Aldosterone-Producing Adrenocortical Adenoma Complicated by Chronic Renal Failure

Itoh, Hiroyuki; Sasaoka, Atsushi; Takao, Toshihiro; Nishiya, Koji; Nanamiya, Wakako; Chikazawa, Hiroaki; Matsumoto, Takafumi; Kitagawa, Shiroshi; Hishimoto, Kozo

doi:10.1159/000013403

Cited by 4 publications

(3 citation statements)

References 23 publications

(40 reference statements)

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“…A previous study has shown that creatinine clearance correlates inversely with PRA in patients with PA, indicating that PRA tends to be higher in PA patients with renal failure (9). There have been several reports on PA cases with renal failure (7,8,11-18). To our knowledge, however, only 6 PA cases with a clinical course similar to that of the present case (i.e., PA with renal failure, accelerated-malignant hypertension, increased PRA, and false-negative result of PAC/PRA ratio) have been reported (11-16).…”

Section: Discussionmentioning

confidence: 99%

Elevated Plasma Renin Activity Caused by Accelerated-malignant Hypertension in a Patient with Aldosterone-producing Adenoma Complicated with Renal Insufficiency

et al. 2019

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During the malignant phase of hypertension in patients with primary aldosteronism complicated with severe renal failure, the plasma renin activity may markedly increase with a false negative screening result for primary aldosteronism, thus potentially leading to a missed diagnosis of primary aldosteronism. We herein report the case of 37-year-old man who presented with accelerated-malignant hypertension complicated with severe renal insufficiency. The plasma renin activity was markedly increased in the malignant phase of hypertension, which were atypical results for primary aldosteronism. However, a plain abdominal computed tomography scan revealed a left adrenal nodule, which was diagnosed as aldosterone-producing adenoma by adrenal venous sampling.

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Section: Discussionmentioning

confidence: 99%

Elevated Plasma Renin Activity Caused by Accelerated-malignant Hypertension in a Patient with Aldosterone-producing Adenoma Complicated with Renal Insufficiency

et al. 2019

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“…Therefore, early treatment of PA can effectively reduce the morbidity and mortality of cardiovascular and cerebrovascular diseases. For some patients with special conditions, such as PA during pregnancy and elderly patients, drug therapy is more appropriate ( 25 , 26 ). Study have shown that in tumor cells, the WNT pathway is overactivated often due to gene mutations, and a large number of β-catenin proteins enter the nucleus for TCF/LEF transcriptional regulation ( 27 ).…”

Section: Discussionmentioning

confidence: 99%

Sfrp2 regulates the WNT/β-catenin pathway to slow the development of aldosterone-producing adenoma

Yang¹,

Ding²,

Zhu³

et al. 2023

Cardiovasc Diagn Ther

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Background To explore a new drug therapy for aldosterone-producing adenoma (APA), and investigate whether Sfrp2 (secreted frizzled-related protein 2) can influence the development of adrenal APA by regulating the WNT/β-catenin pathway. Methods Tissue samples from APA patients were collected to detect the expression of Sfrp2 and β-catenin in APA. NCI-H295R cells were cultured with WNT/β-catenin pathway inhibitors to detect cell proliferation and aldosterone secretion. Then, the expression of Sfrp2 was altered to determine the effect of Sfrp2 expression on WNT/β-catenin pathway activity and aldosterone adenocarcinoma cells. Finally, a mouse APA model was established, and the mice were intravenously injected with WNT/β-catenin pathway inhibitors or transfected with the Sfrp2 gene. The activity of the WNT/β-catenin pathway, blood pressure, aldosterone secretion, and cell growth in the mice were then observed. Results β-catenin was overexpressed in APA tissues, while Sfrp2 was underexpressed. Sfrp2 can negatively regulate β-catenin expression and control the activity of the WNT/β-catenin pathway. Increased Sfrp2 expression inhibited the activity of the WNT/β-catenin pathway, which suppressed aldosterone secretion and APA cell proliferation. The in vivo experiments also demonstrated that inhibition of WNT/β-catenin pathway activity in mice reduced the arterial pressure and aldosterone concentration. The increased expression of Sfrp2 can inhibit the WNT/β-catenin pathway in mice, and can also reduce arterial pressure and APA tissue growth. Conclusions Sfrp2 can inhibit the WNT/β-catenin signaling pathway by suppressing the expression of β-catenin , thus controlling the concentration of aldosterone and hindering APA development. This study provides a novel therapeutic target for the treatment of APA and a new direction for future research.

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“…The diagnosis of PA in patients with CKD is difficult and easily missed, and only 2 cases have been reported in the English literature [20, 21]. This is because CKD masks the typical hallmarks of PA (hypertension, hypokalemia, and low PRA), shares some features with PA (such as hypertension and elevated PAC) [22], and disturbs the renin-angiotension-aldosterone system leading to a further decrease of the response of renin/aldosterone to stimuli or suppressive manoeuvres [23].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Value of I‐131 NP‐59 SPECT/CT Scintigraphy in Patients with Subclinical or Atypical Features of Primary Aldosteronism

Chen

Wei

et al. 2011

BioMed Research International

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Accumulating evidence has shown the adverse effect of long-term hyperaldosteronism on cardiovascular morbidity that is independent of blood pressure. However, the diagnosis of primary aldosteronism (PA) remains a challenge for patients who present with subtle or atypical features or have chronic kidney disease (CKD). SPECT/CT has proven valuable in the diagnosis of a number of conditions. The aim of this study was to determine the usefulness of I-131 NP-59 SPECT/CT in patients with atypical presentations of PA and in those with CKD. The records of 15 patients with PA were retrospectively analyzed. NP-59 SPECT/CT was able to identify adrenal lesion(s) in CKD patients with suspected PA. Patients using NP-59 SPECT/CT imaging, compared with those not performing this procedure, significantly featured nearly normal serum potassium levels, normal aldosterone-renin ratio, and smaller adrenal size on CT and pathological examination and tended to feature stage 1 hypertension and non-suppressed plasma renin activity. These findings show that noninvasive NP-59 SPECT/CT is a useful tool for diagnosis in patients with subclinical or atypical features of PA and those with CKD.

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Aldosterone-Producing Adrenocortical Adenoma Complicated by Chronic Renal Failure

Cited by 4 publications

References 23 publications

Elevated Plasma Renin Activity Caused by Accelerated-malignant Hypertension in a Patient with Aldosterone-producing Adenoma Complicated with Renal Insufficiency

Elevated Plasma Renin Activity Caused by Accelerated-malignant Hypertension in a Patient with Aldosterone-producing Adenoma Complicated with Renal Insufficiency

Sfrp2 regulates the WNT/β-catenin pathway to slow the development of aldosterone-producing adenoma

Diagnostic Value of I‐131 NP‐59 SPECT/CT Scintigraphy in Patients with Subclinical or Atypical Features of Primary Aldosteronism

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