A ldosterone-producing adenomas (APAs) are responsible for ≈5% of hypertension and are probably its most common curable cause. 1 The heterogeneity of these tumors has been highlighted by the landmark discovery of somatic mutations of KCNJ5, followed by others in ATP2B3, ATP1A1, CACNA1D, and CTNNB1. [2][3][4][5] The genotype and histological features delineate 2 overlapping APA subtypes: the common, large KCNJ5 mutant APAs histology is usually similar to cortisol-producing zona fasciculata (ZF) and smaller APAs with other mutations are mainly composed of zona glomerulosa (ZG)-like compact, lipid-depleted cells.The 2 subtypes present other phenotypic differences: for instance, elevated secretion from an APA of hybrid steroids 18-hydroxycortisol and 18-oxocortisol could be considered a fingerprint of KCNJ5 mutation.6 Further differences about the response to aldosterone secretagogues, such as angiotensin II or metoclopramide, have been previously reported. 7,8 Dopamine is one of the main regulators of aldosterone secretion. 9 The 5 known dopamine receptors belong to the G-protein-coupled receptor superfamily and are classified into 2 major subgroups (D1-like and D2-like) according to their structure and opposite action on cAMP production. Activation of the D1-like subfamily members (D1R and D5R) causes an increase of intracellular cAMP levels. The D2-like subfamily includes D2R, D3R, and D4R receptors; their transduction of signal causes a reduction of cAMP production.
10In human adrenal, most attention has been paid to the D2R subtype. This is expressed in normal ZG and mediates dopamine inhibition of aldosterone response to angiotensin II (but not to adrenocorticotropic hormone or potassium) 11,12 and tonic