A comprehensive review of the clinical aspects of primary aldosteronism

Rossi, Gian Paolo

doi:10.1038/nrendo.2011.76

Cited by 100 publications

(82 citation statements)

References 92 publications

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“…These findings indicate that serum PTH is useful for discriminating between subtypes of PA. Hence, once PA has been demonstrated by use of the ARR, 21 the measurement of PTH could be useful to decide whether to submit the patients to AVS, as indicated in the purposed algorithm (Figure 2). This gain of diagnostic information can be particularly important for those centers where AVS procedure is not readily available and systematically used.…”

Section: Discussionmentioning

confidence: 99%

“…The diagnosis of PA was made as described 21 ; APAs were diagnosed by the "4-corners criteria," which entail the following: (1) a biochemical diagnosis of PA; (2) lateralization of aldosterone secretion at AVS; (3) adenoma at histopathology; and (4) outcome of adrenalectomy at follow-up. 22 Of these patients, 116 were reported recently in a study that provided the first evidence for an increase of PTH in PA patients.…”

Section: Diagnostic Criteriamentioning

confidence: 99%

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Hyperparathyroidism Can Be Useful in the Identification of Primary Aldosteronism Due To Aldosterone-Producing Adenoma

et al. 2012

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Abstract-Hyperparathyroidism represents as a novel feature of primary aldosteronism (PA). Its occurrence in patients with the surgically correctable aldosterone-producing adenoma (APA) and not in those with bilateral adrenal hyperplasia suggested that the measurement of parathyroid hormone could help in differentiating between these subtypes of PA. To test this hypothesis we measured the plasma levels of intact parathyroid hormone, Ca 2ϩ , and several markers of calcium/phosphorus metabolism in 132 hypertensive patients, including 74 with primary (essential) hypertension and 58 consecutive PA patients. Of the latter, 46 were conclusively diagnosed as APA (by finding of lateralized aldosterone excess, pathology, correction of the hyperaldosteronism, and evidence of a fall of blood pressure after adrenalectomy) and 12 as bilateral adrenal hyperplasia. Based on these diagnoses we used the area under the receiver operator characteristic curve analysis to assess the accuracy of serum parathyroid hormone for identifying the PA cases in the whole group and for distinguishing between APA and bilateral adrenal hyperplasia. In this selected population of hypertensive patients for identifying PA cases, the accuracy of serum parathyroid hormone tended to be lower than that of the aldosterone:renin ratio. However, for discriminating between APA and bilateral adrenal hyperplasia patients it was better than that under the identity line and also that for the aldosterone:renin ratio for pinpointing APA cases among patients with PA. Hence, these findings indicate that raised serum parathyroid hormone levels are a feature of APA that can be useful for selecting the PA patients to be submitted to adrenal vein sampling. (Hypertension. 2012;60:431-436.) Key Words: aldosterone Ⅲ mineralocorticoids Ⅲ PTH Ⅲ endocrine hypertension Ⅲ secondary hypertension Ⅲ aldosterone-producing adenoma Ⅲ diagnosis Ⅲ calcium I n patients with primary aldosteronism (PA), the discrimination between the surgically curable aldosterone-producing adenoma (APA) and the medically treatable bilateral adrenal hyperplasia (BAH) is a challenging task that usually requires adrenal vein sampling, 1 a minimally invasive, risky, expensive, and not widely available procedure. Accordingly, there is an unmet need of a better strategy for selecting patients more likely to have an APA to be submitted to adrenal vein sampling (AVS). After the pilot reports of secondary hyperparathyroidism in patients with PA 2,3 and also with secondary aldosteronism attributed to congestive heart failure, 4-6 we and others recently documented an elevation of serum parathyroid hormone (PTH) levels in large cohorts of patients with confirmed PA. 7,8 These observations are of great interest given the adverse cardiovascular consequences of excess PTH, which is now appreciated as a cardiovascular risk factor, 9,10 and also because of the evidence that PTH can exert a secretagogue effect on aldosterone. In vitro studies consistently showed that PTH concentration-dependently increases aldosterone in...

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Section: Discussionmentioning

confidence: 99%

Section: Diagnostic Criteriamentioning

confidence: 99%

Hyperparathyroidism Can Be Useful in the Identification of Primary Aldosteronism Due To Aldosterone-Producing Adenoma

et al. 2012

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“…Las mediciones de estas hormonas fueron realizadas bajo tratamiento con amlodipino, el cual tiene mínima infl uencia sobre el eje renina-angiotensina-aldosterona y no afecta la medición de las metanefrinas urinarias 2,3 . Ecografía tiroidea evidenció nódulos tiroideos bilaterales de aspecto coloideo, el mayor en lóbulo derecho de 10 mm.…”

Section: Caso Clínicounclassified

Paragangliomas múltiples asociados a mutación del gen SDHB: Caso clínico

Díaz¹,

Utreras

Ascuí

et al. 2011

Rev. méd. Chile

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Multiple paragangliomas associated to a SDHB gene mutation. Report of one case 1 . Las ubicaciones más frecuente de los PG son: el cuerpo de Zuckerkandl, en relación a la arteria mesentérica superior, los plexos simpáticos de la vejiga, riñón, corazón, mediastino, cabeza y cuello; estos últimos generalmente parasimpáticos y por lo tanto no secretores de catecolaminas.La incidencia de FEO/PG es < 1:300.000/año y clínicamente se presentan con hipertensión asociada a síntomas paroxísticos (taquicardia, cefalea, palpitaciones y sudoración) espontáneos o provocados por aumento de la presión intraabdominal, o mínimamente sintomáticos, siendo diagnosticados al estudiar un incidentaloma suprarrenal 1 . Existe asociación importante de FEO/PG con síndromes genéticos hereditarios y se considera actualmente que 30% se encuentran en el contexto de alguna mutación genética 1 . Avances importantes al respecto se han realizado en la última década lo que ha facilitado la comprensión, diagnóstico y seguimiento de esta patología.Presentamos el caso de una paciente portadora de paragangliomas múltiples en la cual se realizó estudio genético, enfatizando la utilidad de realizarlo en pacientes seleccionados y su relevancia en el tratamiento y seguimiento de estos pacientes y sus familias. Caso clínicoPaciente de sexo femenino de 29 años, procedente de Calama. Dentro de sus antecedentes destaca trombosis retinal de ojo izquierdo 2 meses

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“…Hence, the Endocrine Society practice guidelines endorse its systematic use in the PA patients who seek surgical cure (1,2). However, notwithstanding recent improvements (3), unresolved issues concerning the performance and interpretation of AVS still remain (4,5,6,7,8).…”

Section: Introductionmentioning

confidence: 99%

A stress reaction affects assessment of selectivity of adrenal venous sampling and of lateralization of aldosterone excess in primary aldosteronism

Seccia

Miotto²,

Battistel³

et al. 2012

European Journal of Endocrinology

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Background: A stress reaction involving increased cortisol release, which has not been documented thus far, might affect the assessment of selectivity of catheterization during adrenal venous sampling (AVS). Objective: To investigate whether an ACTH-driven cortisol release occurs during AVS and whether it influences the assessment of selectivity by the step-up of cortisol (plasma cortisol concentrations, PCC) between the adrenal vein blood (PCC SIDE ) and the inferior vena cava (PCC IVC ), e.g. the selectivity index (SI). Design and methods: We determined the SI in samples obtained simultaneously at starting AVS (t-15) and again after 15 min (t0) in 34 consecutive patients with proven aldosterone-producing adenoma. We then calculated the SI with PCC SIDE obtained at t-15 and at t0, and the PCC IVC values obtained at the different time point, thus simulating sequential AVS. Results: The PCC SIDE and the SI fell significantly from t-15 to t0 on both the sides. When PCC SIDE obtained at t-15 was combined with PCC IVC at t0, the SI values were higher than those obtained with simultaneously drawn samples. This led to label as selective more AVS studies than with bilaterally simultaneous data, especially when using higher cutoffs for the SI. Conclusions: A transient increase in cortisol release from both adrenal glands occurs in the majority of the patients who undergo AVS. This stress reaction can influence the assessment of both the selectivity of the catheterization during the sequential AVS technique and the lateralization of aldosterone excess.

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A comprehensive review of the clinical aspects of primary aldosteronism

Cited by 100 publications

References 92 publications

Hyperparathyroidism Can Be Useful in the Identification of Primary Aldosteronism Due To Aldosterone-Producing Adenoma

Hyperparathyroidism Can Be Useful in the Identification of Primary Aldosteronism Due To Aldosterone-Producing Adenoma

Paragangliomas múltiples asociados a mutación del gen SDHB: Caso clínico

A stress reaction affects assessment of selectivity of adrenal venous sampling and of lateralization of aldosterone excess in primary aldosteronism

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