Roles of Clinical Criteria, Computed Tomography Scan, and Adrenal Vein Sampling in Differential Diagnosis of Primary Aldosteronism Subtypes

Mulatero, Paolo; Bertello, Chiara; Rossato, Denis; Mengozzi, Giulio; Milan, Alberto; Garrone, C; Giraudo, G.; Passarino, G; Garabello, Domenica; Verhovez, Andrea; Rabbia, Franco; Veglio, Franco

doi:10.1210/jc.2007-2055

Cited by 152 publications

(104 citation statements)

References 19 publications

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“…3 Our study revealed that hypokalemia was seen in only 22.2 percent of cardiovascular diseases patients whereas the recent studies carried out by Mulatero et al and E. BornFrontsberg et al revealed that hypokalemia was seen in more than 50% of cardiovascular diseases. 4 Hypokalemia is associated with decrease in myocardial membrane permeability resulting in arrhythmia and sudden cardiac arrest which is similar to our results. 5 It has been reported that hypokalemia is independently associated with severity of arrhythmias in patients with acute myocardial infarction, and chronic hypokalemia is not associated with higher incidence of intra operative dysrhythmias.…”

Section: Discussionsupporting

confidence: 92%

Association between hypokalemia and cardiovascular diseases among hospitalized patients in tertiary care teaching hospital in North Karnataka: a retrospective study

et al. 2017

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INTRODUCTIONGlobally millions of deaths are caused due to sudden cardiac arrest and these are elevated by interplay between substrate and triggering factors, of which hypokalemia in heart cell is the major risk factor.1 Hypokalemia refers to a condition in which concentration of potassium in blood is lower than 3.6 mmol/L.Causes of hypokalemia are: Depletion of potassium due to increased loss of potassium as well as decreased intake of potassium, potassium shift in case of administration of ABSTRACT Background: Potassium is an extremely crucial element in maintaining the normal charge between intracellular and extracellular space. Normal cellular function is maintained through potassium homeostasis. The normal range of plasma potassium is 3.5 to 5.1 mmol/L. The deviation both hypo and hyperkalaemia are associated with cardiovascular diseases especially cardiac arrhythmia. The objective was to study the association of hypokalaemia on cardiovascular diseases. Methods: During this one year of retrospective study socio-demographic profile of the patients were collected from the medical record section of hospital. The participants were grouped into four classes based on the serum potassium levels as, Group A: < 2 mmol/L, group B: 2-2.49 mmol/l, group C: 2.5 -2.9 mmol/L, group D: 3 -3.49 mmol/L and group E (control group) 3.5 to 5.1 mmol/L. The participants were also grouped as those suffering from cardiovascular diseases and those with non-cardiovascular diseases. Results: In our study 4818 records were categorized into 5 groups including control group. Males (61.35%) were slightly more than female (38.65%). The mean age group was 43±4 years. Results revealed that there was positive association between the sexes. Females were more commonly associated as compared to males. Hypokalaemia among cardiovascular diseases was only 22.2% as compared to non-cardiovascular diseases. The mean systolic (142±8) and diastolic Blood pressure (92±2) among cardiovascular diseases was slightly higher as compared with the noncardiovascular diseases. Conclusions: Hypokalaemia is significantly associated with myocardial infarction when compared with other disorders. Hypokalaemia was more commonly associated with cardiovascular diseases as compared with noncardiovascular diseases.

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Section: Discussionsupporting

confidence: 92%

Association between hypokalemia and cardiovascular diseases among hospitalized patients in tertiary care teaching hospital in North Karnataka: a retrospective study

et al. 2017

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“…However, it should be noted that, in our experience, patients with bilaterally normal appearance of the adrenal glands on computed tomography scanning are often associated with a very high probability of bilateral adrenal hyperplasia (95%). 20 A limitation of the present study is that the prevalence of FH-III has been based on the clinical phenotype. When the present article was in preparation, Choi et al 18 demonstrated the genetic cause determining FH-III as a mutation in the potassium channel KCNJ5.…”

Section: Discussionmentioning

confidence: 94%

“…20 Briefly, patients were screened using the serum aldosterone:plasma renin activity (PRA) ratio (ARR), and PA was confirmed using the intravenous saline load test. 21 All of the patients with confirmed PA underwent computed tomography scanning and AVS.…”

Section: Diagnosis Of Pamentioning

confidence: 99%

Prevalence and Characteristics of Familial Hyperaldosteronism

Mulatero¹,

Tizzani²,

Viola³

et al. 2011

Hypertension

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Abstract-Primary aldosteronism (PA) is the most frequent cause of secondary hypertension, and patients display an increased prevalence of cardiovascular events compared with essential hypertensives. To date, 3 familial forms of PA have been described and termed familial hyperaldosteronism types I, II, and III (FH-I to -III). The aim of this study was to investigate the prevalence and clinical characteristics of the 3 forms of FH in a large population of PA patients. Three-hundred consecutive PA patients diagnosed in our unit were tested by long-PCR of the CYP11B1/CYP11B2 hybrid gene that causes FH-I, and all of the available relatives of PA patients were screened to confirm or exclude PA and, thus, FH-II. Urinary 18-hydroxycortisol and 18-oxocortisol were measured in all of the familial PA patients. Two patients were diagnosed with FH-I (prevalence: 0.66%), as well as 21 of their relatives, and clinical phenotypes of the 2 affected families varied markedly. After exclusion of families who refused testing and those who were not informative, 199 families were investigated, of which 12 were diagnosed with FH-II (6%) and an additional 15 individuals had confirmed PA; clinical and biochemical phenotypes of FH-II families were not significantly different from sporadic PA patients. None of the families displayed a phenotype compatible with FH-III diagnosis. Our study demonstrates that familial forms of hyperaldosteronism are more frequent than previously expected and reinforces the recommendation of the Endocrine Society Guidelines to screen all first-degree hypertensive relatives of PA patients. (Hypertension. 2011; 58:797-803.)Key Words: familial hyperaldosteronism Ⅲ endocrine hypertension Ⅲ primary aldosteronism Ⅲ aldosterone P rimary aldosteronism (PA) is the most frequent cause of secondary hypertension; it accounts for 5% to 15% of hypertensives, depending on the severity of the disease.

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“…15 To date, proposed clinical prediction scores cannot replace AVS. [16][17][18][19][20] An interesting novel approach consists of the measurement of a selected steroid profile by mass spectrometry. 21,22 Nevertheless, additional diagnostic steps will be needed to localize potential APA.…”

Section: Hypertensionmentioning

confidence: 99%

Targeting CXCR4 (CXC Chemokine Receptor Type 4) for Molecular Imaging of Aldosterone-Producing Adenoma

Heinze¹,

Fuß²,

Mulatero³

et al. 2018

Hypertension

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Primary aldosteronism is the most frequent cause of secondary hypertension and is associated with increased morbidity and mortality compared with hypertensive controls. The central diagnostic challenge is the differentiation between bilateral and unilateral disease, which determines treatment options. Bilateral adrenal venous sampling, currently recommended for differential diagnosis, is an invasive procedure with several drawbacks, making it desirable to develop novel noninvasive diagnostic tools. When investigating the expression pattern of chemokine receptors by quantitative real-time polymerase chain reaction and immunohistochemistry, we observed high expression of CXCR4 (CXC chemokine receptor type 4) in aldosterone-producing tissue in normal adrenals, adjacent adrenal cortex from adrenocortical adenomas, and in aldosterone-producing adenomas (APA), correlating strongly with the expression of CYP11B2 (aldosterone synthase). In contrast, CXCR4 was not detected in the majority of nonfunctioning adenomas that are frequently found coincidently. The specific CXCR4 ligand 68Ga-pentixafor has recently been established as radiotracer for molecular imaging of CXCR4 expression and showed strong and specific binding to cryosections of APAs in our study. We further investigated 9 patients with primary aldosteronism because of APA by 68Ga-pentixafor–positron emission tomography. The tracer uptake was significantly higher on the side of increased adrenocortical aldosterone secretion in patients with APAs compared with patients investigated by 68Ga-pentixafor–positron emission tomography for other causes. Molecular imaging of aldosterone-producing tissue by a CXCR4-specific ligand may, therefore, be a highly promising tool for noninvasive characterization of patients with APAs.

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Roles of Clinical Criteria, Computed Tomography Scan, and Adrenal Vein Sampling in Differential Diagnosis of Primary Aldosteronism Subtypes

Abstract: This study underlines the central role of AVS in the subtype diagnosis of PA. The use of the clinical criteria to distinguish between APA and BAH did not display a satisfactory diagnostic power.

Cited by 152 publications

References 19 publications

Association between hypokalemia and cardiovascular diseases among hospitalized patients in tertiary care teaching hospital in North Karnataka: a retrospective study

Association between hypokalemia and cardiovascular diseases among hospitalized patients in tertiary care teaching hospital in North Karnataka: a retrospective study

Prevalence and Characteristics of Familial Hyperaldosteronism

Targeting CXCR4 (CXC Chemokine Receptor Type 4) for Molecular Imaging of Aldosterone-Producing Adenoma

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