scholarly journals Bilateral adrenal hyperplasia; a common cause of drug-refractory hypertension yet amenable to medical treatment

2020 ◽  
Vol 10 (1-s) ◽  
pp. 79-82
Author(s):  
El-Reshaid Kamel ◽  
Shaikha Al-Bader
Keyword(s):  
Clinical Laboratory ◽  
Antihypertensive Drugs ◽  
Adrenal Adenoma ◽  
Adrenal Hyperplasia ◽  
Refractory Hypertension ◽  
Endocrine Disease ◽  
The Past ◽  
R Ratio ◽  
Daily Dose ◽  
Bilateral Adrenal Hyperplasia

Over the past 4 and 1/2 years, a total of 97 patients had hypertension yet lacked clinical, laboratory and radiological evidence of renal, renovascular and endocrine disease were investigated for A/R ratio.  High A/R was detected in 30 patients.  Five patients had unilateral adrenal adenoma and 1 had cancer while 24 patients (24.7%) had bilateral enlargements indicating bilateral adrenal hyperplasia (BAH).  Our study has shown that BAH is: (a) easily diagnosed with a combination of A/R ratio and CT scan of the adrenal gland, (b) responsible for 24.7% of hypertension cases, (c) associated with moderate to severe hypertension that may require 2-4 antihypertensives, (d) associated with hypokalemia in only in 54% of the cases, (e) not controlled with a single daily dose of Spironolactone (S) and ½ the cases require 50 mg/day.   Moreover, it has shown that S treatment was not associated with significant hyperkalemia yet gynecomastia and erectile dysfunction were common side effects.  Interestingly; and despite normalization of A/R ratio, most patients continue to require antihypertensive drugs though the number and dosage were less.  The latter phenomenon was more evident in those with higher initial A/R ratio and longer duration of hypertension.  Nephroangiosclerosis is the most plausible explanation for it.  In conclusion; BAH is not a rare disease and should be considered in cases of refractory hypertension.  Keywords: Aldosterone, Aldosterone/Renin ratio, hypertension, Spironolactone.

scholarly journals Predictive Value of Preoperative Tests in Discriminating Bilateral Adrenal Hyperplasia from an Aldosterone-Producing Adrenal Adenoma

2000 ◽  
Vol 85 (12) ◽  
pp. 4526-4533 ◽  
Author(s):  
John L. Phillips ◽  
McClellan M. Walther ◽  
John C. Pezzullo ◽  
Walter Rayford ◽  
Peter L. Choyke ◽  
...  
Keyword(s):  
Predictive Value ◽  
Adrenal Adenoma ◽  
Adrenal Hyperplasia ◽  
Bilateral Adrenal Hyperplasia

scholarly journals A Case of Primary Aldosteronism due to Bilateral Adrenal Hyperplasia with Hidden Undiagnosed Adrenal Adenoma for Eight Years

1996 ◽  
Vol 19 (1) ◽  
pp. 47
Author(s):  
Seock Ah Im ◽  
Eun Mi Nam ◽  
Si Hoon Park ◽  
Gil Ja Shin ◽  
Woo Hyung Lee ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Adrenal Adenoma ◽  
Adrenal Hyperplasia ◽  
Bilateral Adrenal Hyperplasia

scholarly journals MANAGEMENT OF ENDOCRINE DISEASE: Differential diagnosis, investigation and therapy of bilateral adrenal incidentalomas

2018 ◽  
Vol 179 (2) ◽  
pp. R57-R67 ◽  
Author(s):  
Isabelle Bourdeau ◽  
Nada El Ghorayeb ◽  
Nadia Gagnon ◽  
André Lacroix
Keyword(s):  
Differential Diagnosis ◽  
Hormone Secretion ◽  
Adrenal Incidentalomas ◽  
Adrenal Hyperplasia ◽  
Acth Secretion ◽  
Ectopic Acth ◽  
Ectopic Acth Secretion ◽  
Endocrine Disease ◽  
Bilateral Adrenal Hyperplasia ◽  
Hormonal Evaluation

The investigation and management of unilateral adrenal incidentalomas have been extensively considered in the last decades. While bilateral adrenal incidentalomas represent about 15% of adrenal incidentalomas (AIs), they have been less frequently discussed. The differential diagnosis of bilateral incidentalomas includes metastasis, primary bilateral macronodular adrenal hyperplasia and bilateral cortical adenomas. Less frequent etiologies are bilateral pheochromocytomas, congenital adrenal hyperplasia (CAH), Cushing’s disease or ectopic ACTH secretion with secondary bilateral adrenal hyperplasia, primary malignancies, myelolipomas, infections or hemorrhage. The investigation of bilateral incidentalomas includes the same hormonal evaluation to exclude excess hormone secretion as recommended in unilateral AI, but diagnosis of CAH and adrenal insufficiency should also be excluded. This review is focused on the differential diagnosis, investigation and treatment of bilateral AIs.

scholarly journals Long-term Outcomes of Unilateral Adrenalectomy in Patients with Dominant-side Adrenal Hyperplasia

2017 ◽  
Vol 9 (2) ◽  
pp. 37-40
Author(s):  
Haim Paran, ◽  
Guy Elad, ◽  
Sydney Benchetrit, ◽  
Igal Griton, ◽  
Ilana Haas, ◽  
...  
Keyword(s):  
Antihypertensive Drugs ◽  
Adrenal Adenoma ◽  
Adrenal Hyperplasia ◽  
Venous Sampling ◽  
Long Term Outcomes ◽  
Unilateral Adrenalectomy ◽  
Number Of Patients ◽  
Aldosterone Production ◽  
Dominant Side

ABSTRACT Introduction Usual treatment for patients with aldosterone-producing adrenal adenoma is adrenalectomy, whereas adrenal hyperplasia is generally treated medically. Selective adrenal venous sampling (AVS) has been adopted to differentiate between adenoma and hyperplasia. A previous ratio used in our institution for the diagnosis of adenoma proved to be too low. As a result, a disproportionate number of patients with a preoperative diagnosis of adenoma were operated and subsequently found to have hyperplasia. Materials and methods This prospective study evaluated the long-term outcomes of unilateral laparoscopic adrenalectomy in the setting of lateralizing aldosterone hypersecretion caused by adrenal hyperplasia. Results Twelve patients with unilateral excess aldosterone production due to hyperplasia underwent dominant side adrenalectomy. Long-term follow-up (mean 12 years) of these patients showed that blood pressure decreased from a mean of 163.4 ± 17.5/100 to 131.5 ± 9.7/80 mm Hg (p < 0.05), and the number of antihypertensive drugs decreased from 4.3 ± 0.7 to 2.2 ± 0.9 (p < 0.05). Mean potassium level increased from 3.7 to 4.2 mEq/L and the plasma aldosterone level decreased from 26.5 to 10.1 ng/dL. Conclusion Dominant side adrenalectomy in patients with primary aldosteronism (PA) due to hyperplasia results in long-term clinical improvement. This procedure should be considered in selected patients with lateralization confirmed by venous sampling. How to cite this article Paran H, Elad G, Benchetrit S, Griton I, Haas I, Yaslowitz O, Shmulevsky P. Long-term Outcomes of Unilateral Adrenalectomy in Patients with Dominant-side Adrenal Hyperplasia. World J Endoc Surg 2017;9(2):37-40.

scholarly journals Iatrogenic myxoedema madness following radioactive iodine ablation for Graves' disease, with a concurrent diagnosis of primary hyperaldosteronism

2015 ◽  
Vol 2015 ◽  
Author(s):  
V Larouche ◽  
L Snell ◽  
D V Morris
Keyword(s):  
Radioactive Iodine ◽  
Psychiatric Symptoms ◽  
Adrenal Adenoma ◽  
Primary Hyperaldosteronism ◽  
Graves Disease ◽  
List Type ◽  
Adrenal Hyperplasia ◽  
Bilateral Adrenal Hyperplasia ◽  
Acute Hypothyroidism ◽  
Radioactive Iodine Ablation

Summary Myxoedema madness was first described as a consequence of severe hypothyroidism in 1949. Most cases were secondary to long-standing untreated primary hypothyroidism. We present the first reported case of iatrogenic myxoedema madness following radioactive iodine ablation for Graves' disease, with a second concurrent diagnosis of primary hyperaldosteronism. A 29-year-old woman presented with severe hypothyroidism, a 1-week history of psychotic behaviour and paranoid delusions 3 months after treatment with radioactive iodine ablation for Graves' disease. Her psychiatric symptoms abated with levothyroxine replacement. She was concurrently found to be hypertensive and hypokalemic. Primary hyperaldosteronism from bilateral adrenal hyperplasia was diagnosed. This case report serves as a reminder that myxoedema madness can be a complication of acute hypothyroidism following radioactive iodine ablation of Graves' disease and that primary hyperaldosteronism may be associated with autoimmune hyperthyroidism. Learning points Psychosis (myxoedema madness) can present as a neuropsychiatric manifestation of acute hypothyroidism following radioactive iodine ablation of Graves' disease. Primary hyperaldosteronism may be caused by idiopathic bilateral adrenal hyperplasia even in the presence of an adrenal adenoma seen on imaging. Adrenal vein sampling is a useful tool for differentiating between a unilateral aldosterone-producing adenoma, which is managed surgically, and an idiopathic bilateral adrenal hyperplasia, which is managed medically. The management of autoimmune hyperthyroidism, iatrogenic hypothyroidism and primary hyperaldosteronism from bilateral idiopathic adrenal hyperplasia in patients planning pregnancy includes delaying pregnancy 6 months following radioactive iodine treatment and until patient is euthyroid for 3 months, using amiloride as opposed to spironolactone, controlling blood pressure with agents safe in pregnancy such as nifedipine and avoiding β blockers. Autoimmune hyperthyroidism and primary hyperaldosteronism rarely coexist; any underlying mechanism associating the two is still unclear.

scholarly journals Primary Aldosteronism: The Next Five Years

2017 ◽  
Vol 49 (12) ◽  
pp. 977-983 ◽  
Author(s):  
John Funder
Keyword(s):  
Primary Aldosteronism ◽  
Germline Mutations ◽  
Adrenal Hyperplasia ◽  
Bilateral Disease ◽  
The Past ◽  
Wide Range ◽  
Unilateral Disease ◽  
Bilateral Adrenal Hyperplasia ◽  
Aldosterone Producing Adenoma ◽  
Current Guidelines

AbstractThe management of primary aldosteronism is widely varied within various published guidelines, with very little in the way of data supporting the choice of one variation over others. Current estimates of prevalence are probably accurate for aldosterone producing adenoma, but fall very short of that for bilateral adrenal hyperplasia. Discovery at the level of basic science has proven illuminating over the past 6 years in terms of unilateral disease and both somatic and germline mutations, with much less focus on the much more common bilateral disease; Attempts at harmonization have begun – for example, criteria for complete/partial/absent cure after adrenalectomy for unilateral disease; again focus on bilateral disease is muted. A number of possibilities are suggested as agenda for active consideration and change, across a wide range of areas – referral patterns, screening, confirmation and lateralization, what will be needed is discussion and agreement, to fill the lacunae within the current guidelines. Those involved will want to change to make such an agenda possible.

Macronodular bilateral adrenal hyperplasia: diagnose the aberrant receptors and current aspects of treatment

2016 ◽  
Vol 18 (10) ◽  
pp. 29-33
Author(s):  
M.Yu. Yukina ◽  
◽  
N.F. Nuralieva ◽  
D.G. Beltsevich ◽  
E.A. Troshina ◽  
...  
Keyword(s):  
Adrenal Hyperplasia ◽  
Bilateral Adrenal Hyperplasia

scholarly journals Triangulating abuse liability assessment for flavoured cigar products using physiological, behavioural economic and subjective assessments: a within-subjects clinical laboratory protocol

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e023850
Author(s):  
Catherine S Wall ◽  
Rose S Bono ◽  
Rebecca C Lester ◽  
Cosima Hoetger ◽  
Thokozeni Lipato ◽  
...  
Keyword(s):  
Clinical Laboratory ◽  
Subjective Effects ◽  
Latin Square ◽  
Abuse Liability ◽  
Smoke Inhalation ◽  
Nicotine Concentration ◽  
The Past ◽  
The Usa ◽  
Behavioural Economic ◽  
Scientific Meetings

IntroductionIn the USA, Food and Drug Administration regulations prohibit the sale of flavoured cigarettes, with menthol being the exception. However, the manufacture, advertisement and sale of flavoured cigar products are permitted. Such flavourings influence positive perceptions of tobacco products and are linked to increased use. Flavourings may mask the taste of tobacco and enhance smoke inhalation, influencing toxicant exposure and abuse liability among novice tobacco users. Using clinical laboratory methods, this study investigates how flavour availability affects measures of abuse liability in young adult cigarette smokers. The specific aims are to evaluate the effect of cigar flavours on nicotine exposure, and behavioural and subjective measures of abuse liability.Methods and analysesParticipants (projected n=25) are healthy smokers of five or more cigarettes per day over the past 3 months, 18–25 years old, naive to cigar use (lifetime use of 50 or fewer cigar products and no more than 10 cigars smoked in the past 30 days) and without a desire to quit cigarette smoking in the next 30 days. Participants complete five laboratory sessions in a Latin square design with either their own brand cigarette or a session-specific Black & Mild cigar differing in flavour (apple, cream, original and wine). Participants are single-blinded to cigar flavours. Each session consists of two 10-puff smoking bouts (30 s interpuff interval) separated by 1 hour. Primary outcomes include saliva nicotine concentration, behavioural economic task performance and response to various questionnaire items assessing subjective effects predictive of abuse liability. Differences in outcomes across own brand cigarette and flavoured cigar conditions will be tested using linear mixed models.Ethics and disseminationThe Virginia Commonwealth University Institutional Review Board approved the study (VCU IRB: HM20007848). Dissemination channels for study findings include scientific journals, scientific meetings, and policy briefs.Trial registration numberNCT02937051.

scholarly journals Impact of hospitalization for checking medication adherence due to resistant and refractory hypertension suspicious on short and mid-term blood pressure control

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Pio-Abreu ◽  
F Trani-Ferreira ◽  
G.V Silva ◽  
L.A Bortolotto ◽  
L Drager
Keyword(s):  
Blood Pressure ◽  
Hospital Discharge ◽  
Outpatient Clinic ◽  
Antihypertensive Drugs ◽  
Outpatient Visit ◽  
Target Organ Damage ◽  
Refractory Hypertension ◽  
Gold Standard Method ◽  
Medication Intake

Abstract Background Resistant (HR) and refractory hypertension (HRef) are associated with increased cardiovascular events and target-organ damage. However, appropriate HR and HRef diagnosis require good drug adherence. In this context, the “gold standard” method for assessing adherence is supervised medication intake. However, it is not clear the real utility of supervised medication intake in clinical practice. Purpose To evaluate whether hospitalization for confirming anti-hypertensive adherence in patients with HR and HRef may impact blood pressure (BP) control after hospital discharge in patients with HR or HRef suspicious at a tertiary outpatient clinic. Methods We recruited consecutive patients with HR or HRef suspicious admitted to the Hospital for confirming treatment adherence. HR was defined as uncontrolled office BP (≥140 and/or ≥90mmHg) despite using ≥3 classes at optimal doses (one of them being diuretic) or controlled BP using ≥4 classes. HRef was defined as no BP control despite using ≥5 antihypertensive drugs. Patients with suspected HRef who did not meet the criteria but full field the HR definition were named HRNoRef. During hospitalization, all patients used low sodium diet and had supervised taking of prescribed drugs by the medical team aiming BP control. We defined not only the rate of adherence and HF/HRef status but also BP and number of antihypertensive drugs at hospital discharge and in the two first return outpatient's visits. Results We studied a total of 83 patients with suspected HR/HRef (age 53±14 years; 76% females; pre-hospitalization systolic and diastolic BP: 177±28 and 106±21mmHg, respectively). Of these, 68.7% (57 patients) had suspected HRef in the outpatient clinic. The average number of antihypertensive drugs on admission was 5.3±1.3 classes. After hospitalization, the overall frequency of HR fell to 80% (66 patients). The average number of antihypertensive drugs at hospital discharge as well as systolic and diastolic BP was 4.5±1.3 classes, 131±17mmHg and 80±12mmHg, respectively (p&lt;0.001 vs. pre-hospitalization for all comparisons). Among the HR types, HRef was confirmed in only 27 patients (32.5%). During the outpatient follow-up, the patients remained with lower number of antihypertensive drugs as well as lower systolic and diastolic BP at first outpatient visit (mean returned time: 2.1±1.7months) and second outpatient visit post-discharge (mean returned time 7.1±2.6months) as compared to pre-hospitalization data: First visit: 4.3±1.2 classes, systolic: 152±24mmHg, diastolic BP: 89±17mmHg; second visit: 4.5±1.3 classes, systolic: 150±26mmHg, diastolic BP: 89±15mmHg; (p&lt;0.001 vs. pre-hospitalization for all comparisons). Conclusion Supervised medication intake during hospitalization may help not only to define the HR and HRef status but also to have impact on the number of antihypertensive drugs and lower BP values at short and mid-term follow-up. Funding Acknowledgement Type of funding source: None

Sign in / Sign up

Export Citation Format

Share Document