Endocrine hypertension secondary to adrenal tumors: clinical course and predictive factors of clinical remission

Clemente-Gutiérrez, U.; Pérez-Soto, Rafael Humberto; Hernández-Acevedo, J.D.; Iñiguez-Ariza, Nicole M.; Casanueva-Pérez, Enrique; Pantoja-Millán, Juan Pablo; Sierra-Salazar, Mauricio; Herrera, Miguel F.; Velázquez-Fernández, David

doi:10.1007/s00423-021-02245-2

Cited by 6 publications

(3 citation statements)

References 33 publications

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“…In PA and subclinical or clinical Cushing syndrome, the goals of treatment are to normalize both blood pressure and excessive aldosterone/cortisol production, to reduce associated comorbidities, to improve the quality of life and to reduce disease-related mortality [ 153 , 154 , 155 , 156 , 157 , 158 , 159 ].…”

Section: Approach Of Connshing Syndromementioning

confidence: 99%

“…Bilateral PA is treated with mineralocorticoid receptor antagonists, if a unilateral source of aldosterone and/or cortisol source is not indicated by AVS to be a surgery candidate. Laparoscopic adrenalectomy, typically with a good outcome and a significant post-surgery remission/improvement of the clinical picture, remains the treatment of choice in unilateral PA and patients with Cushing syndrome, thus (indirectly) also in patients with Connshing syndrome which is not the subject of any distinct guideline/protocol, though it is included as a particular section in recommendations for PA patients [ 153 , 155 , 156 , 157 , 158 , 160 , 161 ].…”

Section: Approach Of Connshing Syndromementioning

confidence: 99%

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The Entity of Connshing Syndrome: Primary Aldosteronism with Autonomous Cortisol Secretion

Cârșote¹

2022

Diagnostics

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Connshing syndrome (CoSh) (adrenal-related synchronous aldosterone (A) and cortisol (C) excess) represents a distinct entity among PA (primary hyperaldosteronisms) named by W. Arlt et al. in 2017, but the condition has been studied for more than 4 decades. Within the last few years, this is one of the most dynamic topics in hormonally active adrenal lesions due to massive advances in steroids metabolomics, molecular genetics from CYP11B1/B2 immunostaining to genes constellations, as well as newly designated pathological categories according to the 2022 WHO classification. In gross, PA causes 4–10% of all high blood pressure (HBP) cases, and 20% of resistant HBP; subclinical Cushing syndrome (SCS) is identified in one-third of adrenal incidentalomas (AI), while CoSh accounts for 20–30% to 77% of PA subjects, depending on the tests used to confirm autonomous C secretion (ACS). The clinical picture overlaps with PA, hypercortisolemia being mild. ACS is suspected in PA if a more severe glucose and cardiovascular profile is identified, or there are larger tumours, ACS being an independent factor risk for kidney damage, and probably also for depression/anxiety and osteoporotic fractures. It seems that one-third of the PA-ACS group harbours mutations of C-related lines like PRKACA and GNAS. A novel approach means we should perform CYP11B2/CYP11B1 immunostaining; sometimes negative aldosteronoma for CYP11B1 is surrounded by micronodules or cell clusters with positive CYP11B1 to sustain the C excess. Pitfalls of hormonal assessments in CoSh include the index of suspicion (check for ACS in PA patients) and the interpretation of A/C ratio during adrenal venous sample. Laparoscopic adrenalectomy is the treatment of choice. Post-operative clinical remission rate is lower in CoSh than PA. The risk of clinically manifested adrenal insufficiency is low, but a synthetic ACTH stimulating testing might help to avoid unnecessary exposure to glucocorticoids therapy. Finally, postponing the choice of surgery may impair the outcome, having noted that long-term therapy with mineralocorticoids receptors antagonists might not act against excessive amounts of C. Awareness of CoSh improves management and overall prognosis.

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Section: Approach Of Connshing Syndromementioning

confidence: 99%

Section: Approach Of Connshing Syndromementioning

confidence: 99%

The Entity of Connshing Syndrome: Primary Aldosteronism with Autonomous Cortisol Secretion

Cârșote¹

2022

Diagnostics

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“…These tumors span from benign non-hormone-secreting adrenocortical adenomas to hyperfunctional malignancies, like adrenocortical carcinoma, and hormone-secreting adrenal medullary tumors, such as phaeochromocytoma [1]. While many adrenal tumors receive medical attention due to symptoms, often centered around hypertension, incidental discovery also plays a significant role [2]. This is exemplified by the identification of adrenal enlargement during abdominal imaging conducted for unrelated purposes [3].…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic Adrenalectomy: Tailoring Approaches for the Optimal Resection of Adrenal Tumors

Mihai,

Boicean,

Teodoru

et al. 2023

Diagnostics

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In this study, we investigated the outcomes of laparoscopic approaches for adrenal tumor resection in 67 patients from a single center with a median age of 51 (range 40–79). Predominantly comprising women, the majority of patients were overweight or obese. Adrenal tumors larger than 6 cm were mostly treated using the laparoscopic transperitoneal method (p < 0.001). Our results revealed that patients subjected to the retroperitoneal approach exhibited quicker recovery, as evidenced by faster resumption of oral intake and ambulation, along with reduced intraoperative blood loss and shorter hospitalization (p-value < 0.05). In contrast, patients subjected to the transperitoneal approach experienced minimal complications, though not statistically significant, despite the technique’s intricacy and slower recovery. These findings emphasize the significance of tailoring the surgical approach to individual patient characteristics, with particular emphasis on the tumor size. The choice between the retroperitoneal and transperitoneal methods should be informed by patient-specific attributes to optimize surgical outcomes. This study underscores the need for a comprehensive evaluation of factors such as tumor characteristics and postoperative recovery when determining the most suitable laparoscopic approach for adrenal tumor resection. Ultimately, the pursuit of individualized treatment strategies will contribute to improved patient outcomes in adrenal tumor surgery.

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Hydrosaline Alterations in Cushing Disease

Alcubierre¹,

Sbardella²,

Isidori³

2023

Endocrinology

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Endocrine hypertension secondary to adrenal tumors: clinical course and predictive factors of clinical remission

Cited by 6 publications

References 33 publications

The Entity of Connshing Syndrome: Primary Aldosteronism with Autonomous Cortisol Secretion

The Entity of Connshing Syndrome: Primary Aldosteronism with Autonomous Cortisol Secretion

Laparoscopic Adrenalectomy: Tailoring Approaches for the Optimal Resection of Adrenal Tumors

Hydrosaline Alterations in Cushing Disease

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