Primary Aldosteronism Combined With Preclinical Cushing's Syndrome in an Elderly Patient

Fujii, Hideki; Kamide, Kei; Miyake, Osamu; Abe, Toyofumi; Nagai, Michiko; Nakahama, Hajime; Horio, Takeshi; Takiuchi, Shin; Okuyama, Äkïhïko; Yutani, Chikao; Kawano, Yuhei

doi:10.1253/circj.69.1425

Cited by 18 publications

(16 citation statements)

References 6 publications

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“…186,187 Primary aldosteronism prevalence varies from 1% to 11%, increases according to hypertension severity, 188 and cross-sectional and prospective studies report primary aldosteronism in Ͼ10% of patients with hypertension, 189 with approximately 70% caused by adrenal adenomas. 190 The adenoma is usually unilateral and comprised of glomerulosa cells in the adrenal cortex.…”

Section: Primary Aldosteronismmentioning

confidence: 99%

ACCF/AHA 2011 Expert Consensus Document on Hypertension in the Elderly

et al. 2011

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Section: Primary Aldosteronismmentioning

confidence: 99%

ACCF/AHA 2011 Expert Consensus Document on Hypertension in the Elderly

et al. 2011

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“…Atrophy was also observed in 7 out of the 11 cases assumed to be NFA. The past few years have seen an increase in the number of reports of adrenocortical adenoma associated with preclinical CS identified in cases previously regarded as NFA (26,27). Cases 30, 32, 34, 36, and 37 showed low levels of plasma ACTH, loss of circadian rhythm or a significant isotope accumulation on an I 131 -aldosterol scintigram, providing the opportunity to correlate function with anatomic abnormalities (28).…”

Section: Discussionmentioning

confidence: 99%

Analysis of mRNA expression for steroidogenic enzymes in the remaining adrenal cortices attached to adrenocortical adenomas.

Shigematsu¹,

Nakagaki²,

Yamaguchi³

et al. 2008

European Journal of Endocrinology

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Design and methods:We have recently demonstrated that the adrenal cortices attached to aldosteroneproducing adenoma (APA) contained microscopic subcapsular micronodules suggestive of active aldosterone production. In this study, we used in situ hybridization to investigate the mRNA expression of steroidogenic enzymes in the adrenal cortices attached to cortisol-producing adenoma (CPA) and clinically silent adenoma (non-functioning adenoma; NFA), in addition to APA. Results: Microscopic subcapsular micronodules, which were several hundreds of micrometers in size and spheroid in shape, were observed in the cortices attached to CPA and NFA, as well as APA, at high frequency. Most of the cortical nodules in zona fasciculata to zona reticularis showed a suppressed steroidogenesis in the cortices attached to adenoma, but some expressed intensely all necessary steroidogenic enzyme mRNAs for cortisol synthesis. Conclusions: It is thus necessary to keep in mind, on the occasion of subtotal adrenalectomy, that lesions with the potential to later develop into functional adrenocortical nodules may be present in other parts of the ipsilateral or contralateral adrenal cortices.European Journal of Endocrinology 158 867-878

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“…Simultaneous autonomous overproduction of cortisol and aldosterone by an APA is increasingly recognized although still apparently uncommon (1,134,155,156,230,478). Because cortisol levels are used during AVS to judge success of adrenal venous cannulation and to correct for differences in dilution of adrenal with nonadrenal venous blood when assessing for lateralization, unilateral cortisol overproduction with contralateral suppression could confound the interpretation of AVS results (213).…”

Section: Importance Of Recognizing Concurrent Autonomous Cortisol mentioning

confidence: 99%

Primary Aldosteronism: Changing Definitions and New Concepts of Physiology and Pathophysiology Both Inside and Outside the Kidney

Stowasser

Gordon

2016

Physiological Reviews

128

134

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In the 60 years that have passed since the discovery of the mineralocorticoid hormone aldosterone, much has been learned about its synthesis (both adrenal and extraadrenal), regulation (by renin-angiotensin II, potassium, adrenocorticotrophin, and other factors), and effects (on both epithelial and nonepithelial tissues). Once thought to be rare, primary aldosteronism (PA, in which aldosterone secretion by the adrenal is excessive and autonomous of its principal regulator, angiotensin II) is now known to be the most common specifically treatable and potentially curable form of hypertension, with most patients lacking the clinical feature of hypokalemia, the presence of which was previously considered to be necessary to warrant further efforts towards confirming a diagnosis of PA. This, and the appreciation that aldosterone excess leads to adverse cardiovascular, renal, central nervous, and psychological effects, that are at least partly independent of its effects on blood pressure, have had a profound influence on raising clinical and research interest in PA. Such research on patients with PA has, in turn, furthered knowledge regarding aldosterone synthesis, regulation, and effects. This review summarizes current progress in our understanding of the physiology of aldosterone, and towards defining the causes (including genetic bases), epidemiology, outcomes, and clinical approaches to diagnostic workup (including screening, diagnostic confirmation, and subtype differentiation) and treatment of PA.

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Primary Aldosteronism Combined With Preclinical Cushing's Syndrome in an Elderly Patient

Cited by 18 publications

References 6 publications

ACCF/AHA 2011 Expert Consensus Document on Hypertension in the Elderly

ACCF/AHA 2011 Expert Consensus Document on Hypertension in the Elderly

Analysis of mRNA expression for steroidogenic enzymes in the remaining adrenal cortices attached to adrenocortical adenomas.

Primary Aldosteronism: Changing Definitions and New Concepts of Physiology and Pathophysiology Both Inside and Outside the Kidney

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