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primary aldosteronism due to bilateral micronodular hyperplasia and concomitant subclinical Cushing’s syndrome:A case report

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World Journal of Clinical Cases 2021年第5期9卷 1119-1126页

作者： Hiroki Teragawa Chikage Oshita Yuichi Orita Kunihiro Hashimoto Hirofumi Nakayama Yuto Yamazaki Hironobu Sasano Department of Cardiovascular Medicine JR Hiroshima HospitalHiroshima 732-0057Japan Department of Urology JR Hiroshima HospitalHiroshima 732-0057Japan Department of Pathology and Laboratory Medicine JR Hiroshima HospitalHiroshima 732-0057Japan Department of Pathology Tohoku University Graduate School of MedicineSendai 980-8574Japan

BACKGROUND Adrenal incidentaloma(AI)has been frequently encountered in the clinical *** has been shown that primary aldosteronism(PA)or subclinical Cushing’s syndrome(SCS)are the representative causative diseases of ***,the coexistence of PA and SCS has been reportedly ***,we encountered a case of AI,in which PA and SCS coexisted,confirmed by histopathological examinations after a laparoscopic *** believe that there were some clinical implications in the diagnosis of the present *** SUMMARY A 58-year-old man presented with lower right abdominal pain with a blood pressure of 170/100 mmHg.A subsequent computed tomography scan revealed right ureterolithiasis,which was the cause of right abdominal pain,and right AI measuring 22 mm×25 *** the disappearance of right abdominal pain,subsequent endocrinological examinations were ***-related evaluations,including adrenal venous sampling,revealed the presence of bilateral *** addition,several cortisol-related evaluations showed the presence of SCS on the right adrenal adenoma.A laparoscopic right adrenalectomy was then *** histopathological examination of the resected right adrenal revealed the presence of a cortisol-producing adenoma,while CYP11B2 immunoreactivity was absent in this ***,in the adjacent nonneoplastic adrenal,multiple CYP11B2-positive adrenocortical micronodules were detected,showing the presence of aldosterone-producing adrenocortical *** Careful clinical and pathological examination should be performed when a patient harboring AI presents with concomitant SCS and PA.

关键词： primary aldosteronism Subclinical Cushing’s syndrome Adrenal incidentaloma Micronodular hyperplasia Case report

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Advances in Medical Treatment of primary aldosteronism

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Chinese Medical Sciences Journal 2023年第1期38卷 49-56页

作者： Ying-Jie Li Zhi-Gang Ji Jin Wen Department of Urology Peking Union Medical College HospitalChinese Academy of Medical Science&Peking Union Medical CollegeBeijing 100730China

primary aldosteronism(PA)is the most common form of secondary hypertension,with its main manifestations including hypertension and *** identification of PA is extremely important as PA patients can easily develop cardiovascular complications such as atrial fibrillation,stroke,and myocardial *** past decade has witnessed the rapid advances in the genetics of PA,which has shed new light on PA *** surgery is the first choice for unilateral diseases,bilateral lesions can be treated with mineralocorticoid receptor antagonists(MRAs).The next-generation non-steroidal MRAs are under *** medications including calcium channel blockers,macrophage antibiotics,and aldosterone synthase inhibitors have provided a new perspective for the medical treatment of PA.

关键词： primary aldosteronism mineralocorticoid receptor antagonists calcium channel blockers macrolide antibiotics aldosterone synthase inhibitors

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Diagnostic evaluation of plasma aldosterone concentration to plasma renin activity ratio in primary aldosteronism

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Frontiers of Medicine 2008年第1期2卷 11-14页

作者： Huilan ZHANG Daowen WANG Cardiovascular Department of Tongji Hospital Tongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030China

Using the plasma aldosterone concentration to plasma renin activity ratio(PAC/PRA ratio)as the screening test of choice for primary aldosteronism in hypertensive patients,we studied the clinical character-istics and the diagnostic value of PAC/PRA ratio in primary *** plasma aldosterone concen-tration(PAC)and plasma renin activity(PRA)levels were measured by radioimmunoassay in 902 hypertensive patients from out-patient clinics or *** hundred and twenty-six suspected primary aldosteronism patients whose PAC/PRA ratio was>25 ng/dL/ng/mL/hr had a lamellar computed tomography(CT)scan in the adrenal gland and follow-up *** proportion of primary aldosteronism in hypertensive patients was 14%(126/902).There were 54 patients with unilateral or bilateral hyperplasia and 25 patients with adenoma according to the CT scan.39%(49/126)of the patients with primary aldosteronism had ***-five patients received surgical *** efficacy and cure rates were 100%(25/25)and 48%(12/25),*** effective rate of aldactone and the single-drug cure rate were 89%(48/54)and 24%(13/54),*** aldosteronism affects over 10%of hypertensive patients in *** PAC/PRA ratio can be considered as a routine screening test in hypertensives,especially resistant hypertensive patients and a high PAC/PRA ratio is an invaluable index in primary aldosteronism diagnosis.

关键词： hypertension primary aldosteronism aldos-terone renin

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Diagnostic value of aldosterone to renin ratio calculated by plasma renin activity or plasma renin concentration in primary aldosteronism: a meta-analysis

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Chinese Medical Journal 2022年第6期135卷 639-647页

作者： Zhenjie Liu Xiaohong Deng Li Luo Shaopeng Li Man Li Qinqin Deng Weiguo Zhong Qiang Luo Department of Clinical Laboratory The Second Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouGuangdong 510120China Department of Clinical Laboratory Guangdong Provincial Hospital of Chinese MedicineGuangzhouGuangdong 510120China Guangzhou University of Chinese Medicine GuangzhouGuangdong 510120China

Background:Since the diagnostic value of aldosterone to renin ratio(ARR)calculated by plasma renin concentration(PRC)or plasma renin activity(PRA)is still inconclusive,we conducted a meta-analysis by systematically reviewing relevant literature to explore the difference in the diagnostic efficacy of ARR calculated by PRC or PRA,so as to provide guidance for clinical ***:We searched PubMed,Embase,and Cochrane Library from the establishment of the database to March *** included studies that report the true positive,false positive,true negative,and false negative values for the diagnosis of primary aldosteronism,and we excluded duplicate publications,research without full text,incomplete information,or inability to conduct data extraction,animal experiments,reviews,and systematic *** 15.1 was used to analyze the ***:The pooled results showed that ARR(plasma aldosterone concentration[PAC]/PRC)had a sensitivity of 0.82(95%confidence interval[CI]:0.78-0.86),a specificity of 0.94(95%CI:0.92-0.95),a positive-likelihood ratio(LR)of 12.77(95%CI:7.04-23.73),a negative LR of 0.11(95%CI:0.07-0.17),and symmetric area under the curve(SAUC)of 0.982,***,the diagnostic odds ratio(DOR)of ARR(PAC/PRC)was ***,the pooled results showed that ARR(PAC/PRA)had a sensitivity of 0.91(95%CI:0.86-0.95),a specificity of 0.91(95%CI:0.90-0.93),a positive LR of 7.30(95%CI:2.99-17.99),a negative LR of 0.10(95%CI:0.04-0.26),and SAUC of 0.976,*** DOR of ARR(PAC/PRA)was ***,we conducted a subgroup analysis for the different thresholds(<35 or≥35)of PAC/*** results showed that the DOR of the cut-off≥35 groups was higher than the cut-off<35 groups(DOR=340.15,95%CI:38.32-3019.66;DOR=116.40,95%CI=23.28-581.92).Conclusions:The research results suggest that the determination of ARR(PAC/PRC)and ARR(PAC/PRA)was all effective screening tools for *** diagnostic accuracy and diagnostic value of ARR(PAC/PRC)

关键词： primary aldosteronism Aldosterone to renin ratio Plasma renin activity Plasma renin concentration Diagnostic value Meta-analysis

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Comparison of Cardiac Structural Improvement in Patients with primary aldosteronism after Surgical Therapy and Drug Therapy: A Meta-Analysis

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Open Journal of Endocrine and Metabolic Diseases 2022年第12期12卷 283-295页

作者： Junchi Cheng Ruohan Ma Ruohan Dai Jinxin Ran Bo Wang The Second Affiliated Hospital of Chongqing Medical University Chongqing China

Background: At present, in clinical practice, patients with primary hyperaldosteronism (PA) are mainly treated by surgery or medical drugs (spironolactone/spironolactone, epridone, etc.). Some studies show that the left ventricular hypertrophy of patients can be significantly improved after treatment. However, at present, the relevant research is very limited, and there is still controversy on the improvement of cardiac structure and function between the two treatment methods. No reliable conclusions have been drawn. Objective: We conducted this meta-analysis to compare the improvement of cardiac structure of patients after surgical treatment and drug treatment, so as to clarify the efficacy of surgical treatment and drug treatment for PA patients. Methods: In order to examine the cardiac color ultrasound data of PA patients receiving surgical treatment and drug therapy (spironolactone, antisterone), randomized or observational studies were searched through Pubmed, Cochrane Library, and Embase. Meta-analysis was then carried out on the comprehensive and individual outcomes. The ROINBS-I scale is utilized to assess the offset risk of study inclusion. Outcomes: A total of nine studies involving 799 patients with PA into meta analysis, according to the results of the surgery in the treatment of patients with PA, left ventricular mass index (LVMI) changes in value (drop range) is significantly higher than drug therapy (Mean difference IV: —2.32, P In 6 studies, after surgical treatment of interventricular septal thickness (IVSD), changes in value (drop range) are also higher than drug therapy (Mean difference IV: —0.35, P In 2 studies, the surgical treatment of plasma aldosterone concentration (PAC) drop degree is superior to drug therapy (Mean difference IV: —12.63, P < 0.05), and blood pressure to improve the degree of surgery and drug treatment has no obvious difference. Conclusions: This meta-analysis result confirmed that after medical and surgical treatment of PA

关键词： primary aldosteronism Adrenalectomy Mineralocorticoid Receptor Antagonist Left Ventricular Mass Fraction Ventricular Septal Thickness

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