scholarly journals Clinical Characteristics of Aldosterone- and Cortisol-Coproducing Adrenal Adenoma in Primary Aldosteronism

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Lu Tang ◽  
Xintao Li ◽  
Baojun Wang ◽  
Xin Ma ◽  
Hongzhao Li ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Cardiovascular Events ◽  
Clinical Characteristics ◽  
Metabolic Disorders ◽  
Adrenal Adenoma ◽  
Cardiovascular Complications ◽  
Pcr Analysis ◽  
Cortisol Secretion ◽  
Quantitative Real Time Pcr ◽  
Biological Features

Aldosterone- and cortisol-coproducing adrenal adenoma (A/CPA) cases have been observed in patients with primary aldosteronism (PA). This study investigated the incidence, clinical characteristics, and molecular biological features of patients with A/CPAs. We retrospectively identified 22 A/CPA patients from 555 PA patients who visited the Chinese People’s Liberation Army General Hospital between 2004 and 2015. Analysis of clinical parameters revealed that patients with A/CPAs had larger tumors than those with pure APAs (P<0.05). Moreover, they had higher proportions of cardiovascular complications, glucose intolerance/diabetes, and osteopenia/osteoporosis compared to the pure APA patients (P<0.001). In the molecular biological findings, quantitative real-time PCR analysis revealed similar CYP11B1 and CYP17A1 mRNA expressions in resected A/CPA specimens and in pure APA specimens. Western blot and immunochemical analyses showed CYP11B1, CYP11B2, and CYP17A1 expressions in both A/CPAs and pure APAs. Seventeen cases with KCNJ5 mutations were detected among the 22 A/CPA DNA samples, but no PRKACA or other causative mutations were observed. Each patient improved following adrenalectomy. In conclusion, A/CPAs were not rare among PA patients. These patients associated with high incidences of cardiovascular events and metabolic disorders. Screening for excess cortisol secretion is necessary for PA patients.

scholarly journals Alteration of Gut Microbiota Relates to Metabolic Disorders in Primary Aldosteronism Patients

2021 ◽  
Vol 12 ◽  
Author(s):  
Yu Liu ◽  
Qingyao Jiang ◽  
Zhihong Liu ◽  
Sikui Shen ◽  
Jianzhong Ai ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Gut Microbiota ◽  
Primary Aldosteronism ◽  
Clinical Characteristics ◽  
Metabolic Disorders ◽  
Sugar Metabolism ◽  
Primary Hypertension ◽  
Healthy Controls ◽  
Blood Potassium ◽  
Mannose Metabolism

PurposeThis study aimed to determine the relationships among gut microbiota, primary aldosteronism (PA), and related metabolic disorders.MethodsThe study enrolled 13 PA patients, 26 sex-matched primary hypertension patients, and 26 sex-matched healthy controls. Demographic and clinical characteristics such as age, body mass index (BMI), blood aldosterone–renin ratio, blood potassium, blood glucose, blood lipid parameters, and history of diabetes mellitus (DM) were compared between the three groups. The gut microbiota of each participant was examined by 16S rRNA gene sequencing. Spearman correlation analysis was performed to demonstrate the relationship between gut microbiota and clinical characteristics.ResultsBMI and the percentage of DM in PA patients were higher than those in healthy controls (p &lt; 0.05), but not higher than those in primary hypertension patients (p &gt; 0.05). The gut microbiota of healthy controls and primary hypertension patients had a higher alpha diversity level than that of PA patients. PA patients had fewer short-chain fatty acid (SCFA)-producing genera (Prevotella, Blautia, Coprococcus, Anaerostipes, and Ruminococcus) and more inflammation-associated genera (Megamonas, Sutterella, and Streptococcus) than healthy controls (p &lt; 0.05). The gut microbiota of PA patients was more inclined to encode microbial pathways involved in sugar metabolism, such as starch and sucrose metabolism and fructose and mannose metabolism. Blood potassium was negatively correlated with the relative abundance of Romboutsia (R = −0.364, q = 0.023). Diastolic blood pressure (DBP) was positively correlated with Romboutsia (R = 0.386, q = 0.015). Systolic blood pressure (SBP) was negatively correlated with Blautia (R = −0.349, q = 0.030).ConclusionsThe alteration of gut microbiota in PA patients, especially bacteria and pathways involved in inflammation, SCFAs, and sugar metabolism, may be associated with chronic metabolic disorders.

Enhanced performance of a modified diagnostic test of primary aldosteronism in patients with adrenal adenomas

2021 ◽  
Author(s):  
Athina Markou ◽  
Gregory A Kaltsas ◽  
Labrini Papanastasiou ◽  
Chris Gravvanis ◽  
Nick Voulgaris ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Adrenal Adenoma ◽  
Plasma Renin ◽  
Serum Cortisol ◽  
Cortisol Secretion ◽  
Normal Limits ◽  
Adrenal Imaging ◽  
Increased Risk ◽  
Autonomous Cortisol Secretion ◽  
Aldosterone To Renin Ratio

Objective: Primary aldosteronism (PA) is the commonest cause of endocrine hypertension ranging from 4.6%-16.6% according to the diagnostic tests employed. The aim of this study was to compare the traditional saline infusion test (SIT) with the modified post-dexamethasone SIT (DSIT) by applying both tests on the same subjects. Methods: We studied 68 patients (72% hypertensives) with single adrenal adenoma and 55 normotensive controls, with normal adrenal imaging. Serum cortisol, aldosterone and plasma renin concentration (PRC) were measured and the aldosterone-to-renin ratio (ARR) was calculated. Using the mean+2SD values from the controls, we defined the upper normal limits (UNL) for cortisol, aldosterone and PRC for both the SIT and DSIT. Results: In the controls, the post-DSIT aldosterone levels and the ARR were approximately 2-fold and 3-fold lower respectively than the corresponding post-SIT values (all p=0.001) leading to lower cut-offs of aldosterone suppression. Applying these cut-offs to patients with adrenal adenomas, the prevalence of PA was 13.2% following the SIT and 29.4% following the DSIT, respectively. In addition, 54.5% of patients with PA had concomitant autonomous cortisol secretion. Targeted treatment of PA resulted in resolution of hypertension and restoration of normal secretory aldosterone dynamics. Conclusions: The DSIT improves the diagnostic accuracy of PA, allowing for the detection of milder forms of PA in patients with adrenal adenomas. This is of particular importance as such patients may be at an increased risk for developing cardiovascular and renal morbidity that could be enhanced in the presence of concomitant autonomous cortisol secretion.

scholarly journals Primary Aldosteronism Caused by a Unilateral Adrenal Adenoma Accompanied by Autonomous Cortisol Secretion

2007 ◽  
Vol 30 (4) ◽  
pp. 367-373 ◽  
Author(s):  
Jiro SUZUKI ◽  
Fumio OTSUKA ◽  
Kenichi INAGAKI ◽  
Hiroyuki OTANI ◽  
Tomoko MIYOSHI ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Adrenal Adenoma ◽  
Cortisol Secretion ◽  
Autonomous Cortisol Secretion

CLINICAL CHALLENGES FOR ANESTHESIOLOGIST FACING PATIENT WITH ACROMEGALY. CASE REPORT

2020 ◽  
Vol 30 (3) ◽  
pp. 56-59
Author(s):  
Jūratė Gudaitytė ◽  
Justina Jermolajevaitė ◽  
Martynas Judickas
Keyword(s):  
Atrial Fibrillation ◽  
Case Report ◽  
General Population ◽  
Metabolic Disorders ◽  
Upper Airway ◽  
Cardiovascular Complications ◽  
Case Presentation ◽  
Increased Risk ◽  
Fluid Regulation ◽  
Class Iv

Background and objectives: Acromegaly is endocri­nal disorder which results in changes involving ge­neral appearance as well as upper airway abnorma­lities, cardiovascular and metabolic disorders which can aggravate the anesthesia and can lead to compli­cations. We aim to discuss the challenges for anesthe­siologist that occurs facing patient with acromegaly and are necessary to investigate before performing any kind of intervention. Case Presentation: 79 years old male patient presen­ted the hospital with recently diagnosed acromegaly for rectal prolapse surgery. From anamnesis he had NYHAIII with cardiomyopathy, atrial fibrillation and arterial hypertension, also multiple old compressive fractures Th10 – L5. He was graded with Mallam­pati score IV and ASA class IV. The complemen­tary examinations were made to assess the possible complications. In induction of general anesthesia the intubation was performed using fibro- bronchoscope and anesthesia went without complications except hypotension which was managed. After surgery the patient was leaded to the postoperative room for furt­her monitoring. Discussion and Conclusion: Acromegalic patients have an increased risk of difficulty during anesthe­sia compared to general population due to difficult intubation, cardiovascular complications , OSA , alte­ration in intraoperative glucose intolerance and fluid regulation. Therefore profound investigation and as­sessment are necessary to predict and prepare for possible difficulties in the surgery room.

scholarly journals Cardiovascular events and all-cause mortality in surgically or medically treated primary aldosteronism: A Meta-analysis

2021 ◽  
Vol 22 (1) ◽  
pp. 147032032110037
Author(s):  
Ying Jing ◽  
Kangla Liao ◽  
Ruolin Li ◽  
Shumin Yang ◽  
Ying Song ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Primary Aldosteronism ◽  
Cardiovascular Events ◽  
Meta Analysis ◽  
Elevated Risk ◽  
Cochrane Library ◽  
Mineralocorticoid Receptor Antagonist ◽  
Primary Endpoints ◽  
All Cause Mortality ◽  
Reduced Risk

Objectives: To compare the effect of surgical or medical treatment on the risk of cardiovascular diseases (CVD) and all-cause mortality in patients with established primary aldosteronism (PA). Methods: We searched PUBMED, MEDLINE and Cochrane Library for the meta-analysis. We included patients who were diagnosed with PA following guideline-supported protocols and received surgery or mineralocorticoid receptor antagonist (MRA)-based medical treatment, and age-sex matched patients with treated essential hypertension (EH). Primary endpoints were CVD incidence and all-cause mortality. Results: Compared with EH, patients with treated PA had a higher risk of CVD [odds ratio (OR) 1.79; 95% confidence interval (CI) 1.39–2.31]. This elevated risk was only observed in patients with medically treated PA [OR 2.11; 95%CI 1.88–2.38] but not in those with surgically treated PA. The risk of all-cause mortality was significantly lower in patients with treated PA [OR 0.86; 95% CI 0.77–0.95] compared to EH. The reduced risk was only observed in patients with surgically treated PA [OR 0.47; 95% CI 0.34–0.66], but not in those with medically treated PA. Conclusions: Patients with medically treated PA have a higher risk of CVD compared to patients with EH. Surgical treatment of PA reduces the risk of CVD and all-cause mortality in patients with PA.

Cardiovascular complications of mild autonomous cortisol secretion

2021 ◽  
pp. 101494
Author(s):  
Carmen Aresta ◽  
Vittoria Favero ◽  
Valentina Morelli ◽  
Luca Giovanelli ◽  
Chiara Parazzoli ◽  
...  
Keyword(s):  
Cardiovascular Complications ◽  
Cortisol Secretion ◽  
Autonomous Cortisol Secretion

scholarly journals Comparison of biomarkers of endothelial dysfunction and microvascular endothelial function in patients with primary aldosteronism and essential hypertension

2021 ◽  
Vol 22 (1) ◽  
pp. 147032032199949
Author(s):  
Miaomiao Sang ◽  
Yu Fu ◽  
Chenmin Wei ◽  
Jing Yang ◽  
Xueting Qiu ◽  
...  
Keyword(s):  
Essential Hypertension ◽  
Endothelial Dysfunction ◽  
Endothelial Function ◽  
Primary Aldosteronism ◽  
Cardiovascular Events ◽  
Statistical Significance ◽  
Enzyme Linked Immunosorbent Assay ◽  
Microvascular Endothelial ◽  
Pai 1 ◽  
Microvascular Endothelial Function

Introduction: Studies have shown that primary aldosteronism (PA) has a higher risk of cardiovascular events than essential hypertension (EH). Endothelial dysfunction is an independent predictor of cardiovascular events. Whether PA and EH differ in the endothelial dysfunction is uncertain. Our study was designed to investigate the levels of biomarkers of endothelial dysfunction (Asymmetric dimethylarginine, ADMA; E-selectin, and Plasminogen activator inhibitor-1, PAI-1) and assess the microvascular endothelial function in patients with PA and EH, respectively. Methods: The biomarkers of endothelial dysfunction were measured by enzyme-linked immunosorbent assay (ELISA). Microvascular endothelial function was evaluated by Pulse amplitude tonometry (PAT). Results: Thirty-one subjects with EH and 36 subjects with PA including 22 with aldosterone-producing adenoma (APA) and 14 with idiopathic hyperaldosteronism (IHA) were enrolled in our study. The ADMA levels among the three groups were different (APA 47.83 (27.50, 87.74) ng/ml vs EH 25.08 (22.44, 39.79) ng/ml vs IHA 26.00 (22.23, 33.75) ng/ml; p = 0.04), however, when the APA group was compared with EH and IHA group, there was no statistical significance (47.83 (27.50, 87.74) ng/ml vs 25.08 (22.44, 39.79) ng/ml for EH, p = 0.11; 47.83 (27.50, 87.74) ng/ml vs IHA 26.00 (33.75) ng/ml, p = 0.07). The results of ADMA levels are presented as Median (p25, p75). Whereas, levels of PAI-1 and E-selectin, microvascular endothelial function were not significantly different between PA and EH subjects. Conclusions: Our study shows no significant differences between PA and EH in terms of biomarkers of endothelial dysfunction and microvascular endothelial function. The microvascular endothelial function of PA and EH patients is comparable.

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