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Hypertension 2021 Jun 14:HYPERTENSIONAHA12117436. Epub 2021 Jun 14.

From the Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan. (H.O., Y.Y., X.G., H. Sasano).

The rapid progression of chronic kidney disease and higher incidence of cardiovascular complications are well known in patients with hyperaldosteronism. However, detailed renal histopathologic characteristics of this disease have remained unknown. Therefore, renal biopsy specimens of 19 cases with unilateral hyperaldosteronism were compared with 22 autopsy renal cases of estimated glomerular filtration rate-matched essential hypertension without nephropathy or endocrine disorders to explore the hyperaldosteronism-specific histopathologic renal changes in this study. Read More

Oman Med J 2021 May 31;36(3):e266. Epub 2021 May 31.

Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Kashmir, India.

Primary hyperaldosteronism (PA) is a common disease with a prevalence of 5-10% in unselected patients with hypertension. Medullary nephrocalcinosis is a radiological diagnosis and refers to diffuse calcification in the renal parenchyma. The three commonest causes of nephrocalcinosis are hyperparathyroidism, distal renal tubular acidosis, and medullary sponge kidney. Read More

Front Endocrinol (Lausanne) 2021 24;12:646933. Epub 2021 May 24.

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

Background: Primary aldosteronism (PA) is a common cause of secondary hypertension and associated with higher incidence of new-onset atrial fibrillation (NOAF). However, the effects of surgical or medical therapies on preventing NOAF in PA patents remain unclear. The aim of this meta-analysis study was to assess the risk of NOAF among PA patients receiving mineralocorticoid receptor antagonist (MRA) treatment, PA patients receiving adrenalectomy, and patients with essential hypertension. Read More

Biomedicines 2021 May 18;9(5). Epub 2021 May 18.

Department of Pathology, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan.

In situ cortisol excess was previously reported to promote cellular senescence, a cell response to stress, in cortisol-producing adenomas (CPA). The aim of this study was to explore senescence pathways in aldosterone-producing cells and related disorders, and the influence of aldosterone overproduction on in situ senescence. We analyzed 30 surgical cases of aldosterone-producing adenoma (APA), 10 idiopathic hyperaldosteronism (IHA) and 19 normal adrenals (NA). Read More

Dtsch Med Wochenschr 2021 Jun 1;146(11):742-746. Epub 2021 Jun 1.

Medizinische Klinik und Poliklinik I, Lehrstuhl Endokrinologie und Diabetologie, Universitätsklinikum Würzburg.

Resistant hypertension (RH) is defined in patients who do not meet their blood pressure targets despite the daily intake of three antihypertensive drugs in maximally tolerated dosages. This triple treatment should comprise (1) an angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB), (2) a calcium channel blocker and (3) a diuretic. RH should also be diagnosed in patients on four or more antihypertensive drug classes. Read More

Case Rep Urol 2021 10;2021:6672052. Epub 2021 May 10.

Service d'Urologie, Hopital d'Instruction des Armees Centre Hospitalier Universitaire (HIA-CHU), Cotonou, Benin.

We report a case of Conn's adenoma in a 35-year-old female successfully managed in a poor hospital technology environment. Read More

Sci Rep 2021 May 27;11(1):11181. Epub 2021 May 27.

Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ziemssenstraße 1, 80336, Munich, Germany.

Treatment of choice in patients with unilateral aldosterone producing adenoma (APA) is adrenalectomy. Following surgery, most patients retain normal adrenal function, while some develop adrenal insufficiency (AI). To facilitate early detection and treatment of AI, we aimed to identify variables measured pre-operatively that are associated with post-operative AI. Read More

Zhonghua Yi Xue Za Zhi 2021 Jun;101(20):1513-1517

Department of Urology, Baiyin First People's Hospital, Baiyin 730900, China.

To compare the therapeutic effect of transperitoneal transmesenteric approach versus paracolic sulci approach laparoscopic adrenal tumorectomy for treatment of left-sided primary hyperaldosteronism. From January 2017 to July 2019, the clinical data of 70 patients with left-sided primary hyperaldosteronism (PHA) who underwent surgery in the First Hospital of Lanzhou University and five other hospitals in Gansu Province were retrospectively analyzed. There are 43 male and 27 female patients. Read More

Endocrine 2021 May 27. Epub 2021 May 27.

Hypertension and Emergency Unit, Department of Medicine - DIMED, University of Padua, Padova, Italy.

Purpose: Familial hyperaldosteronism type 1 (FH-1) is a rare autosomal dominant form of primary aldosteronism, which features a marked phenotypic heterogeneity, ranging from mild to severe forms of arterial hypertension that can be complicated by stroke and cardiovascular events at a young age. As affected patients usually reach the fertile age, transmission of the disease to offspring is common. Notwithstanding this, reports of FH-1 in pregnancy are limited and there is a lack of treatment guidelines. Read More

Hypertension 2021 May 24:HYPERTENSIONAHA12117348. Epub 2021 May 24.

Medizinische Klinik und Poliklinik IV, Klinikum der Universitaät Muünchen, Ludwig-Maximilians-Universität München, Germany. (L.S.M., L.H., I.K., M.B., M.R., T.A.W.).

Unilateral forms of primary aldosteronism are usually surgically treated to remove the source of aldosterone excess. After adrenalectomy, aldosteronism persists in some patients indicating abnormal aldosterone production from the unresected gland. Our objective was to investigate histopathology, genotype, and postsurgical outcomes in a 3-year prospective cohort of surgically treated patients for primary aldosteronism (from 2016 to 2018). Read More

Sichuan Da Xue Xue Bao Yi Xue Ban 2021 May;52(3):472-476

Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu 610041, China.

Objective: To evaluate the performance of chemiluminescence immunoassay (CLIA) in examining renin and aldosterone and to determine its value for screening for primary aldosteronism (PA).

Methods: According to the relevant documents of Clinical and Laboratory Standards Institute (CLSI), we verified the precision, linear range and carryover rate of examining renin and aldosterone with CLIA. The study included 91 suspected PA patients, using two methods, CLIA and radioimmunoassay (RIA), to examine renin and aldosterone levels in order to compare the correlation between the two methods and their value for PA screening. Read More

Tohoku J Exp Med 2021 ;254(1):1-15

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

Aldosterone plays pivotal roles in renin-angiotensin-aldosterone system in order to maintain the equilibrium of liquid volume and electrolyte metabolism. Aldosterone action is mediated by both mineralocorticoid receptor and 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD2). Its excessive actions directly induced tissue injuries in its target organs such as myocardial and vascular fibrosis in addition to chronic kidney diseases. Read More

J Clin Endocrinol Metab 2021 May 19. Epub 2021 May 19.

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

Context: The aldosterone-to-renin ratio (ARR) is the guideline-recommended screening test for primary aldosteronism. However, there is limited data in regard to the diagnostic performance of the ARR.

Objective: To evaluate the sensitivity and specificity of the ARR as a screening test for primary aldosteronism. Read More

Hypertens Res 2021 May 17. Epub 2021 May 17.

Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Japan.

Among individuals with hypertension, the prevalence of secondary hypertension has been reported to be ≈10%. More than half of individuals with secondary hypertension have associated hyperaldosteronism. However, given the current clinical environment, these patients often remain undiagnosed. Read More

Obstet Med 2021 Mar 24;14(1):35-38. Epub 2019 Mar 24.

Obstetric Medicine and Endocrinology, Mater Health, Brisbane, Queensland, Australia.

Mineralocorticoid receptor antagonists are highly effective in the management of resistant hypertension and primary hyperaldosteronism. Recent studies demonstrate that mineralocorticoid receptor antagonists significantly reduce blood pressure, severity of obstructive sleep apnoea and arterial stiffness in patients with resistant hypertension and moderate-severe obstructive sleep apnoea. Eplerenone is a selective mineralocorticoid receptor antagonist that does not act as an androgen receptor blocker, thus reducing the risk of fetal anti-androgenic effects. Read More

J Appl Lab Med 2021 Apr;6(3):668-678

SAS Laboratory Endocrinology, St James University Hospital, Leeds, UK.

Background: Aldosterone and renin are pivotal hormones in the regulation of salt and water homeostasis and blood pressure. Measurement of renin and aldosterone in serum/plasma is essential for the investigation of primary hyperaldosteronism (PA) and monitoring of glucocorticoid replacement therapy.

Methods: We report 2 LC-MS/MS methods developed to measure aldosterone and plasma renin activity (PRA). Read More

Biomedicines 2021 Apr 10;9(4). Epub 2021 Apr 10.

Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan.

Primary aldosteronism (PA) is the most common form of secondary hypertension, with a prevalence of 5-10% among patients with hypertension. PA is mainly classified into two subtypes: aldosterone-producing adenoma (APA) and bilateral idiopathic hyperaldosteronism. Recent developments in genetic analysis have facilitated the discovery of mutations in , , , , , , and in sporadic or familial forms of PA in the last decade. Read More

Front Endocrinol (Lausanne) 2021 12;12:645395. Epub 2021 Apr 12.

Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.

Introduction: Some aldosterone-producing micro-adenomas cannot be detected through image inspection. Therefore, adrenal venous sampling (AVS) is often performed, even in primary aldosteronism (PA) patients who have no apparent adrenal tumors (ATs) on imaging. In most of these cases, however, the PA is bilateral. Read More

Eur J Endocrinol 2021 May 21;185(1):R1-R11. Epub 2021 May 21.

Departments of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, Michigan, USA.

Primary aldosteronism (PA) is a common cause of secondary hypertension. Recent technological advances in genetic analysis have provided a better understanding of the molecular pathogenesis of this disease. The application of next-generation sequencing has resulted in the identification of somatic mutations in aldosterone-producing adenoma (APA), a major subtype of PA. Read More

Proc Natl Acad Sci U S A 2021 Apr;118(17)

Department of Nephrology, Charité-Universitätsmedizin Berlin, 10115 Berlin, Germany;

Gain-of-function mutations in the gene (encoding the T-type calcium channel Ca3.2) cause autosomal-dominant familial hyperaldosteronism type IV (FH-IV) and early-onset hypertension in humans. We used CRISPR/Cas9 to generate knockin mice as a model of the most common FH-IV mutation, along with corresponding knockout mice ( ). Read More

Hypertension 2021 Jun 19;77(6):1964-1973. Epub 2021 Apr 19.

Department of Internal Medicine (N.H., H.L., S.L., Y.R.), Yonsei University College of Medicine, Seoul.

[Figure: see text]. Read More

Endocr Pract 2021 May 14;27(5):478-483. Epub 2020 Dec 14.

Center of Laboratory Medicine, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China. Electronic address:

Objective: To investigate the prevalence of primary aldosteronism (PA) among participants with hypertension, evaluate the concordance of PA classification between adrenal computed tomography and adrenal venous sampling, and compare the outcomes of surgery and medication for unilateral PA.

Methods: A prospective study was conducted among all inpatients with hypertension (n = 7594) at the National Center for Cardiovascular Diseases, China, from May 2016 to April 2018.

Results: Of the 7594 participants, 8. Read More

Clin Kidney J 2021 Apr 7;14(4):1269-1271. Epub 2020 Oct 7.

Stanford Hypertension Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.

Primary aldosteronism is the most common cause of secondary hypertension; however, the dynamic regulation of aldosterone by potassium is less well studied and current diagnostic recommendations are imprecise. We describe a young man who presented with resistant hypertension and severe hypokalemia. The workup initially revealed undetectable aldosterone despite acute potassium repletion. Read More

Am J Case Rep 2021 Apr 10;22:e929758. Epub 2021 Apr 10.

Division of Urology, Department of Surgery, Cathay General Hospital, Taipei, Taiwan.

BACKGROUND Primary aldosteronism, also known as Conn's syndrome, is a clinical condition caused by excessive production of aldosterone. The classic presenting signs of primary aldosteronism are hypertension and hypokalemia. However, rhabdomyolysis induced by severe hypokalemia is a rare manifestation of primary aldosteronism. Read More

Atherosclerosis 2021 05 29;324:84-90. Epub 2021 Mar 29.

Clinical Research Institute of Endocrinology and Metabolism, Kyoto Medical Center, National Hospital Organization, Endocrine Center, Ijinkai Takeda General Hospital, Kyoto, Japan.

Background And Aims: We used a dataset from a Japanese nationwide registry of patients with primary aldosteronism, to determine which of the parameters of hyperaldosteronism and blood pressure before or after treatments for primary aldosteronism (i.e., surgical adrenalectomy or a medication treatment) are important in terms of cardiovascular prognosis. Read More

Neurology 2021 05 7;96(20):960-962. Epub 2021 Apr 7.

From the Departments of Neurology (S.M.L., S.Y.M.), Endocrinology (Y.J.C.), Ophthalmology (K.L.), Thyroid Endocrinology Surgery (H.K.K.), Cardiology (J.-S.P.), Neurosurgery (Y.C.L.), and Pathology (J.-H.K.), Ajou University School of Medicine; and Department of Medical Sciences (S.M.L.), Graduate School of Ajou University, Suwon, Republic of Korea.

Clin Chem Lab Med 2021 Apr 8. Epub 2021 Apr 8.

Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.

Biomedicines 2021 Mar 17;9(3). Epub 2021 Mar 17.

Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan.

For the last seven decades, primary aldosteronism (PA) has been gradually recognized as a leading cause of secondary hypertension harboring increased risks of cardiovascular incidents compared to essential hypertension. Clinically, PA consists of two major subtypes, surgically curable and uncurable phenotypes, determined as unilateral or bilateral PA by adrenal venous sampling. In order to further optimize the treatment, surgery or medications, diagnostic procedures from screening to subtype differentiation is indispensable, while in the general clinical practice, the work-up rate is extremely low even in the patients with refractory hypertension because of the time-consuming and labor-intensive nature of the procedures. Read More

Nutrients 2021 Mar 8;13(3). Epub 2021 Mar 8.

Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, "Aghia Sophia" Children's Hospital, 11527 Athens, Greece.

Primary aldosteronism (PA), a condition characterized by autonomous aldosterone hypersecretion, constitutes the most common cause of secondary hypertension. Over the last decade, major breakthroughs have been made in the field of genetics underpinning PA. The advent and wide application of Next Generation Sequencing (NGS) technology led to the identification of several somatic and germline mutations associated with sporadic and familial forms of PA. Read More

Intern Med 2021 1;60(7):993-998. Epub 2021 Apr 1.

Division of Endocrinology and Metabolism, Department of Internal Medicine, Kanazawa University Graduate School of Medicine, Japan.

Objective Primary aldosteronism (PA) is a major cause of secondary hypertension. The association between PA and other hormone disorders is unclear. The present study aimed to evaluate whether the parathyroid hormone (PTH) value is associated with PA subtypes or specific treatments. Read More