Distribution characteristics of plasma renin concentration in patients with aldosterone-producing adenoma / 中华内科杂志

Objective:To analyze the distribution characteristics of plasma renin concentration (PRC) in patients with aldosterone-producing adenoma (APA) and its impact on diagnosis.Methods:In this retrospective case series, clinical data from 200 patients with APA (80 men and 120 women; mean age 45.6 years) in the First Affiliated Hospital of Chongqing Medical University from November 2013 to January 2022 were evaluated. PRC was determined by automated chemiluminescence immunoassay. The distribution characteristics of PRC were analyzed, and 8.2 mU/L was used as the low renin cutoff to evaluate whether renin was suppressed.Results:The median PRC was 1.6 mU/L (range, 0.4-41.5 mU/L). There were 116 patients with APA with PRC of ≤2 mU/L, 41 patients with 2<PRC≤4 mU/L. PRC was not suppressed (PRC>8.2 mU/L) in 8.0% (16/200) of the patients with APA. And PRC was not suppressed in 2.5% (5/200) of the patients with APA, resulting in a primary aldosteronism negative screening outcome.Conclusions:Although most patients with APA have low PRC, there are a small number (8%) of patients whose PRC has not been fully suppressed, which can lead to missed diagnoses during primary aldosteronism screening. While primary aldosteronism is highly suspected, further investigations are required to determine the diagnosis, even if PRC is not fully suppressed at screening.

Preliminary study on the ability of 68Ga-Pentixafor PET/CT to differentiate between adrenal aldosterone-producing adenoma and nonfunctional adenoma / 中华内科杂志

Objective:To evaluate the ability of 68Ga-Pentixafor (nuclide ligand imaging agents for chemokine receptor 4) PET/CT to differentiate between aldosterone-producing adenoma (APA) and adrenal nonfunctional adenoma (NFA), and to assess how well this imaging method correlates with clinical features and postoperative outcomes. Methods:This was a cross-sectional study involving 73 APA and 12 NFA patients who received 68Ga-Pentixafor PET/CT imaging at Peking Union Medical College Hospital from August 2018 to October 2021. The receiver operating characteristic (ROC) curve was used to evaluate the differential value of visual analysis and the maximum standard uptake value (SUV max) of the focus on APA and NFA. The related factors of SUV max, and its predictive effect on postoperative outcomes were analyzed using Pearson or Spearman analysis and χ2 text. Results:68Ga-Pentixafor PET/CT imaging was positive in 64 APA patients (sensitivity=87.7%) and negative in all 12 NFA patients (specificity=100%). The area under the ROC curve with SUV max differentiating APA and NFA was 0.932 ( P<0.001). When the SUV max cut-off point was 6.23, the sensitivity was 80.8% and the specificity was 100%. The SUV max correlated positively with lesion size ( r=0.598) and aldosterone/renin activity ratio ( r=0.313) and correlated negatively with potassium level ( r=-0.286), renin activity ( r=-0.240) and age of diagnosis ( r=-0.273) (all P<0.05). Of the patients who underwent adrenalectomy and received more than 6 months of post-surgical follow-up, the clinical complete remission rate was higher for 68Ga-Pentixafor PET/CT imaging-positive patients than imaging-negative patients (24/39 vs. 0/4, P=0.031). Conclusions:68Ga-Pentixafor PET/CT is effective at differentiating between APA and NFA. The SUV max of 68Ga-Pentixafor PET/CT correlates with age at onset, lesion size, and the severity of clinical manifestations, and is able to predict postoperative outcomes.

A retrospective cohort study on the treatment outcome after Unilateral Adrenalectomy among patients with Aldosterone-Producing Adenoma at the University of Santo Tomas Hospital

Background@#Unilateral adrenalectomy is indicated for patients with unilateral primary aldosteronism resulting in normalization of hypokalemia and resolution of hypertension. This study aims to determine the proportion of patients with cure of hypertension and improvement of hypokalemia after unilateral adrenalectomy among patients with aldosterone-producing adenoma and assess the association of preoperative factors with these outcomes.@*Methods@#This is a retrospective cohort study among patients with aldosterone-producing adenoma who underwent unilateral adrenalectomy with at least one month follow-up after the operation. Patients were selected from admissions to the University of Santo Tomas Hospital from January 2008 to November 2018. The proportion of patients with cure of hypertension and resolution of hypokalemia were determined. Binary logistic regression was used to determine preoperative factors associated with these outcomes.@*Results@#Twenty-one patients were included in this study. Cure of hypertension was noted in 47.62% and 42.86% of patients within 24 hours of adrenalectomy and on follow-up, respectively. Improvement of hypokalemia was noted in 61.90% of patients within 24 hours of operation while all patients had improvement of hypokalemia on follow-up. Patients without preoperative hypokalemia were more likely to have cure of hypertension within 24 hours of adrenalectomy (OR=0.0250, p=0.005) and on follow-up (OR=0.0571, p=0.010).@*Conclusion@#Unilateral adrenalectomy results in improvement of hypertension and hypokalemia in the majority of patients with aldosterone-producing adenoma. Shorter duration of hypertension and absence of preoperative hypokalemia were significantly associated with cure of hypertension after unilateral adrenalectomy.

Bioinformatics analysis of key genes and its biofunction of aldosterone producing adenoma / 中华内分泌代谢杂志

Objective:To explore the key genes and its biological functions of aldosterone producing adenoma (APA) using bioinformatics analysis.Methods:Differentially expressed genes of APA were identified from two training datasets GSE60042 and GSE64957 in GEO database. Function and pathway enrichment analyses for differentially expressed genes were performed and transcriptional regulation network among these genes were determined. Hub genes were extracted by node analysis from the protein-protein interaction (PPI) network. The expression of key genes was verified by a testing dataset GSE8514. Receiver operating characteristic(ROC) curve analysis was applied to assess the diagnostic efficiency of key genes in APA. The biofunction of each key gene were determined by gene set enrichment analysis (GSEA).Results:A total of 68 differentially expressed genes, including 33 up-regulated genes and 35 down-regulated genes, were detected from the training datasets. These genes were mainly enriched in aldosterone biosynthetic process, calcium signaling pathway, serotonin receptor signaling pathway, transcriptional activator activity, and regulation of transcription. JUN and VDR were at the center of the transcriptional factor-gene network. Furthermore, we identified nine Hub genes from the PPI network. In testing dataset, CYP11B2 and VDR showed the higher expression, while JUN, NFKBIZ, EGR3, and KLF6 showed lower expression in APA (all P<0.05), and the value of area under ROC curve analysis was 0.936, 0.833, 0.953, 0.854, 0.868, and 0.929, respectively. GSEA indicated the alter of key genes in APA led to up-regulation of the steroid biosynthesis, cell adhesion molecules, immune cells signaling pathway, and complement and coagulation cascades [all normalized enrichment score (NES)>1.5, P<0.05], but down-regulation of the DNA replication, ribosome, and autophagy (all NES<-1.5, P<0.05). Conclusion:Results of bioinformatics indicate that JUN and VDR are key transcriptional factors, and CYP11B2, NFKBIZ, EGR3, and KLF6 are the key genes for APA, which are involved in the steroid biosynthesis, cell adhesion molecules, immune cells signaling pathway in APA.

Gold standard for primary aldosteronism subtype diagnosis: adrenal vein sampling / 中华内分泌外科杂志

Adrenal vein sampling (AVS),as the gold standard of subtype diagnosis for primary aldosteronism,can directly detect the hormone concentration in adrenal vein by adrenal vein cannulation.Adrenal tumor can be categorized into no function adenoma,adrenal carcinoma,aldosterone producing adenoma (APA),cortisol producing adenoma (CPA) and pheochromocytoma.Traditionally,peripheral blood hormone testing and image examination were performed to make functional diagnosis of adrenal tumor,which exhibits low specificity and sensitivity.On the contrary,AVS can help make a distinct lateralization diagnosis according the aldosterone concentration of each gland,even in the condition of bilateral adrenal tumor and early stage tumor,which is difficult to make functional lateralization diagnosis by traditional methods.AVS can be categorized into simultaneous sampiing and sequencing sampling,according to the order of sampling.According to using adrenocorticotropic hormone (ACTH) or not,AVS can be categorized into no stimulus sampling and post-stimulus sampling.

Primary culture and identification of cells from human aldosterone-producing adenoma / 基础医学与临床

Objective To establish the primary culture of aldosterone-producing adenoma cells. Methods The tumor tissue was digested by collagen type I and cultured in complete DMEM/F12 medium. Aldosterone concentra-tion in culture medium was detected by radioimmunoassay. The expression of aldosterone synthase in the culture cells was detected by immunofluorescence. Results Aldosterone-producing adenoma cells grew adherently in a round or approximately round shape. The cells were positively immunostained for aldosterone synthase. The aldoste-rone concentration in the culture medium at the 5th culture day was (30.0±8.9)nmol/L. During the primary cul-ture,aldosterone secretion was the strongest at the first day,and decreased afterwards. It kept stable from day 4 to 11. Conclusions We successfully established the primary culture of aldosterone-producing adenoma cells, which are important for the future studying on the mechanism and function of aldosterone-producing adenoma.

Rabdomiólisis por hipocalemia: manifestación atípica del síndrome de Conn / Rhabdomyolysis due to hypokalemia: an atypical manifestation of Conn's syndrome

Resumen La rabdomiólisis es una afección con espectro de manifestación amplio que puede cursar desde una enfermedad leve asintomática hasta complicaciones mortales por desequilibrio hidroelectrolítico, arritmias o lesión renal aguda. Se comunica el caso de una paciente de 35 años de edad, hipertensa, que ingresó por debilidad muscular posterior a un cuadro gastrointestinal. Tenía hipocalemia severa, elevación de creatincinasa, función renal conservada, hipocalcemia y alcalosis metabólica. Su evaluación integral culminó en el diagnóstico de hiperaldosteronismo primario secundario a un adenoma productor de aldosterona que fue removido de manera quirúrgica sin complicaciones. La manifestación del síndrome de Conn con rabdomiólisis por hipocalemia es excepcional porque la mayoría de los casos se diagnostican con normocalemia o hipocalemia leve a partir del protocolo de hipertensión secundaria. Es necesario un alto nivel de sospecha y evaluación integral para llegar al diagnóstico certero.

Abstract Rhabdomyolysis is a condition with a broad spectrum of presentation that can range from mild asymptomatic disease to fatal complications due to electrolyte imbalance, arrhythmias and/or acute renal injury. We report the case of a 35-year-old woman, hypertensive, who was admitted for muscle weakness following a gastrointestinal condition. Biochemically with severe hypokalemia, elevated creatinekinase, conserved renal function, hypocalcemia and metabolic alkalosis. Their comprehensive evaluation culminated in the diagnosis of primary hyperaldosteronism secondary to an aldosterone-producing adenoma which was surgically removed without complications. The presentation of Conn's syndrome with hypokalemia rhabdomyolysis is exceptional since most cases are diagnosed with normokalemia or mild hypokalemia from the secondary hypertension protocol. A high level of suspicion and integral evaluation are necessary to arrive at the correct diagnosis.

Adrenal sparing surgery compared with total adrenalectomy for aldosterone producing adenoma:A meta-analysis / 解放军医学杂志

Objective To compare the perioperative safety and curative effects oflaparoscopic adrenal sparing surgery (ASS) with laparoscopic total adrenalectomy (TA) for aldosterone producing adenoma (APA).Methods An online systematical retrieval was performed with Pubmed,ScienceDirect,Springerlink,the Cochrane library,CNKI and China Biology Medicine disc for clinical comparative studies published before May 2016,these studies reported the treatment of ASS/partial adrenalectomy (PA) versus TA for APA.The selected studies were applied to Revman 5.3 software for meta-analysis.The main contents were perioperative outcomes (operative time,intra-operative blood loss,and length of hospital stay) and postoperative efficacy (cure rate,partial response rate,inefficiency rate).Results A total of 9 clinical studies (3 English documents and 6 Chinese documents) with 1036 patients were included into the final analysis,among which 544 patients were assigned to ASS group and 492 in TA group.The analyzed results demonstrated no statistical significance between ASS group and TA group on operative time (WMD:-2.09min,95％CI:-9.86-5.67,P=0.60),length of hospital stay (WMD:-0.10d,95％CI:-0.32-0.12,P=0.36),intra-operative blood loss (WMD:1.13ml,95％CI:-8.86-11.12,P=0.82),cure rate (OR=l.07,95％CI:0.73-1.58,P=0.72),partial response rate (OR=0.85,95％CI:0.57-1.27,P=0.43) and inefficiency rate (OR=2.15,95％CI:0.32-14.34,P=0.43).Conclusion For surgical treatment of APA,ASS is technically safe,can achieve reliable postoperative efficacy and a similar therapeutic effect compared with TA,so deserves further application in clinical practice.

Hipertensión secundaria por hiperaldosteronismo primario / Secondary hypertension caused by primary hyperaldosteronism: a case report

El hiperaldosteronismo primario es la causa más frecuente de hipertensión de origen endocrino. El exceso de aldosterona se asocia a elevación de la presión arterial, hipokalemia, hiperglucemia e hipertrofa ventricular. La presencia de hipertensión arterial y niveles bajos de potasio en sangre, alertan al clínico a buscar una causa secundaria de hipertensión arterial. Se presenta el caso de un hombre de 39 años de edad con síndrome de Conn (hiperaldosteronismo primario por adenoma suprarrenal), con confrmación bioquímica e imagenológica y posterior cirugía exitosa (adrenalectomía unilateral). Se presenta el enfoque del paciente con sospecha de hiperaldosteronismo, la interpretación de las pruebas actuales en nuestro medio y su pronóstico.

Primary hyperaldosteronism is the most common cause of hypertension of endocrine origin. Aldosterone excess is associated with elevated blood pressure, hypokalemia, hyperglycemia and ventricular hypertrophy. The presence of arterial hypertension and low potassium levels in the blood alert the clinician to search for a secondary cause of arterial hypertension. We present the case of a 39 year old with Conn's syndrome (primary aldosteronism by adrenal adenoma), with biochemical and imagiological confrmation and subsequent successful surgery (unilateral adrenalectomy). We present the approach to patients with suspected hyperaldosteronism, interpretation of current tests in our environment and its prognosis.

The Detection Rate and Characteristics of Primary Aldosteronism in Hypertensive Patients / 天津医药

Objective To study the detection rate and characteristics of primary aldosteronism (PA) in patients with hypertension. Methods A total of 197 patients with hypertension were enrolled and underwent PA and other related exami-nation to exclude the secondary hypertension. Patients were divided into two groups: PA group and essential hypertension (EH) group. The upright position test, supine position test, captopril test, venous high sodium test, potassium concentration examination and adrenal CT scanning were detected in two groups. Values of blood aldosterone, renin activity and aldoste-rone to renin activity ratio (ARR) were detected in some patients. Results (1) In 197 hypertensive patients, 38 were diag-nosed as PA (19.29%), 13 were confirmed by pathology, (6 cases aldosterone-producing adenoma and 7 unilateral adrenal hyperplasia). (2) There were no significant differences in the history of hypertension and body mass index (BMI) between two groups. There were more male patients than female patients in both groups. (3) Compared with EH group, there were relative-ly young age of onset, higher levels of systolic and diastolic blood pressure in PA group, but the difference was not statistical-ly significant (P>0.05). The levels of blood aldosterone and ARR were significantly increased in upright position and supine position in PA group (P<0.01), but the blood level of renin activity was significantly decreased(P<0.01). There was no sig-nificant significance in blood potassium level between two groups. Conclusion There was a higher detection rate of PA in patients hospitalized with hypertension. The detection rate of aldosterone-producing adenoma was similar to that of unilater-al adrenal hyperplasia in patients with PA. The hypokalemia was uncommon.

Association of KCNJ5 gene missense mutations with aldosterone-producing adenoma and primary hyperaldosteronism / 中华内分泌代谢杂志

Objective This study is about to detect the KCNJ5 gene variations in aldosterone-producing adenoma (APA) with primary hyperaldosteronism (PA),and to investigate the association of the KCNJ5 gene missense mutations with APA and PA.Methods A total of 46 APA tumors and their clinical characteristics were collected from Hypertension Center of the People's Hospital of Xinjiang Uygur Autonomous Region,and all the tumors were confirmed by pathology.All the samples of the coding region segments of KCNJ5 were detected by PCR and direct DNA sequencing to compare the different missense mutations in the tumor cells and peripheral blood cells and to analyze the association between the genotype and phenotype.Results Three missense mutations were found in 46 patients with APA:c.451G ＞ C/A (p.G151R) (5/46),c.503T ＞ G (p.L168R) (4/46),c.830T ＞ A (p.S209T) (12/46).S209T,as an unreported somatic mutation was observed.There were no missense mutations detected in the peripheral blood.Sex,age,systolic blood pressure,diastolic blood pressure,duration of hypertension,plasma potassium,urine potassium,aldosterone,plasma renin activity,aldosterone,and plasma renin activity ratio,as well as the rate of positive family history were compared between the mutants and wild-types.Systolic blood pressure and plasma potassium level among G151 R,L168R,and S209T had statistical differences.Systolic blood pressure in G151R was significantly higher than the other two groups,while the plasma potassium level was significantly lower than the other groups.Conclusions Three missense mutations were found in 46 patients with APA.The subjects with mutations had more serious condition than those without mutations after comparing their clinical phenotype.Besides,other different subtypes may exist in PA.

Identification of the etiology of primary aldosteronism with adrenal vein sampling in patients with equivocal imaging findings / 中华内分泌代谢杂志

A group of 19 referred hypertensive patients were diagnosed to have primary aldosteronism(PA) with inconclusive computed tomography scan results.Adrenal vein sarmpling (AVS) was performed in all patients.AVS was successful in 16 cases but failed in 3 cases.According to the results of AVS and postoperative pathology,8 cases were diagnosed as aldosterone-producing adenoma (APA) and unilateral adrenal hyperplasia (UAH),and the other 8 cases were diagnosed as idiopathic hyperaldosteronism (IHA).In conclusion,AVS is one of the most crucial methods in typing diagnosis of PA.

Gender-related differences of clinical characteristics and vascular complications in patients with aldosterone-producing adenoma / 中华内分泌代谢杂志

Objective To study gender-related differences of clinical characteristics and vascular complications in patients with aldosterone-producing adenoma(APA).Method Consecutive 315 patients with APA confirmed by pathological diagnosis were included and the clinical features and vascular complications were compared based on gender.Results (1) Of the 315 patients with APA,female accounted for 52.7％ (166/315).Male patients with APA presented a higher BMI,compared with females [(25.4± 2.9) vs (24.1 ± 3.2) kg/m2,P＜0.01],and the history of smoking and drinking was more common in male patients.No significant difference was found in regard to the age,duration,hypokalemia,tumor size,and family history of hypertension between two groups (P＞0.05).(2) No significant difference was found in the prevalence of hypertension,duration of hypertension,blood pressure,and antihypertensive medieation between two groups.However,the patients with grade 3 hypertension tended to be more prevalent in males(P =0.08).(3) Serum aldosterone concentrations were similar in two groups,but 24 h urinary aldosterone showed an increased trend in male group (P =0.07).(4) The overall prevalences of cardiovascular (51.0％ vs 36.1％) and cerebrovascular (9.4％ vs 3.0％) complications were significantly higher in male group (P ＜ 0.05).Further analysis of cardiac events revealed significantly higher rates of left ventricular hypertrophy (23.5％ vs 13.9％) and arrhythmia (21.5％ vs 10.8％) in males (P＜0.05).However,no significant difference in the prevalence between two groups was found in regard to cerebral hemorrhage,infarction,and chronic renal insufficiency.(5) The fall of blood pressure and recovery from hypokalemia were comparable between males and females in two weeks after sugery.However,in the patients with persistent hypertension,the number of antihypertensive drugs used in males was greater than that in females and more male patients needed ≥ 2 types of antihypertensive drugs.Conclusion There were significant gender-related differences with regard to clinical features and vascular complications in patients with APA.

The advances of research on adrenal diseases from 2010 to 2012 / 中华内分泌代谢杂志

This article reviews the major advances of basal and clinical research on the adrenal diseases at home and abroad from 2010 to 2012.There are many advances including the diagnostic value of steroidogenic factor-1 in adrenal tumors,the pathogenesis and new diagnostic methods of aldosterone-producing adenoma,the treatment for severe ACTH-dependent Cushing's syndrome,approach to the patient with an adrenal incidentaloma and subclinical hypercortisolism,screening test for subclinical hypercortisolism in the patients with diabetes or osteoporosis,the characterization of macronodular adrenocortical hyperplasia of the zona reticularis,as well as genetic testing for pheochromocytoma and paragangliomas,etc.

Association of Polymorphisms in Angiotensin Ⅱ Receptor Genes with Aldosterone-producing Adenoma / 华中科技大学学报（医学）（英德文版）

This study examined the association of polymorphisms in angiotensin Ⅱ receptor genes (AT1R and AT2R) with the risk for aldosterone-producing adenoma (APA) in a Chinese Han population.Four polymorphisms including rs5182 (573T/C) in exon 4,rs5186 (1166A/C) in 3'-untranslated region (3'-UTR) in AT1R gene and rs5194 (2274G/A) in 3'-UTR,rs1403543 (1675G/A) in intron 1 in AT2R gene were detected in 148 APA patients and 192 normal subjects (serving as control) by using a MGB-Taqman probe.The distribution of genotypes of each locus was in accordance with Hardy-Weinberg Equilibrium (HWE) in the APA and control groups (P＞0.05).The allele A frequency at rs5194 was significantly higher in the APA group (0.49) than in the control group (0.35) (X2=12.08,P=0.001).Subjects with homozygotic genotype AA and heterozygotic genotype GA were at an increased risk for APA as compared to those with GG genotype (OR=2.66,95％ CI=1.45-4.87; OR=1.67,95％ CI=1.02-2.74).Furthermore,rs5194 single-nucleotide polymorphism (SNP) at AT2R gene was significantly associated with APA in additive (OR=1.64,95％ CI=1.21-2.20,P=0.001),dominant (OR=1.94,95％ CI=1.23-3.06,P=0.003),and recessive model (OR=2.01,95％ CI=1.17-3.45,P=0.01).It was concluded that rs5194 polymorphism at AT2R gene was associated with the risk for APA,which may constitute a genetic marker of APA.

A case of idiopathic hyperaldosteronism vs. bilateral aldosterone producing adenoma / 대한내과학회지

In most cases, primary aldosteronism is due to a unilateral adrenal adenoma or bilateral hyperplasia of the adrenal cortex. However, a few bilateral adrenal tumors have also been reported in primary aldosteronism. In such cases, it is important to differentiate bilateral aldosterone-producing adenomas from bilateral adrenal hyperplasia so as to develop the optimal treatment plan. We report a case of idiopathic hyperaldosteronism due to bilateral adrenal hyperplasia that could have been misdiagnosed as a bilateral aldosterone-producing adenoma. An adrenal CT scan revealed bilateral adrenal tumors (1.5 cm [right] and 3.6 cm [left] in diameter). Idiopathic hyperaldosteronism was properly diagnosed using a posture test and selective adrenal venous sampling.

Clinical analysis of primary hyperaldosteronism and predictive value of preoperative test for primary hyperaldosteronism / 中国医师进修杂志

Objective To evaluate the clinical feature of the aldosterone-producing adenoma(APA) and idiopathic hyperaldosteronism(IHA)in primary hyperaldosteronism.Methods Retrospectively analyzed clinical feaures of 76 patients with APA and 17 patients with IHA.Results (1)Compared with the patients with IHA,the patients with APA had higher plasma and urinary aldosterone,lower serum potassium.(2)Furosemide provocation test(FPT)in 48 patients with APA and 14 patients with IHA were carried out.It was found that the plasma aldosterone after FPT was increased or no changed in 27 patients with adenoma,and increased in the others.It was increased in all IHA patients.(3)The diagnostic accuracy rate of CT was 84.2% in 88 patients with computed tomography imaging(CT).Conclusion The anomalies of laboratory in patients with APA are more evidence than those of IHA.The results of FPT are overlapped in a considerable amount of APA and IHA.Now those with elevation of serum aldosterone after the FPT can not exclude the adenoma.The diagnostic accuracy rate can be improved according to FPT and CT.

Expression of aldosterone synthesis related enzyme and associated regulatory factor genes in aldosterone-producing adenoma / 上海第二医科大学学报

Objective To investigate the discrepancy of aldosterone synthesis process and potential regulation abnormality between aldosterone-producing adenoma(APA) and normal adrenal(NA) with microarray. Methods cRNA probes labelled with biotin were prepared from mRNA of APAs(APA group,n=10) or NAs(control group,n=7).The probes were hybridized with oligonucleotide microarray of target gene expression profile.Expression levels were read from the fluorescent intensity scanned.The difference of gene expression profile was analyzed by computer software.Differentially expressed genes were verified by real-time RT-PCR. Results Compared with control group,97 genes were up-regulated and 168 genes were down-regulated in APA group.In the genes related to steroid hormone synthesis,only CYP11B2 was significantly up-regulated.In the physiologic regulators of aldosterone synthesis,CYB5A,CYP17A1,DUSP1 and HMGCR were down-regulated,while RENBP and NR1H2 were up-regulated.As a key enzyme in the biosynthesis of cortisol,the expression of CYP17A1 gene was inhibited. Conclusion Among the aldosterone synthesis related enzyme and corresponding regulatory genes in APA,CYP11B2 may be a key synthetase,and the suppressed physiologic regulators of aldosterone synthesis may indicate the existence of neoplastic modulation.

Role of imaging diagnosis in surgical treatment of primary aldosteronism / 上海第二医科大学学报

Objective To evaluate the role of imaging diagnosis in surgical treatment of primary aldosteronism(PA). MethodsFrom Jan 1995 to Dec 2004,245 patients with PA were hospitalized in our hospital.Before the operations,all the patients underwent B-ultrasonography and CT scaning,240 received intravenous pyelography and 75 MRI.The preoperative imaging diagnosis were compared with the findings during the operations and postoperative pathologic results. Results Compared with the findings during the operations,the accuracy rates of localized diagnosis for PA with B-ultrasonography,CT scanning and MRI were 92.7%,98.2% and 90.4%,respectively.Compared with the postoperative pathologic results,the accuracy rates of qualitative diagnosis for aldosterone-producing adenoma(APA) with B-ultrasonography,CT scanning and MRI were 83.0%,90.7% and 72.2%,respectively. Conclusion The comprehensive imaging data are helpful in the localized diagnosis of PA.Correct preoperative qualitative diagnosis of APA is the key step for the surgical treatment for PA.

A Case Of Transient Hyporeninemic Hypoaldosteronism After Unilateral Adrenalrectomy for Aldosterone-Producing Adenoma / 대한내분비학회지

Primary aldosteronism is due to either a unilateral adrenal adenoma or bilateral hyperplasia of the adrenal cortex in most cases. A unilateral adrenalectomy in hypertensive and hypokalemic patients, with a well-documented adrenal adenoma, is usually followed by the correction of hypokalemia in all subjects, with the cure of hypertension in 60 to 87% of patients. Here, a unique case, in which a unilateral adrenalectomy for the removal of an adrenal adenoma was followed by severe hyperkalemia, low levels of plasma renin activity and serum aldosterone, suggestive of chronic suppression of the renin-aldosterone axis, is reported. In a follow-up Lasix stimulation test on the 70th day after surgery, the suppression of the renin-aldosterone axis was resolved, indicating the suppression was transient. Patients undergoing a unilateral adrenalectomy for an aldosterone-producing adenoma should be closely followed up to avoid severe hyperkalemia.