Taiwan mini-frontier of primary aldosteronism: Updating detection and diagnosis

Chang, Chin Chen; Chen, Yingying; Lai, Tai‐Shuan; Zeng, Yi-Hong; Chen, Chung-Kuang; Tu, Kun-Hua; Lu, Ching‐Chu; Wu, Vin‐Cent; Er, Leay Kiaw

doi:10.1016/j.jfma.2020.08.001

Cited by 10 publications

(12 citation statements)

References 55 publications

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“…The classification of PA into subtypes was based on TAIAPI experience (2,19). IHA was diagnosed according to the following criteria: (a) evidence of bilateral diffuse enlargement on preoperative computed tomography (CT); (b) nonlateralization of aldosterone secretion during adrenal venous sampling; and (c) diffuse cell hyperplasia on biopsy of resected specimen in patients who underwent an operation.…”

Section: Classification Of Pa Subtypesmentioning

confidence: 99%

Evaluation of Abdominal Computed Tomography Scans for Differentiating the Discrepancies in Abdominal Adipose Tissue Between Two Major Subtypes of Primary Aldosteronism

et al. 2021

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The aim of this study was to analyze the differences in the distribution of abdominal adipose tissue between the two subtypes of primary aldosteronism (PA) using abdominal computed tomography. We retrospectively analyzed patients diagnosed as having essential hypertension (EH) or PA from the prospectively collected Taiwan Primary Aldosteronism Investigation (TAIPAI) database. Patients with PA were divided into the subgroups of idiopathic hyperaldosteronism (IHA) and unilateral aldosterone-producing adenoma (APA). Patients’ basic clinicodemographic data were collected, and a self-developed CT-based software program was used to quantify the abdominal adiposity indexes, including visceral adipose tissue (VAT) area, VAT ratio, waist circumference (WC), subcutaneous adipose tissue (SAT) area, and SAT ratio. We included 190 patients with EH and 436 patients with PA (238 with IHA and 198 with APA). The APA group had significantly lower abdominal adiposity indexes than the other groups. We also found negative correlations of aldosterone-to-renin ratio (ARR) with VAT area, VAT ratio, WC, and body mass index (BMI) in the APA group. After propensity score matching (which left 184 patients each in the IHA and APA groups), patients in the APA group still had significantly lower WC, SAT area, SAT ratio, and VAT ratio than those in the IHA group. Furthermore, logistic regression analysis indicated that lower probability of abdominal obesity was significantly related to patients with APA. Our data revealed that the distribution of abdominal adipose tissue was similar in patients with IHA and those with EH, but the abdominal adiposity indexes were significantly lower in patients with APA than in those with IHA and EH.

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Section: Classification Of Pa Subtypesmentioning

confidence: 99%

Evaluation of Abdominal Computed Tomography Scans for Differentiating the Discrepancies in Abdominal Adipose Tissue Between Two Major Subtypes of Primary Aldosteronism

et al. 2021

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Section: Discussionmentioning

confidence: 99%

“…We furthermore applied two semiquantitative parameters, ALR and CON, to predict postsurgical outcome which found that ALR and CON greater than the cutoff were significantly correlated with improvement of postsurgical outcome (9). In Taiwan mini-frontier of primary aldosteronism we suggested that NP-59 adrenal scintigraphy is an alternative method for lateralization when AVS is not available based on the above mentioned evidence (26). Recognition of KCNJ5 mutation in APAs by Choi et al in 2011 is the most tremendous progression to understand the pathophysiology of PA. KCNJ5 mutation altered the selectivity of encoding potassium channel which lead to cell membrane depolarization, influx of calcium ion and subsequent aldosterone production (6).…”

Section: Discussionmentioning

confidence: 99%

NP-59 Adrenal Scintigraphy as an Imaging Biomarker to Predict KCNJ5 Mutation in Primary Aldosteronism Patients

Yen

Peng

et al. 2021

Front. Endocrinol.

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PurposeSomatic KCNJ5 mutation occurs in half of unilateral primary aldosteronism (PA) and is associated with more severe phenotype. Mutation status can only be identified by tissue sample from adrenalectomy. NP-59 adrenal scintigraphy is a noninvasive functional study for disease activity assessment. This study aimed to evaluate the predictive value of NP-59 adrenal scintigraphy in somatic KCNJ5 mutation among PA patients who received adrenalectomy.MethodsSixty-two PA patients who had NP-59 adrenal scintigraphy before adrenalectomy with available KCNJ5 mutation status were included. Two semiquantitative parameters, adrenal to liver ratio (ALR) and lesion to contralateral ratio of bilateral adrenal glands (CON) derived from NP-59 adrenal scintigraphy, of mutated and wild-type patients were compared. Cutoff values calculated by receiver-operating characteristic (ROC) analysis were used as a predictor of KCNJ5 mutation.ResultsTwenty patients had KCNJ5 mutation and 42 patients were wild type. Patients harboring KCNJ5 mutation had both higher ALR and CON (p = 0.0031 and 0.0833, respectively) than wild-type patients. With ALR and CON cutoff of 2.10 and 1.95, the sensitivity and specificity to predict KCNJ5 mutation were 85%, 57% and 45%, 93%, respectively. Among 20 patients with KCNJ5 mutation, 16 showed G151R point mutation (KCNJ5- G151R) and 4 showed L168R point mutation (KCNJ5-L168R), which former one had significantly lower ALR (p=0.0471).ConclusionPA patients harboring somatic KCNJ5 mutation had significantly higher NP-59 uptake regarding to ALR and CON than those without mutation. APAs with KCNJ5-L168R point mutation showed significantly higher ALR than those with KCNJ5-G151R point mutation.

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“…Depending on comprehensive review of the prevalence of PA (Table 1 and 2), 15,21,22,24,25 we listed candidates for PA screening suggested as follows, based on three guidelines and consensus.…”

Section: Candidates Are Screened For Pa Based On Guidelines and Conse...mentioning

confidence: 99%

Who should be screened for primary aldosteronism? A comprehensive review of current evidence

Huang

Lin

et al. 2022

J of Clinical Hypertension

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Arterial hypertension is a major risk factor for cardiovascular disease. The prevalence of primary aldosteronism (PA) ranges from 5% to 10% in the general hypertensive population and is regarded as one of the most common causes of secondary hypertension.There are two major causes of PA: bilateral adrenal hyperplasia and aldosteroneproducing adenoma. The diagnosis of PA comprises screening, confirmatory testing, and subtype differentiation. The Endocrine Society Practice Guidelines for the diagnosis and treatment of PA recommends screening of patients at an increased risk of PA. These categories include patients with stage 2 and 3 hypertension, drug-resistant hypertension, hypertensive with spontaneous or diuretic-induced hypokalemia, hypertension with adrenal incidentaloma, hypertensive with a family history of early onsetThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

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Taiwan mini-frontier of primary aldosteronism: Updating detection and diagnosis

Cited by 10 publications

References 55 publications

Evaluation of Abdominal Computed Tomography Scans for Differentiating the Discrepancies in Abdominal Adipose Tissue Between Two Major Subtypes of Primary Aldosteronism

Evaluation of Abdominal Computed Tomography Scans for Differentiating the Discrepancies in Abdominal Adipose Tissue Between Two Major Subtypes of Primary Aldosteronism

NP-59 Adrenal Scintigraphy as an Imaging Biomarker to Predict KCNJ5 Mutation in Primary Aldosteronism Patients

Who should be screened for primary aldosteronism? A comprehensive review of current evidence

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