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

Rossi, Gian Paolo; Ragazzo, Fabio; Seccia, Teresa Maria; Maniero, Carmela; Barisa, Marlena; Calò, Lorenzo A.; Frigo, Anna Chiara; Fassina, Ambrogio; Pessina, Achille C.

doi:10.1161/hypertensionaha.112.195891

Cited by 62 publications

(66 citation statements)

References 28 publications

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“…In 1 study, serum 18OHB, 18-hydroxycortisol, and 18-oxocortisol before and after saline infusion were all higher in patients with APA than those with IHA or essential hypertension 70 ; likewise, the serum levels of parathyroid hormone and of autoantibodies for the type 1 angiotensin receptor were all higher in patients with APA than those with IHA or essential hypertension, with only small overlap between values for patients with APA and IHA. 71,72 Consequently, peripheral blood values for these substances, in combination with clinical criteria such as hypokalemia or lack thereof, 18,49 might be used to characterize which patients will benefit most from AVS when access to AVS and resources are limited.…”

Section: Clinical Decision Making Based On Equivocal Avs Resultsmentioning

confidence: 99%

An Expert Consensus Statement on Use of Adrenal Vein Sampling for the Subtyping of Primary Aldosteronism

et al. 2014

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Abstract-Adrenal venous sampling is recommended by current guidelines to identify surgically curable causes of hyperaldosteronism but remains markedly underused. Key factors contributing to the poor use of adrenal venous sampling include the prevailing perceptions that it is a technically challenging procedure, difficult to interpret, and can be complicated by adrenal vein rupture. In addition, the lack of uniformly accepted standards for the performance of adrenal venous sampling contributes to its limited use. Hence, an international panel of experts working at major referral centers was assembled to provide updated advice on how to perform and interpret adrenal venous sampling. To this end, they were asked to use the PICO (Patient or Problem, Intervention, Control or comparison, Outcome) strategy to gather relevant information from the literature and to rely on their own experience. The level of evidence/recommendation was provided according to American Heart Association gradings whenever possible. A consensus was reached on several key issues, including the selection and preparation of the patients for adrenal venous sampling, the procedure for its optimal performance, and the interpretation of its results for diagnostic purposes even in the most challenging

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Section: Clinical Decision Making Based On Equivocal Avs Resultsmentioning

confidence: 99%

An Expert Consensus Statement on Use of Adrenal Vein Sampling for the Subtyping of Primary Aldosteronism

et al. 2014

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“…27,28 Likewise, the recently reported increase of parathyroid hormone in PA patients was found in APA patients and not IHA patients, 29,30 thus being clinically helpful in the differential diagnosis between these conditions. 31 Furthermore, Satoh et al recently reported that 18-OH cortisol and 18-oxo cortisol were raised in patients with APA, and not in those with IHA. 32 Hence, the present result is not unique in showing biomarker differences between the APA and IHA patients.…”

Section: Discussionmentioning

confidence: 98%

Elevation of Angiotensin-II Type-1-Receptor Autoantibodies Titer in Primary Aldosteronism as a Result of Aldosterone-Producing Adenoma

et al. 2013

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A large prospective study showed that primary aldosteronism (PA) is the most prevalent form of endocrine hypertension among hypertensive patients referred to specialized hypertension centers. 1 The discrimination between its main subtypesaldosterone-producing adenoma (APA) and bilateral adrenal hyperplasia (BAH, also referred to as idiopathic hyperaldosteronism, IHA)-is crucial, as the former is surgically curable, whereas the latter requires lifelong medical treatment.2,3 This distinction is, however, challenging because of the biochemical and pathological overlapping of APA and BAH, and the lack of well-defined functional and morphological criteria. The tissue surrounding the APA often contains multiple nodules and shows paradoxical hyperplastic changes. Furthermore, cases of multinodular adrenal hyperplasia have been reported, 4 even though their distinctive criteria from APA remain vague.Thus, a pathological continuum between APA and BAH featuring a transition from hyperplasia to a nodular phase has been proposed, 5 which suggests that pathogenic mechanisms common to these conditions exist. However, the stimuli driving this transition eluded identification thus far notwithstanding a long quest. For example, even though angiotensin-II type-1 (AT1) receptors were detected in both the normal adrenocortical zona glomerulosa and in APA, 6-8 angiotensin-II (Ang-II), one of the known secretagogues of aldosterone, is barely detectable in PA patients.Of interest, circulating autoantibodies against a specific epitope of the AT1 receptor (AT1AA) with specific agonistic activity have been suggested to play a pathogenic role in diseases characterized by vascular and renal damage, such as preeclampsia and malignant hypertension. 9-16These agonistic autoantibodies against type-1 angiotensin-II receptor (AT1AA) could stimulate aldosterone secretion and trigger the development of hyperplastic changes in the zona glomerulosa in PA patients. We therefore sought for AT1AA in serum of patients with PA and investigated whether their titer was higher Abstract-The mechanisms of excess aldosterone secretion in primary aldosteronism (PA) remain poorly understood, although a role for circulating factors has been hypothesized for decades. Agonistic autoantibodies against type-1 angiotensin-II receptor (AT1AA) are detectable in malignant hypertension and preeclampsia and might play a role in PA. Moreover, if they were elevated in aldosterone-producing adenoma (APA) and not in idiopathic hyperaldosteronism (IHA), they might be useful for discriminating between these conditions. To test these hypotheses, we measured the titer of AT1AA in serum of 46 patients with PA (26 with APA, 20 with IHA), 62 with primary hypertension (PH), 13 preeclamptic women, and 45 healthy normotensive blood donors.We found that the AT1AA titer was higher (P<0.

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“…Another recent study from our group showed that patients with APA have a 31 % higher parathormone (PTH) levels than demographically comparable primary (essential) hypertension patients with similarly elevated blood pressure values [ 52 ]. A mild increase of PTH can therefore be a further, albeit hitherto unappreciated, feature of APA that can be useful in pinpointing the patients with these tumors [ 52 ].…”

Section: Molecular Mechanisms Of Pamentioning

confidence: 94%

Primary Aldosteronism: Molecular Mechanisms and Diagnosis

Rossi

Lenzini

2014

Primary Aldosteronism

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Primary aldosteronism (PA) is the most common endocrine form of high blood pressure (BP) and causes excessive organ damage to the heart, vessels, and kidneys, which translates into an excess of cardiovascular events.When the diagnosis is made early on and an appropriate therapy is timely instituted, the hyperaldosteronism and the hypokalemia can be cured in practically all the cases, while the arterial hypertension is cured in about 40 % of the cases and BP control markedly ameliorated in the rest. Thus, an aggressive diagnostic approach in hypertensive patients is justifi ed.The recent discoveries with molecular biology techniques have led to the identifi cation of some mechanisms that can explain the persistent hyperaldosteronism in spite of the high BP, the hypokalemia, and the suppression of renin, all factors that would be expected to shut down aldosterone secretion.The purpose of this chapter is to provide updated information on molecular genetics of PA and the diagnostic strategy for case detection and subtype differentiation of PA. While a cost effective strategy for the screening of patients with PA can be exploited at most centers, the identifi cation of its subtypes involves adrenal vein sampling, which is a procedure technically diffi cult to perform and interpret. Therefore, it should be undertaken at tertiary referral centers with experience in performing and interpreting this test.

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

Cited by 62 publications

References 28 publications

An Expert Consensus Statement on Use of Adrenal Vein Sampling for the Subtyping of Primary Aldosteronism

An Expert Consensus Statement on Use of Adrenal Vein Sampling for the Subtyping of Primary Aldosteronism

Elevation of Angiotensin-II Type-1-Receptor Autoantibodies Titer in Primary Aldosteronism as a Result of Aldosterone-Producing Adenoma

Primary Aldosteronism: Molecular Mechanisms and Diagnosis

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