scholarly journals Adrenocortical Causes of Hypertension

2011 ◽  
Vol 2011 ◽  
pp. 1-10 ◽  
Author(s):  
Andreas Moraitis ◽  
Constantine Stratakis
Keyword(s):  
Primary Aldosteronism ◽  
Secondary Hypertension ◽  
Common Cause ◽  
The Past ◽  
New Onset

Primary aldosteronism is the most common cause of secondary hypertension. In the past, screening for primary aldosteronism was offered only in patients with hypertension associated with hypokalemia. Recent studies showed that hypokalemia is seen in only 25% of the patients with primary aldosteronism, which has increased the prevalence of primary aldosteronism to 10–15% of all cases with new onset hypertension.

Clinicopathologic Correlates of Primary Aldosteronism

2015 ◽  
Vol 139 (7) ◽  
pp. 948-954 ◽  
Author(s):  
Kai Duan ◽  
Ozgur Mete
Keyword(s):  
Primary Aldosteronism ◽  
Molecular Basis ◽  
Clinical Presentation ◽  
Current Knowledge ◽  
Secondary Hypertension ◽  
The Past ◽  
Adrenocortical Adenomas ◽  
Cardiovascular Morbidity And Mortality ◽  
Common Clinical Presentation ◽  
Important Disease

Primary aldosteronism is the most common cause of secondary hypertension, incurring significant cardiovascular morbidity and mortality. Our understanding of this disease has evolved substantially during the past decade. Recently, the molecular basis of primary aldosteronism has begun to be unraveled, with the discovery of mutations in potassium channel (KCNJ5), ATPases (ATP1A1, ATP2B3), and calcium channel (CACNA1D), and aberrant Wnt/β-catenin signaling. The most recent data suggest that 95% of cases are sporadic, whereas 5% of cases are hereditary. Pathologic correlates of primary aldosteronism include adrenal cortical hyperplasia, adenoma, and carcinoma. Although the most common clinical presentation is bilateral adrenal cortical hyperplasia, this entity is usually treated medically. Therefore, in the setting of primary aldosteronism, surgical pathologists are most commonly exposed to adrenocortical adenomas and the odd occasional carcinoma. This review provides an update on the current knowledge of primary aldosteronism and discusses the clinicopathologic correlations of this important disease.

scholarly journals Recent Development toward the Next Clinical Practice of Primary Aldosteronism: A Literature Review

Biomedicines ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 310
Author(s):  
Yuta Tezuka ◽  
Yuto Yamazaki ◽  
Yasuhiro Nakamura ◽  
Hironobu Sasano ◽  
Fumitoshi Satoh
Keyword(s):  
Clinical Practice ◽  
Primary Aldosteronism ◽  
Diagnostic Procedures ◽  
Secondary Hypertension ◽  
Refractory Hypertension ◽  
Diagnostic Biomarkers ◽  
Histopathological Classification ◽  
Subtype Differentiation ◽  
Work Up

For the last seven decades, primary aldosteronism (PA) has been gradually recognized as a leading cause of secondary hypertension harboring increased risks of cardiovascular incidents compared to essential hypertension. Clinically, PA consists of two major subtypes, surgically curable and uncurable phenotypes, determined as unilateral or bilateral PA by adrenal venous sampling. In order to further optimize the treatment, surgery or medications, diagnostic procedures from screening to subtype differentiation is indispensable, while in the general clinical practice, the work-up rate is extremely low even in the patients with refractory hypertension because of the time-consuming and labor-intensive nature of the procedures. Therefore, a novel tool to simplify the diagnostic flow has been recently in enormous demand. In this review, we focus on recent progress in the following clinically important topics of PA: prevalence of PA and its subtypes, newly revealed histopathological classification of aldosterone-producing lesions, novel diagnostic biomarkers and prediction scores. More effective strategy to diagnose PA based on better understanding of its epidemiology and pathology should lead to early detection of PA and could decrease the cardiovascular and renal complications of the patients.

Asthma and Pneumomediastinum

PEDIATRICS ◽  
1985 ◽  
Vol 75 (5) ◽  
pp. 990-990
Author(s):  
ROBERT G. ZWERDLING
Keyword(s):  
Case Report ◽  
Childhood Asthma ◽  
Mediastinal Emphysema ◽  
Review Of The Literature ◽  
Common Cause ◽  
The Past ◽  
Treatable Condition

To the Editor.— Sturtz's case report and brief review of the literature on spontaneous mediastinal emphysema is interesting.1 However, he neglects to mention what is perhaps the most common cause of this condition in childhood—asthma. Indeed, reports of this complication have occurred over the past 130 years.2-4 Recognition of this fact often results in an understanding of the cause for the pneumomediastinum as well as tipping the clinician off to a possibly undiagnosed but readily treatable condition.

scholarly journals Pituitary injury and persistent hypofunction resulting from a peripartum non-hemorrhagic, vaso-occlusive event

2015 ◽  
Vol 2015 ◽  
Author(s):  
Anita Kuriya ◽  
David V Morris ◽  
Michael H Dahan
Keyword(s):  
Literature Review ◽  
Pituitary Gland ◽  
Dopamine Agonists ◽  
List Type ◽  
Fetal Demise ◽  
Common Cause ◽  
The Past ◽  
Vascular Accidents ◽  
Learning Points ◽  
Do So

Summary Cerebral vascular accidents are caused by vasospasm when induced by preeclampsia or by dopamine agonists. However, six arteries nourish the pituitary and prevent against vasospasm-induced damage, which up until now has not been thought to occur. Bromocriptine was used to arrest lactation in a 31-year-old with secondary amenorrhea following preeclampsia and fetal demise at 28 weeks gestation. Tests and history revealed panhypopituitarism not associated with hemorrhage or mass infarction but instead caused by vasospasm. The present study is the first report of pituitary damage from a non-hemorrhagic, vaso-occlusive event in the literature. In keeping with Sheehan's and Simon's syndromes, we have named pituitary damage resulting from vaso-occlusion as Dahan's syndrome, and a literature review suggests that it may be a common and previously overlooked disorder. Learning points Vasospasm can cause damage to the pituitary gland, although it was not previously believed to do so. Preeclampsia and the use of a dopamine agonist, particularly in the peripartum state, may trigger vasospasm. Vasospasm resulting from dopamine agonists may be a common cause of injury to the pituitary gland, and it may have been overlooked in the past.

scholarly journals Comparison of Clinical Features between Primary Aldosteronism and Essential Hypertension in Chinese Patients: A Case-Control Study

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Xiaoyu Huang ◽  
Shuang Yu ◽  
Huangmeng Xiao ◽  
Ling Pei ◽  
Yan Chen ◽  
...  
Keyword(s):  
Essential Hypertension ◽  
Insulin Secretion ◽  
Clinical Features ◽  
Primary Aldosteronism ◽  
Structural Damage ◽  
Case Control ◽  
Secondary Hypertension ◽  
Left Ventricular ◽  
Chinese Patients ◽  
Significant Difference

Primary aldosteronism (PA) is one of the most common forms of secondary hypertension. Recent studies suggest that, compared with essential hypertension (EH), PA presents more severe disorders of glycolipid metabolism and organ damages. This case-control retrospective study aimed to ascertain clinical features and metabolic parameters between Chinese patients of PA and EH. 174 PA patients and 174 matched EH patients were recruited. Their clinical features, biochemistry parameters, the ventricular septal thickness, and left ventricular mass index (LVMI) were compared. HOMA-β% and HOMA-IR were calculated to evaluate glucose metabolism. The results showed that there was no significant difference regarding BMI, waist-to-hip ratio, and blood pressure between the two groups. The blood potassium level was significantly lower in PA patients than those in EH patients. The abnormal glucose tolerance and the incidence of diabetes in the PA group were not significantly different from those in EH group, but the insulin secretion levels at 0 min and 30 min were significantly weaker than those in the EH group, and the HOMA-β% was also lower in the PA group than those in the EH group. Left ventricular structural abnormalities in PA patients were more severe than those in EH patients. Subtype analysis indicated that patient with aldosterone-producing adenoma (APA) has more serious hypokalemia and lower levels of HOMA-β% and HOMA-IR comparing to those in the idiopathic adrenal hyperplasia (IHA) patient. These findings demonstrated that PA patients showed more impaired insulin secretion function and more severe left ventricular structural damage compared with EH patients.

Abstract 12591: Impact of Aldosterone Producing Adenoma on Endothelial Function and Rho-Associated Kinase Activity in Patients With Primary Aldosteronism

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Takeshi Matsumoto ◽  
Yukihito Higashi ◽  
Nozomu Oda ◽  
Akimichi Iwamoto ◽  
Yumiko Iwamoto ◽  
...  
Keyword(s):  
Endothelial Dysfunction ◽  
Primary Aldosteronism ◽  
Vascular Function ◽  
Cardiovascular Events ◽  
Plasma Renin ◽  
Secondary Hypertension ◽  
Plasma Aldosterone Concentration ◽  
Significant Difference ◽  
Aldosterone Producing Adenoma ◽  
Rock Activity

Background: Hypertension is associated with endothelial dysfunction and activated Rho-associated kinases (ROCKs) activity. Primary aldosteronism (PA) is a most common cause of secondary hypertension. Recent studies have shown that risk of cardiovascular events is higher in patients with PA than in patients with essential hypertension (EH). However, there is little information on the relationship between subtype of PA and the grade of atherosclerosis. The purpose of this study was to evaluate the vascular function and ROCK activity in patients with PA. Methods: Vascular function, including flow-mediated vasodilation (FMD) and nitroglycerin-induced vasodilation, and ROCK activity in peripheral leukocytes were evaluated in 21 patients with aldosterone producing adenoma (APA) group (50.7±14.3 years, 9 males), 23 patients with idiopathic hyperaldosteronism (IHA) group (55.8±9.9 years, 12 males), and 33 age-, gender-, and blood pressure-matched EH group (54.9 ± 10.7 years, 18 males). Results: FMD was significantly lower in the APA group than in the IHA group and EH group (3.2±2.0% vs. 4.6±2.3% and 4.4±2.2%, P<0.05, respectively), whereas there was no significant difference in FMD between the IHA group and EH group. There was no significant difference in the response of nitroglycerine in three groups. ROCK activity was significantly higher in the APA group than in the IHA group and EH group (1.29±0.57 vs. 1.00±0.46 and 0.81±0.36, P<0.05 and P<0.001, respectively), whereas there was no significant difference in ROCK activity between the IHA group and EH group. FMD correlated with age (r=-0.31, P<0.01), brachial arterial diameter (r=-0.44, P<0.01), plasma aldosterone concentration (PAC) (r=-0.35, P<0.01) and plasma renin activity ratio (ARR) (r=-0.34, P<0.01). ROCK activity correlated with age (r=-0.24, P=0.04), PAC (r=0.33, P<0.01) and ARR (r=0.46, P<0.01). Conclusions: APA was associated with both endothelial dysfunction and increased ROCK activity compared with those in IHA and EH. These findings suggest that APA may have a higher risk of future cardiovascular events.

A PAncreatic cancer screening study in individuals with New-onset or DeteriOrating diabetes MEllitus (PANDOME study).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. TPS10607-TPS10607
Author(s):  
Richard C. Frank ◽  
Tammy Lo ◽  
Dugho Jin ◽  
Cornelius Ferreira ◽  
Ramanathan Seshadri ◽  
...  
Keyword(s):  
Blood Glucose ◽  
High Risk ◽  
Blood Donation ◽  
Early Stage ◽  
Fasting Blood Glucose ◽  
Tumor Board ◽  
The Past ◽  
Pancreatic Cancer Screening ◽  
Increased Risk ◽  
New Onset

TPS10607 Background: Pancreatic adenocarcinoma (PC) has a persistently high mortality as it presents in the advanced stages and has largely not benefited from the genomic and immunotherapeutic revolutions in oncology. Improvements in screening to detect early stage cancers are therefore urgently needed. Screening studies such as those from the International CAPS Consortium have demonstrated improved survivals in hereditary high risk individuals. In the sporadic population, individuals with new-onset diabetes (NOD) or long-standing deteriorating diabetes (DD) are at substantially increased risk of PC in the 12 months following these diagnoses and have been proposed as target populations for screening efforts. This trial will study the benefits of PC screening in the latter populations in a community setting. Methods: Individuals ≥ 50 years of age with either NOD or DD will be eligible. Criteria for NOD (within the past 12 months) include: fasting blood glucose ≥ 126 mg/dL, random blood glucose ≥ 200 mg/dL, or HbA1c ≥ 6.5%, with confirmed prior normal values. For those without prior glycemic values, a HbA1c ≥ 7.0% is required. Transition from pre-diabetes requires an increase in HgA1c of ≥ 0.5%. DD is defined by an increase in HbA1c of ≥ 2% within the past six months that is not associated with medication non-compliance or weight gain. Study participants will undergo every 6 months: evaluation by an APRN, testing for anxiety and depression and blood donation for biobanking purposes. High resolution MRI/MRCP with gadolinium will be performed at study entry and annually for 2 years. Images will be reviewed at a multi-disciplinary tumor board consisting of body-image certified radiologists, interventional gastroenterologists, hepatobiliary surgeons and medical oncologists. MRI results will be classified according to a novel PANC-RADS system. High-risk pancreatic findings will be further interrogated by endoscopic ultrasound (EUS). Study endpoints include detection rate of high-risk lesions, referrals for EUS and surgery and detection of incidental findings leading to unnecessary procedures. Adverse psychological impacts will be assessed through HADS testing. Target accrual: 500 patients within 3 years. Clinical trial information: NCT03937453 .

Ecocriticism extends its boundaries

2017 ◽  
Author(s):  
Peter Barry ◽  
William Welstead
Keyword(s):  
Climate Change ◽  
Social Science ◽  
Environmental Crisis ◽  
Literary Texts ◽  
Creative Arts ◽  
Environmental Humanities ◽  
Common Cause ◽  
The Past ◽  
Increasing Trend ◽  
Heritage Interpretation

This chapter maps out the richness of ecocriticism as it has extended its boundaries during the past decade from environmental literary texts to the wider environmental humanities. The still growing sense of environmental crisis and climate change is significantly influencing both creative methodologies and outputs, and critical responses, in the humanities and beyond. In particular, there is an increasing trend towards collaboration between the creative arts and the sciences, and between writers and artists in different media. At the same time, disciplines from social science and heritage interpretation are finding common cause with the creative arts. These themes are further explored in the introduction to subsequent chapters.

Risk of new-onset autoimmune diseases in primary aldosteronism

2019 ◽  
pp. 1
Author(s):  
Leay Kiaw Er ◽  
Likwang Chen ◽  
Yao-Chou Tsai ◽  
Yen-Hung Lin ◽  
Wei-Chieh Huang ◽  
...  
Keyword(s):  
Autoimmune Diseases ◽  
Primary Aldosteronism ◽  
New Onset
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