Diverse pathological lesions of primary aldosteronism and their clinical significance.
Adrenal venous sampling
Aldosterone
Primary aldosteronism
Journal
Hypertension research : official journal of the Japanese Society of Hypertension
ISSN: 1348-4214
Titre abrégé: Hypertens Res
Pays: England
ID NLM: 9307690
Informations de publication
Date de publication:
05 2021
05 2021
Historique:
received:
11
05
2020
accepted:
01
10
2020
revised:
29
09
2020
pubmed:
14
1
2021
medline:
28
12
2021
entrez:
13
1
2021
Statut:
ppublish
Résumé
Primary aldosteronism (PA) is mainly clinically classified as unilateral aldosterone-producing adenoma (APA) or bilateral idiopathic hyperaldosteronism. Immunohistochemistry for aldosterone synthase reveals a diverse PA pathology, including pathological APA and aldosterone-producing cell clusters. The relationship between PA pathology and adrenalectomy outcomes was examined herein. Data from 219 unilaterally adrenalectomized PA cases were analyzed. Pathological analyses revealed diverse putative aldosterone-producing lesions. Postoperative biochemical outcomes in 114 cases (test cohort) were classified as complete success (n = 85), partial success (n = 19), and absent success (n = 10). Outcomes in the large and small PA lesion groups, rather than between PA lesion types, were compared at five threshold values for PA lesion sizes (2-6 mm with 1-mm increments) to streamline the results. The proportion of complete success was significantly higher in the large PA lesion group than in the small PA lesion group at the 5-mm threshold only. The proportion of absent success was significantly higher in the small PA lesion group than in the large PA lesion group at all thresholds. Univariate and multivariate analyses of the test cohort identified serum K as an independent predictive factor for the small PA lesion group, which was confirmed in the 105-case validation cohort. Chi-squared automatic interaction detector analysis revealed that the best threshold of serum K for predicting large PA lesions was 2.82 mEq/L. These results will be beneficial for treating PA in clinical settings because patients with low serum K levels and apparent adrenal masses on CT may be subjected to adrenalectomy even if the adrenal venous sampling test is unavailable.
Identifiants
pubmed: 33437027
doi: 10.1038/s41440-020-00579-w
pii: 10.1038/s41440-020-00579-w
pmc: PMC8099725
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
498-507Investigateurs
Takuyuki Katabami
(T)
Hisashi Fukuda
(H)
Yasushi Tanaka
(Y)
Yoshiyu Takeda
(Y)
Isao Kurihara
(I)
Hiroshi Itoh
(H)
Hironobu Umakoshi
(H)
Mika Tsuiki
(M)
Takamasa Ichijo
(T)
Norio Wada
(N)
Yui Shibayama
(Y)
Takanobu Yoshimoto
(T)
Yoshihiro Ogawa
(Y)
Junji Kawashima
(J)
Masakatsu Sone
(M)
Nobuya Inagaki
(N)
Katsutoshi Takahashi
(K)
Megumi Fujita
(M)
Minemori Watanabe
(M)
Yuichi Matsuda
(Y)
Hiroki Kobayashi
(H)
Hirotaka Shibata
(H)
Kohei Kamemura
(K)
Michio Otsuki
(M)
Yuichi Fujii
(Y)
Hiromi Rakugi
(H)
Koichi Yamamoto
(K)
Atsushi Ogo
(A)
Shintaro Okamura
(S)
Shozo Miyauchi
(S)
Toshihiko Yanase
(T)
Tomoko Suzuki
(T)
Takashi Kawamura
(T)
Mitsuhide Naruse
(M)
Tomikazu Fukuoka
(T)
Tatsuya Kai
(T)
Shoichiro Izawa
(S)
Yuichiro Yoshikawa
(Y)
Shigeatsu Hashimoto
(S)
Masanobu Yamada
(M)
Ryuichi Sakamoto
(R)
Chiba Yoshiro
(C)
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