AVS). To validate those claims, we performed a retrospective cross-sectional study that included all patients at our center who had positive SIT to confirm PA and were diagnosed with either bilateral disease (BPA) according to AVS or with lateralized disease (LPA) if biochemically cured after adrenalectomy from November 2004 to the end of 2019. Final diagnoses were used to evaluate the diagnostic performance of proposed clinical prediction tools. Read More

Front Endocrinol (Lausanne) 2022 19;13:869980. Epub 2022 Apr 19.

Department of Endocrinology, CGH, Singapore, Singapore.

Background: Primary aldosteronism (PA) is the most common cause of secondary hypertension, and patients are at an increased risk of atrial fibrillation (AF) and stroke. We assessed the prevalence of PA in patients with recent stroke.

Methods: We recruited 300 patients admitted to an acute stroke unit with diagnosis of cerebrovascular accident (haemorrhagic/ischaemic) or transient ischaemic attack. Read More

Probl Endokrinol (Mosk) 2022 02 18;68(2):9-15. Epub 2022 Feb 18.

Endocrinology Research Centre.

Primary hyperaldosteronism (PHA) is the most common form of endocrine hypertension. Until recently, the reason for the development of this condition was believed to be the presence of genetic mutations, however, many studies declare that the disease can be polyetiologic, be the result of genetic mutations and autoimmune triggers or cell clusters of aldosterone-producing cells diffusely located in the adrenal gland at the zona glonerulosa, zona fasculata, zona reticularis, as well as directly under the adrenal capsule. Recently, the actions of autoantibodies to type 1 angiotensin II receptors have been described in patients with renal transplant rejection, with preeclampsia, and with primary hyperaldosteronism. Read More

PLoS One 2022 28;17(4):e0267732. Epub 2022 Apr 28.

Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Yokohama, Kanagawa, Japan.

Primary aldosteronism (PA) usually accompanies suppressed plasma renin activity (PRA) through a negative feedback mechanism. While some cases of PA with unsuppressed PRA were reported, there have been no studies about the characteristics of PA with unsuppressed PRA; thus, these characteristics were examined herein. Nine patients with unsuppressed PRA and 86 patients with suppressed PRA were examined. Read More

Chin Med J (Engl) 2022 Mar 20;135(6):639-647. Epub 2022 Mar 20.

Department of Clinical Laboratory, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, China.

Background: Since the diagnostic value of aldosterone to renin ratio (ARR) calculated by plasma renin concentration (PRC) or plasma renin activity (PRA) is still inconclusive, we conducted a meta-analysis by systematically reviewing relevant literature to explore the difference in the diagnostic efficacy of ARR calculated by PRC or PRA, so as to provide guidance for clinical diagnosis.

Methods: We searched PubMed, Embase, and Cochrane Library from the establishment of the database to March 2021. We included studies that report the true positive, false positive, true negative, and false negative values for the diagnosis of primary aldosteronism, and we excluded duplicate publications, research without full text, incomplete information, or inability to conduct data extraction, animal experiments, reviews, and systematic reviews. Read More