المؤلفون: Padraig T Donlon, Michael Conall Dennedy

المصدر: Current Opinion in Endocrinology, Diabetes, and Obesity

مصطلحات موضوعية: Ablation Techniques, medicine.medical_specialty, Adrenal disorder, Endocrinology, Diabetes and Metabolism, Thermal ablation, Adrenal Gland Diseases, Adrenal Gland Neoplasms, Cushing's syndrome, 030209 endocrinology & metabolism, 030204 cardiovascular system & hematology, 03 medical and health sciences, Therapeutic approach, 0302 clinical medicine, Endocrinology, Paraganglioma, Internal Medicine, medicine, adrenal adenoma, Humans, Radiation treatment planning, Microwaves, microwave thermal ablation, Radiofrequency Ablation, Nutrition and Dietetics, primary aldosteronism, business.industry, Adrenal gland, Adrenal tumours, Hyperthermia, Induced, medicine.disease, medicine.anatomical_structure, Clinical evidence, ADRENAL CORTEX AND MEDULLA: Edited by Irina Bancos and Diane Donegan, Radiology, business, adrenal tumour

الوصف: Purpose of review To summarise the emerging role of thermal ablation as a therapeutic modality in the management of functioning adrenal tumours and metastases to the adrenal gland. Recent findings Observational evidence has demonstrated the benefit of thermal ablation in (i) resolving adrenal endocrinopathy arising from benign adenomas, (ii) treating solitary metastases to the adrenal and (iii) controlling metastatic adrenocortical carcinoma and phaeochromocytoma/paraganglioma. Summary Microwave thermal ablation offers a promising, minimally invasive therapeutic modality for the management of functioning adrenocortical adenomas and adrenal metastases. Appropriate technological design, treatment planning and choice of imaging modality are necessary to overcome technical challenges associated with this emerging therapeutic approach.

URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::d2ad154471d256ad9f9a5d6a13211ba6
http://europepmc.org/articles/PMC8183491

المؤلفون: Adina F. Turcu, Yuta Tezuka

المصدر: Endocr Pract

مصطلحات موضوعية: medicine.medical_specialty, Adrenal disorder, Endocrinology, Diabetes and Metabolism, Urology, Angiotensin-Converting Enzyme Inhibitors, 030209 endocrinology & metabolism, Plasma renin activity, Article, Angiotensin Receptor Antagonists, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Endocrinology, Primary aldosteronism, Mineralocorticoid receptor, Interquartile range, Hyperaldosteronism, Renin, medicine, Humans, 030212 general & internal medicine, Aldosterone, Mineralocorticoid Receptor Antagonists, Retrospective Studies, business.industry, Retrospective cohort study, General Medicine, medicine.disease, Hypokalemia, chemistry, Hypertension, medicine.symptom, business

الوصف: Mineralocorticoid receptor antagonists (MRAs) are effective in patients with resistant hypertension and/or primary aldosteronism (PA). Screening for PA should ideally be conducted after stopping medications that might interfere with the renin-angiotensin-aldosterone system, but this is challenging in patients with recalcitrant hypertension or hypokalemia. Herein, we aimed to evaluate the impact of MRAs on PA screening in clinical practice.We conducted a retrospective cohort study of patients with hypertension who had plasma aldosterone and renin measurements before and after MRA use in a tertiary referral center, over 19 years.A total of 146 patients, 91 with PA, were included and followed for up to 18 months. Overall, both plasma renin and aldosterone increased after MRA initiation (from median, interquartile range: 0.5 [0.1, 0.8] to 1.2 [0.6, 4.8] ng/mL/hour and from 19.1 [12.9, 27.7] to 26.4 [17.1, 42.3] ng/dL, respectively; P.0001 for both), while the aldosterone/renin ratio (ARR) decreased from 40.3 (18.5, 102.7) to 23.1 (8.6, 58.7) ng/dL per ng/mL/hour (P.0001). Similar changes occurred irrespective of the MRA treatment duration and other antihypertensives used. Positive PA screening abrogation after MRA initiation was found in 45/94 (48%) patients. Conversely, 17% of patients had positive PA screening only after MRA treatment, mostly due to correction of hypokalemia. An initially positive screening test was more likely altered by high MRA doses and more likely persistent in patients with confirmed PA or taking beta-blockers.MRAs commonly reduce ARR and the proportion of positive PA screening results. When PA is suspected, screening should be repeated off MRAs.ACEI = angiotensin-converting enzyme inhibitor; ARB = angiotensin receptor blocker; ARR = aldosterone/renin ratio; DRC = direct renin concentration; MRA = mineralocorticoid receptor antagonist; PA = primary aldosteronism; PAC = plasma aldosterone concentration; PRA = plasma renin activity; RAAS = renin-angiotensin-aldosterone system.

URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::a7c958d438e409ea48b6e16aa962f212
https://doi.org/10.4158/ep-2020-0277

المؤلفون: Prasanna Santhanam, Stanley M Chen Cardenas

المصدر: Endocrine. 70:479-487

مصطلحات موضوعية: medicine.medical_specialty, Noninvasive imaging, medicine.diagnostic_test, Adrenal disorder, business.industry, Endocrinology, Diabetes and Metabolism, 030209 endocrinology & metabolism, Gold standard (test), Malignancy, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, Primary aldosteronism, Adrenal masses, Positron emission tomography, 030220 oncology & carcinogenesis, 11C-metomidate, medicine, Radiology, business

الوصف: Adrenal masses are commonly encountered in clinical practice, many of whom are incidental. Identifying malignancy, and excess hormone production is essential for appropriate management. Biochemical workup and imaging tests (dedicated adrenal CT and/or MRI) are used to determine the likelihood of excessive hormone function and malignancy, respectively. However, imaging cannot provide information about function and biochemical workup cannot localize the source. Furthermore, in primary aldosteronism, adrenal vein sampling, the gold standard for lateralization, has important limitations such as the technical expertise required, the elevated costs, and potential complications. Over the last decades, there has been a renewed interest in alternative noninvasive imaging techniques that provide information about adrenal function without the need for invasive procedures. In this review, we will evaluate the evidence and the potential role of 11C-metomidate as a promising positron emission tomography (PET) tracer in clinical practice. A review of the English literature for articles describing the use of the tracer 11C-metomidate in adrenal disorders. A total of 12 studies were included in the systematic review, which altogether addressed the use of 11C-metomidate in adrenal masses and the application of this tracer in primary aldosteronism. 11C-metomidate, a selective inhibitor of 11-β-hydroxylase, demonstrated a high specificity for adrenocortical tissue. In addition, 11C-metomidate is correlated with this enzyme activity making it a potentially useful PET tracer for the identification primary aldosteronism, in addition to detection of adrenocortical masses.

URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_________::29420e72b9a421af3ed5cd9131c3cb45
https://doi.org/10.1007/s12020-020-02474-3

المؤلفون: Kazutaka Nanba, William E. Rainey, Aaron M. Udager

المصدر: Frontiers in Endocrinology
Frontiers in Endocrinology, Vol 12 (2021)

مصطلحات موضوعية: 0301 basic medicine, Aldosterone synthase, Adrenal disorder, Endocrinology, Diabetes and Metabolism, DNA Mutational Analysis, Adrenal Gland Neoplasms, Adrenocorticotropic hormone, Review, 030204 cardiovascular system & hematology, Diseases of the endocrine glands. Clinical endocrinology, 03 medical and health sciences, chemistry.chemical_compound, Fixatives, 0302 clinical medicine, Primary aldosteronism, Germline mutation, Endocrinology, Formaldehyde, Hyperaldosteronism, Medicine, Cytochrome P-450 CYP11B2, Humans, somatic mutation, Aldosterone, primary aldosteronism, Paraffin Embedding, biology, business.industry, RC648-665, medicine.disease, Angiotensin II, CYP11B2, 030104 developmental biology, medicine.anatomical_structure, chemistry, Zona glomerulosa, immunohistochemistry, Mutation, biology.protein, Cancer research, next-generation sequencing, business

الوصف: Aldosterone production is physiologically under the control of circulating potassium and angiotensin II as well as adrenocorticotropic hormone and other secretagogues such as serotonin. The adrenal’s capacity to produce aldosterone relies heavily on the expression of a single enzyme, aldosterone synthase (CYP11B2). This enzyme carries out the final reactions in the synthesis of aldosterone and is expressed almost solely in the adrenal zona glomerulosa. From a disease standpoint, primary aldosteronism (PA) is the most common of all adrenal disorders. PA results from renin-independent adrenal expression of CYP11B2 and production of aldosterone. The major causes of PA are adrenal aldosterone-producing adenomas (APA) and adrenal idiopathic hyperaldosteronism. Our understanding of the genetic causes of APA has significantly improved through comprehensive genetic profiling with next-generation sequencing. Whole-exome sequencing has led to the discovery of mutations in six genes that cause renin-independent aldosterone production and thus PA. To facilitate broad-based prospective and retrospective studies of APA, recent technologic advancements have allowed the determination of tumor mutation status using formalin-fixed paraffin-embedded (FFPE) tissue sections. This approach has the advantages of providing ready access to archival samples and allowing CYP11B2 immunohistochemistry-guided capture of the exact tissue responsible for inappropriate aldosterone synthesis. Herein we review the methods and approaches that facilitate the use of adrenal FFPE material for DNA capture, sequencing, and mutation determination.

URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::6eae0c265368fce12e678bf2dab52fa5
http://europepmc.org/articles/PMC8276099

المؤلفون: Liann Abu Salman, Debbie L. Cohen

المصدر: Current opinion in endocrinology, diabetes, and obesity. 28(3)

مصطلحات موضوعية: Blood pressure control, medicine.medical_specialty, Adrenal disorder, Endocrinology, Diabetes and Metabolism, Adrenal Gland Diseases, Adrenal Gland Neoplasms, 030209 endocrinology & metabolism, Blood Pressure, Disease, 030204 cardiovascular system & hematology, urologic and male genital diseases, Pheochromocytoma, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, Primary aldosteronism, Hyperaldosteronism, Internal Medicine, medicine, Humans, Renal Insufficiency, Chronic, Intensive care medicine, Antihypertensive Agents, Nutrition and Dietetics, business.industry, medicine.disease, female genital diseases and pregnancy complications, Work-up, Hypertension, Adrenal hypertension, business, Kidney disease

الوصف: Purpose of review This review will focus on hypertension due to underlying adrenal disorders in chronic kidney disease (CKD). Diagnosis of adrenal hypertension and particularly primary aldosteronism (PA) in CKD is frequently not pursued. We outline limitations that advanced kidney disease poses on the diagnostic work up of these disorders and provide a framework for approaching CKD patients suspected of having an adrenal disorder. Recognition of these disorders is important as they are often underdiagnosed which leads to poorer outcomes. Recent findings Adrenal disease associated with hypertension in CKD is most commonly due to PA whereas pheochromocytoma and Cushing's disease are important but less common. Diagnosis of these diseases is important as their identification leads to better blood pressure control and can possibly mitigate the risk of progression of CKD. Work up and treatment of PA has been shown to be safe and is associated with less antihypertensive medication requirement for the associated hypertension and slower progression of CKD. Summary This chapter summarizes the importance of recognizing adrenal hypertension in CKD and reinforces the need for physicians to pursue these diagnoses in CKD patients as this is safe and improves both BP control and delays progression of CKD.

URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::95065cfb593cf0ef3dbd4c3fed6c1c67
https://pubmed.ncbi.nlm.nih.gov/33741779

المؤلفون: Yuta Tezuka, Adina F. Turcu

المصدر: Frontiers in Endocrinology, Vol 12 (2021)
Frontiers in Endocrinology

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, hypertension, adrenal cortex, Adrenal disorder, Endocrinology, Diabetes and Metabolism, Urology, adrenal disorders, 030209 endocrinology & metabolism, 030204 cardiovascular system & hematology, lcsh:Diseases of the endocrine glands. Clinical endocrinology, Young Adult, 03 medical and health sciences, chemistry.chemical_compound, mineralocorticoid receptor (MR) antagonist, Endocrinology, Sex Factors, 0302 clinical medicine, Primary aldosteronism, Mineralocorticoid receptor, Interquartile range, Hyperaldosteronism, Renin–angiotensin system, medicine, Humans, Original Research, Aged, Mineralocorticoid Receptor Antagonists, Retrospective Studies, Aged, 80 and over, Aldosterone, primary aldosteronism, aldosterone, lcsh:RC648-665, business.industry, Middle Aged, medicine.disease, Eplerenone, Treatment Outcome, adrenal, chemistry, renin, Spironolactone, Female, business, medicine.drug

الوصف: ObjectiveTo investigate how often target renin is pursued and achieved in patients with primary aldosteronism (PA) and other low renin hypertension (LRH) treated with mineralocorticoid receptor antagonists (MRAs), as reversal of renin suppression was shown to circumvent the enhanced cardiovascular and renal morbidity and mortality in these patients.Patients and MethodsWe conducted a retrospective cohort study of patients with PA and LRH treated with MRAs in an academic outpatient practice from January 1, 2000, through May 31, 2020.ResultsOf 30,777 patients with hypertension treated with MRAs, only 7.3% were evaluated for PA. 163 patients (123 with PA) had renin followed after MRA initiation. After a median follow-up of 124 [interquartile range, 65-335] days, 70 patients (43%) no longer had renin suppression at the last visit. The proportion of those who achieved target renin was higher in LRH than in PA (53% vs. 40%). Lower baseline serum potassium, lower MRA doses, and beta-blocker use were independently associated with lower odds of achieving target renin in PA, while male sex was associated with target renin in LRH. Overall, 50 patients (30.7%) had 55 adverse events, all from spironolactone, and 26 patients (52%) were switched to eplerenone or had a spironolactone dose reduction.ConclusionDespite evidence that reversal of renin suppression confers cardio-renal protection in patients with PA and LRH, renin targets are followed in very few and are achieved in under half of such patients seen in an academic setting, with possibly even lower rates in community practices.

URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::ac11fd7f973150a26a50d50be45dd770
https://www.frontiersin.org/articles/10.3389/fendo.2021.625457/full

المؤلفون: Hironobu Sasano, Yoshikiyo Ono, Yasuhiro Nakamura, Yuta Tezuka, Kei Omata, Yuto Yamazaki, Ryo Morimoto, Kazumasa Seiji, Akihiro Ito, Yoshihide Kawasaki, Kei Takase, Hideo Harigae, Fumitoshi Satoh

المصدر: Journal of the Endocrine Society

مصطلحات موضوعية: medicine.medical_specialty, Adrenal disorder, Endocrinology, Diabetes and Metabolism, 030209 endocrinology & metabolism, Case Report, Adrenocorticotropic hormone, Adrenocortical adenoma, 03 medical and health sciences, 0302 clinical medicine, Primary aldosteronism, Internal medicine, medicine, LC-MS/MS, primary aldosteronism, business.industry, Adrenal cortex, medicine.disease, Hyperaldosteronism, ACTH, Endocrinology, medicine.anatomical_structure, Sex steroid, 030220 oncology & carcinogenesis, estrogen-producing adrenocortical adenoma, business, adrenal venous sampling, Hormone

الوصف: Because of its rarity, our understanding of steroidogenesis in estrogen-producing adrenocortical adenoma, including the response to adrenocorticotropic hormone (ACTH) stimulation, remains limited. A 65-year-old man was referred to us because of primary aldosteronism and a right adrenal tumor. Endocrinological evaluations revealed secondary hypogonadism due to hyperestrogenemia. Adrenal venous sampling (AVS) and subsequent liquid chromatography–tandem mass spectrometry (LC-MS/MS) indicated bilateral hyperaldosteronism and a right estrogen-producing adrenocortical tumor. He subsequently underwent right unilateral adrenalectomy, which resulted in clinical remission of hypogonadism. Subsequent histopathological analysis identified a right estrogen-producing adrenocortical adenoma and multiple, concomitant adrenocortical micronodules. Sequential evaluation of steroid profiles using LC-MS/MS revealed unique hormone production, including adrenal androgens, and less responsiveness to ACTH in the right estrogen-producing adrenocortical adenoma as compared to the nonneoplastic adrenal cortex. This case study revealed unique profiles of steroid production in estrogen-producing adrenocortical adenoma associated with concomitant primary aldosteronism. Sequential steroid profiling analysis using LC-MS/MS in combination with AVS can contribute to the diagnosis of various adrenal disorders.

URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::6ecfcab7ea71b42faa0c630127300e46
http://europepmc.org/articles/PMC7031070

المؤلفون: Beom-Jun Kim, Jung Min Koh, Seung Hun Lee

المصدر: Endocrinology and Metabolism
Endocrinology and Metabolism, Vol 33, Iss 1, Pp 1-8 (2018)

مصطلحات موضوعية: 0301 basic medicine, Adrenal disorder, Endocrinology, Diabetes and Metabolism, Osteoporosis, 030209 endocrinology & metabolism, Pheochromocytoma, Bioinformatics, lcsh:Diseases of the endocrine glands. Clinical endocrinology, Bone remodeling, 03 medical and health sciences, Cushing syndrome, 0302 clinical medicine, Endocrinology, Primary aldosteronism, Hyperaldosteronism, medicine, lcsh:RC648-665, business.industry, medicine.disease, 030104 developmental biology, Fracture, Secondary osteoporosis, Namgok Lecture 2017, business

الوصف: Secondary osteoporosis resulting from specific clinical disorders may be potentially reversible, and thus continuous efforts to find and adequately treat the secondary causes of skeletal fragility are critical to ameliorate fracture risk and to avoid unnecessary treatment with anti-osteoporotic drugs. Among the hyperfunctional adrenal masses, Cushing's syndrome, pheochromocytoma, and primary aldosteronism are receiving particularly great attention due to their high morbidity and mortality mainly by increasing cardiovascular risk. Interestingly, there is accumulating experimental and clinical evidence that adrenal hormones may have direct detrimental effects on bone metabolism as well. Thus, the present review discusses the possibility of adrenal disorders, especially focusing on pheochromocytoma and primary aldosteronism, as secondary causes of osteoporosis.

URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::4fea3b0c8bab54112eedcb6623cc42bc
https://pubmed.ncbi.nlm.nih.gov/29589383

المؤلفون: Holger S. Willenberg

المصدر: Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme. 49(3)

مصطلحات موضوعية: medicine.medical_specialty, Hypertension, Renal, Adrenal disorder, Endocrinology, Diabetes and Metabolism, Clinical Biochemistry, MEDLINE, Secondary hypertension, 030209 endocrinology & metabolism, Disease, 030204 cardiovascular system & hematology, Sodium Chloride, Biochemistry, SALT RETENTION, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, Primary aldosteronism, Internal medicine, Health care, Hyperaldosteronism, medicine, Humans, Medical treatment, business.industry, Biochemistry (medical), Genetic Diseases, Inborn, General Medicine, medicine.disease, business

الوصف: The last years have seen substantial progress in primary aldosteronism (PA), which is the most common cause of secondary hypertension. Many programs have been established around the world to meet the needs in healthcare and the management of patients with PA according to published guidelines and clinical protocols. Systematic analysis of emerging data and meticulous scientific work have informed us on the molecular basis of the disease and helped to characterize hereditary forms of PA. Techniques have been developed to better diagnose PA and to establish genotype-phenotype relationships and their impact on hypertension. Studies have been undertaken to stratify patients for risk factors and to ensure quality of best medical treatment. This review focuses on some clinically relevant problems in characterizing autonomous aldosterone secretion and discusses testing and management strategies. Besides, this review puts the emphasis on some colorful studies not to pale soon beside an ever evolving painting background.

URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::fe3789f8f5947e1ce6d3064e597a1652
https://pubmed.ncbi.nlm.nih.gov/28351083

المؤلفون: Gregory A. Kline, Alex Chin

مصطلحات موضوعية: medicine.medical_specialty, Aldosterone, Adrenal disorder, business.industry, Adrenal cortex, 030209 endocrinology & metabolism, Adrenocortical hyperfunction, 030204 cardiovascular system & hematology, medicine.disease, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, medicine.anatomical_structure, Primary aldosteronism, Endocrinology, chemistry, Internal medicine, Addison's disease, Medicine, Congenital adrenal hyperplasia, business, Adrenal medulla

الوصف: Adrenal diseases may arise from either the steroidogenic adrenal cortex or catecholamine-producing adrenal medulla. Knowledge of steroidogenic and catecholamine biosynthetic pathways of formation and metabolism are critical for the understanding and diagnosis of many different potential functional disorders. The measurement and accurate differentiation between many steroid products of very similar structure is a critical task of the medical laboratory. Specific steroid immunoassays have significant limitations and the field of steroid measurement is rapidly evolving toward use of liquid chromatography/mass spectrometry methodology for higher precision than ever before. Diseases of adrenocortical hyperfunction such as primary cortisol or aldosterone excess represent common forms of resistant hypertension, whereas adrenocortical hypofunction from either pituitary injury or autoimmune adrenal destruction may be life threatening. Benign and malignant tumors of the adrenal may produce excessive amounts of either cortical or medullary hormones, each with a distinct phenotype. Congenital disorders of steroidogenesis may include abnormal production of reproductive steroids, resulting in a combination of adrenal dysfunction with disordered sexual development. This chapter presents a logically structured approach to the medical and biochemical features of all such diseases along with practical approaches to laboratory-supported clinical diagnosis.

URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_________::c4c67bba30acff668856f94b6969396d
https://doi.org/10.1016/b978-0-12-803412-5.00005-7