Re: A number of new abstracts on PA for 2011. Many will be of interest to different folks.

July 22, 2011

Kellie, If I've said it once, I've said it 100 times, " The only dumb question is

the one that is NOT asked! "

My version of outsalting: I was DXed with PA about 13mos ago when ARR = 50,

adnoma in rt. adrenal and the doc put me on 25mg of Spiro. My BP dropped

instantly to a point where I called and asked how low was safe, Endo responded

not to worry, I was just where a normal man should be!

One symptom I had was rt. flank pain that radiated to my rt testicle. I was

sure it was somehow related to that nasty little (12x13mm) adnoma. I found this

site just after the first of the year I think and I kept seeing " flank pain " .

All but one of the doctors I " saw " discounted my theory (this included PCP,

Nepr, Endo!) Dr. Grim remained neutral and wanted to get me off my 6BP meds and

Potassium Supl. and titrate Spiro up and let it work.

My NA was high (for me) early in treatment, 5/26/2010 = 141 & 7/8 = 142.

Starting in December I finally got the message (maybe it was the Grim Reality!)

I had 5 readings between 12/14/2010 & 5/12/2011: 136,135,135,137,137 with a

range of 135-145. On Apr. 23, 2011 I was more active than normal which I

attribute to " Kicking Spiro into HIGH Gear " . While Narcotics, Oxycodone and

Methadone, made the pain bearable I was still in pain but suddenly after the 23d

the pain was gone. In addition the trips to pee were greatly reduced (from

often hourly and up 4 times at night to every 6 - 8 hrs during the day and

sleeping thru the night!)

I think I've set the stage, everything was going swimmingly until early June.

We've done low salt at home for years but I was out-n-about a little more and

snuck in a couple fast food and suddenly realized I eas feeling my flank pain

starting to return! You guessed it, NA was 140 when they tested it on June 7th!

The term " Out-Salting " was Dr. Grim's term. He said I had been out-salting the

Spiro until April 23d. My local docs were probably right in that it wasn't the

adnoma causing the pain it was the excess aldosterone (that's what your teenager

would tell you!)

All I know is that I was bound and determined I was going to prove Dr. G. wrong

and show him that meds and surgery did not accomplish the same results, I even

had a surgeon ready to go! I now admit he is right and can hardly contain my

excitement as I start to identify other improvements to my systems!

Hope this helps but if it generates mor questions, ask away! I love to share my

excitement!

- 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank &

testicle pain. I have decided against an adrenalectomy at this time since

Meds. are working so well. Current BP: 130/77

Other Issues/Opportunities: COPD w/ft Oxygen, OSA w Bi-Pap settings 13/19, DM2.

and PTSD

Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG,

Metformin 2000MG and Spironolactone 75 MG.

> > > > > > > >

> > > > > > > > Perhaps someone, ? ?, can summarize the ones on

> > surgery and

> > > > > > > > someone on the Dx issues.

> > > > > > > >

> > > > > > > > I would do an excel set up

> > > > > > > >

> > > > > > > > Paste abstract in first cell then summarize in columns

> > next to it.

> > > > > > > > Number of subjects etc. and conclusions. Also upload all

> > to our

> > > > > > > > references on PA.

> > > > > > > >

> > > > > > > > CE Grim MD

> > > > > > > >

> > > > > > > > Begin forwarded message:

> > > > > > > >

> > > > > > > > > From: Sent by NCBI <nobody@>

> > > > > > > > > Date: July 20, 2011 9:55:01 AM PDT

> > > > > > > > > To: lowerbp2@

> > > > > > > > > Subject: PubMed Search Results

> > > > > > > > >

> > > > > > > > > This message contains search results from the National

> > Center for

> > > > > > > > > Biotechnology Information (NCBI) at the U.S. National

> > Library of

> > > > > > > > > Medicine (NLM). Do not reply directly to this message

> > > > > > > > >

> > > > > > > > > Sender's message: PA refs to July 11

> > > > > > > > >

> > > > > > > > > Sent on: Wed Jul 20 12:52:12 2011

> > > > > > > > > 106 selected items

> > > > > > > > >

> > > > > > > > > pubmed Results

> > > > > > > > > Items 1 -106 of 106

> > > > > > > > >

> > > > > > > > > 1. Clin Endocrinol (Oxf). 2011 Jul 18. doi: 10.1111/j.

> > > > > > > > > 1365-2265.2011.04177.x. [Epub ahead of print]

> > > > > > > > > 100 cases of primary aldosteronism. Careful choice of

> > patients for

> > > > > > > > > surgery using adrenal venous sampling and CT imaging

> > results in

> > > > > > > > > excellent blood pressure and potassium outcomes.

> > > > > > > > >

> > > > > > > > > Graham U, Ellis P, Hunter S, H, Mullan K, Atkinson A.

> > > > > > > > > Source

> > > > > > > > >

> > > > > > > > > Regional Centre for Endocrinology and Diabetes, Royal

> >

> > > > > > > > > Hospital, Belfast Imaging Centre, Royal

> > Hospital, Belfast

> > > > > > > > > Regional Endocrine Laboratory, Royal Hospital,

> > Belfast.

> > > > > > > > >

> > > > > > > > > Abstract

> > > > > > > > >

> > > > > > > > > Objective:ÃfÂ¢Ã¢âEURs(Â¬Ã¢â,¬Å¡ Patients with primary

> > aldosteronism (PA) who are

> > > > > > > > > suitable for surgery should undergo adrenal computerised

> > tomography

> > > > > > > > > (CT) and adrenal venous sampling (AVS). A retrospective

> > study was

> > > > > > > > > performed of 100 patients with PA. We determined the

> > optimal AVS

> > > > > > > > > lateralisation ratio for unilateral disease and reviewed

> > > > > > > > > adrenalectomy outcomes evaluating which characteristics

> > predicted

> > > > > > > > > hypertension cure. Methods:ÃfÂ¢Ã¢âEURs(Â¬Ã¢â,¬Å¡ AVS was

> > performed in 93 patients.

> > > > > > > > > Lateralisation criteria were assessed using ROC curve

> > analysis. The

> > > > > > > > > outcome of adrenalectomy was reviewed in 39 patients and

> > predictive

> > > > > > > > > factors for cure determined using univariate and

> > multivariate

> > > > > > > > > analysis. Results:ÃfÂ¢Ã¢âEURs(Â¬Ã¢â,¬Å¡ Of previously

> > published criteria, ROC curve

> > > > > > > > > analysis found a cortisol corrected aldosterone affected to

> > > > > > > > > unaffected (Aldo/Cort A:U) cut-off of 2.0 was the best

> > predictor of

> > > > > > > > > adenoma identifying 80.4% of patients. A novel ratio

> > calculated by

> > > > > > > > > dividing the affected to unaffected ratio by the

> > unaffected to

> > > > > > > > > peripheral ratio (Aldo/Cort A:U ÃfÆ'Ã,Â· Aldo/Cort

> > U:IVC) was successful in

> > > > > > > > > identifying 87.0% of patients. Cure rate for blood

> > pressure after

> > > > > > > > > adrenalectomy was 38.5% with improvement in 59.0%. On

> > univariate

> > > > > > > > > analysis, predictors of post-operative hypertension were

> > increased

> > > > > > > > > weight, raised creatinine, left ventricular hypertrophy

> > (LVH) and

> > > > > > > > > male sex. On multivariate analysis, male sex and higher

> > pre-

> > > > > > > > > operative systolic blood pressure were predictive.

> > Conclusions:ÃfÂ¢Ã¢âEURs(Â¬Ã¢â,¬Å¡

> > > > > > > > > Patients with PA should have CT scanning and AVS.

> > Aldo/Cort A:U >2.0

> > > > > > > > > is the most accurate of previously published ratios in

> > predicting

> > > > > > > > > unilateral disease. When patients were carefully

> > selected for

> > > > > > > > > surgery, 97% had cure or improvement in blood pressure

> > control.

> > > > > > > > > Further confirmatory work is required on a novel ratio

> > which was

> > > > > > > > > even more predictive in our series.

> > > > > > > > >

> > > > > > > > > PMID:

> > > > > > > > > 21767289

> > > > > > > > > [PubMed - as supplied by publisher]

> > > > > > > > > Related citations

> > > > > > > > > 2. J Clin Hypertens (Greenwich). 2011 Jul;13(7):487-91.

> > doi: 10.1111/

> > > > > > > > > j.1751-7176.2011.00443.x. Epub 2011 Mar 28.

> > > > > > > > > Resistant hypertension and undiagnosed primary

> > hyperaldosteronism

> > > > > > > > > detected by use of a computerized database.

> > > > > > > > >

> > > > > > > > > EA, JR, Meier JL, Swislocki AL, Siegel D.

> > > > > > > > > Source

> > > > > > > > >

> > > > > > > > > From the VA Northern California Health Care System,

> > Mather Field,

> > > > > > > > > CA;the School of Medicine, University of California,

> > , CA.

> > > > > > > > >

> > > > > > > > > Abstract

> > > > > > > > >

> > > > > > > > > J Clin Hypertens (Greenwich).

> > > > > > > > > Periodicals, Inc. A pharmacy database was used to

> > identify patients

> > > > > > > > > with resistant hypertension who could then be tested for

> > the

> > > > > > > > > presence of primary hyperaldosteronism. Inclusion

> > criteria were: (1)

> > > > > > > > > resistant hypertension defined as uncontrolled

> > hypertension and use

> > > > > > > > > of 3 antihypertensive medication classes or

> > ÃfÂ¢Ã¢â,¬Â°Ã,Â¥4 antihypertensive

> > > > > > > > > classes regardless of blood pressure; (2) low or normal

> > potassium

> > > > > > > > > levels (ÃfÂ¢Ã¢â,¬Â°Ã,Â¤4.9ÃfÂ¢Ã¢âEURs(Â¬Ã+'mEq/L); and

> > (3) continuous health care from October

> > > > > > > > > 1, 2008, to February 28, 2009. Exclusion criteria were:

> > (1) past or

> > > > > > > > > current use of an aldosterone antagonist, or (2) a

> > medication

> > > > > > > > > possession ratio (adherence) <80% for any

> > antihypertensive drug.

> > > > > > > > > Hyperaldosteronism was classified as an

> > aldosterone/renin ratio

> > > > > > > > > (ARR) ÃfÂ¢Ã¢â,¬Â°Ã,Â¥30. Using the computer, 746

> > patients were identified who met

> > > > > > > > > criteria. After manual chart review to verify inclusion and

> > > > > > > > > exclusion criteria, 333 patients remained. Of 184

> > individuals in

> > > > > > > > > whom an ARR was obtained, 39 (21.2%) had a ratio of

> > ÃfÂ¢Ã¢â,¬Â°Ã,Â¥30. A computer

> > > > > > > > > database is useful to identify patients with resistant

> > hypertension

> > > > > > > > > and those who may have primary aldosteronism.

> > > > > > > > >

> > > > > > > > > PMID:

> > > > > > > > > 21762361

> > > > > > > > > [PubMed - in process]

> > > > > > > > > Related citations

> > > > > > > > >

> > > > > > > > > 3. Eur J Endocrinol. 2011 Jul 13. [Epub ahead of print]

> > > > > > > > > PHENOTYPE-GENOTYPE CORRELATION AND FOLLOW-UP IN ADULT

> > PATIENTS WITH

> > > > > > > > > HYPOKALAEMIA OF RENAL ORIGIN SUGGESTING GITELMAN SYNDROME.

> > > > > > > > >

> > > > > > > > > Balavoine AS, Bataille P, Vanhille P, Azar R,

> > NoÃfÆ'Ã,Â«l C, Asseman P,

> > > > > > > > > Soudan B, Wemeau JL, Vantyghem MC.

> > > > > > > > > Source

> > > > > > > > >

> > > > > > > > > A Balavoine, Service Endocrinologie et Maladies

> > MÃfÆ'Ã,Â©taboliques,

> > > > > > > > > Clinique Endocrinologique Marc Linquette, Lille, 59037

> > cedex, France.

> > > > > > > > >

> > > > > > > > > Abstract

> > > > > > > > >

> > > > > > > > > Gitelman syndrome is a tubulopathy caused by SLC12A3

> > gene mutations,

> > > > > > > > > which lead to hypokalaemic alkalosis, secondary

> > hyperaldosteronism,

> > > > > > > > > hypomagnesaemia and hypocalciuria. The aim of this study

> > was to

> > > > > > > > > assess the prevalence of SLC12A3 gene mutations in adult

> > > > > > > > > hypokalaemic patients; to compare the phenotype of

> > homozygous,

> > > > > > > > > heterozygous and non-mutated patients; and to determine the

> > > > > > > > > efficiency of treatment. Methods: Clinical, biological

> > and genetic

> > > > > > > > > data were recorded in 26 patients. Results: Screening

> > for the

> > > > > > > > > SLC12A3 gene detected 2 mutations in 15 patients (6

> > homozygous and 9

> > > > > > > > > compound heterozygous), one mutation in 6, and no

> > mutation in 5

> > > > > > > > > patients. There was no statistical difference in

> > clinical symptoms

> > > > > > > > > at diagnosis between the 3 groups. Systolic blood

> > pressure tended to

> > > > > > > > > be lower in patients with 2 mutations (p=0.16).

> > Hypertension was

> > > > > > > > > unexpectedly detected in 4 patients. Five patients with

> > 2 mutated

> > > > > > > > > alleles and 2 with heterozygosity had severe

> > manifestations of GS.

> > > > > > > > > Significant differences were observed between the 3

> > groups in blood

> > > > > > > > > potassium, chloride, magnesium, supine aldosterone,

> > 24-hr urine

> > > > > > > > > chloride and magnesium levels, and in MDRD. Mean blood

> > potassium

> > > > > > > > > levels increased from 2.8ÃfâEURs(Ã,Â±0.3,

> > 3.5ÃfâEURs(Ã,Â±0.5, and 3.2ÃfâEURs(Ã,Â±0.3 before

> > > > > > > > > treatment to 3.2ÃfâEURs(Ã,Â±0.5, 3.7ÃfâEURs(Ã,Â±0.6 and

> > 3.7ÃfâEURs(Ã,Â±0.3 mmol/l with treatment in

> > > > > > > > > groups with 2 (p=0.003), 1 and no mutated alleles,

> > respectively.

> > > > > > > > > Conclusion: In adult patients referred for renal

> > hypokalaemia, we

> > > > > > > > > confirmed the presence of mutations of the SLC12A3 gene

> > in 80% of

> > > > > > > > > cases. GS was more severe in patients with 2 than with 1

> > or no

> > > > > > > > > mutated alleles. High blood pressure should not rule out

> > the

> > > > > > > > > diagnosis, especially in older patients.

> > > > > > > > >

> > > > > > > > > PMID:

> > > > > > > > > 21753071

> > > > > > > > > [PubMed - as supplied by publisher]

> > > > > > > > > Related citations

> > > > > > > > >

> > > > > > > > > 4. J Clin Endocrinol Metab. 2011 Jul 13. [Epub ahead of

> > print]

> > > > > > > > > Significance of Adrenocorticotropin Stimulation Test in the

> > > > > > > > > Diagnosis of an Aldosterone-Producing Adenoma.

> > > > > > > > >

> > > > > > > > > Sonoyama T, Sone M, Miyashita K, Tamura N, Yamahara K,

> > Park K,

> > > > > > > > > Oyamada N, Taura D, Inuzuka M, Kojima K, Honda K,

> > Fukunaga Y,

> > > > > > > > > Kanamoto N, Miura M, Yasoda A, Arai H, Itoh H, Nakao K.

> > > > > > > > > Source

> > > > > > > > >

> > > > > > > > > Department of Medicine and Clinical Science, Kyoto

> > University

> > > > > > > > > Graduate School of Medicine, Sakyo-ku, Kyoto 606-8507,

> > Japan.

> > > > > > > > >

> > > > > > > > > Abstract

> > > > > > > > >

> > > > > > > > > Context: Adrenal venous sampling is the " gold standard "

> > test in the

> > > > > > > > > diagnosis of an aldosterone-producing adenoma (APA)

> > among patients

> > > > > > > > > with primary aldosteronism (PA) but is available only in

> > specialized

> > > > > > > > > medical centers. Meanwhile, an APA is reported to be

> > generally more

> > > > > > > > > sensitive to ACTH than idiopathic hyperaldosteronism.

> > Objective: The

> > > >

> > >

> >

>

July 22, 2011

, If your father and grandfather both smoked around you my Pulmonologist

would contend you smoked also! When I quit smoking I swore I wouldn't restrict

others from smoking around me. 10 years after I quit cigarettes and 6 years

after I stopped using all tobacco she got the " priviledge " of explaining COPD

and the danger of second hand smoke!

- 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank &

testicle pain. I have decided against an adrenalectomy at this time since

Meds. are working so well. Current BP: 130/77

Other Issues/Opportunities: COPD w/ft Oxygen, OSA w Bi-Pap settings 13/19, DM2.

and PTSD

Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG,

Metformin 2000MG and Spironolactone 75 MG.

> > > > > > > > > > > > >

> > > > > > > > > > > > > Perhaps someone, ? ?, can summarize the ones

on

> > > > > > > surgery and

> > > > > > > > > > > > > someone on the Dx issues.

> > > > > > > > > > > > >

> > > > > > > > > > > > > I would do an excel set up

> > > > > > > > > > > > >

> > > > > > > > > > > > > Paste abstract in first cell then summarize in columns

> > > > > > > next to it.

> > > > > > > > > > > > > Number of subjects etc. and conclusions. Also upload

all

> > > > > > > to our

> > > > > > > > > > > > > references on PA.

> > > > > > > > > > > > >

> > > > > > > > > > > > > CE Grim MD

> > > > > > > > > > > > >

> > > > > > > > > > > > > Begin forwarded message:

> > > > > > > > > > > > >

> > > > > > > > > > > > > > From: Sent by NCBI <nobody@>

> > > > > > > > > > > > > > Date: July 20, 2011 9:55:01 AM PDT

> > > > > > > > > > > > > > To: lowerbp2@

> > > > > > > > > > > > > > Subject: PubMed Search Results

> > > > > > > > > > > > > >

> > > > > > > > > > > > > > This message contains search results from the

National

> > > > > > > Center for

> > > > > > > > > > > > > > Biotechnology Information (NCBI) at the U.S.

National

> > > > > > > Library of

> > > > > > > > > > > > > > Medicine (NLM). Do not reply directly to this

message

> > > > > > > > > > > > > >

> > > > > > > > > > > > > > Sender's message: PA refs to July 11

> > > > > > > > > > > > > >

> > > > > > > > > > > > > > Sent on: Wed Jul 20 12:52:12 2011

> > > > > > > > > > > > > > 106 selected items

> > > > > > > > > > > > > >

> > > > > > > > > > > > > > pubmed Results

> > > > > > > > > > > > > > Items 1 -106 of 106

> > > > > > > > > > > > > >

> > > > > > > > > > > > > > 1. Clin Endocrinol (Oxf). 2011 Jul 18. doi:

10.1111/j.

> > > > > > > > > > > > > > 1365-2265.2011.04177.x. [Epub ahead of print]

> > > > > > > > > > > > > > 100 cases of primary aldosteronism. Careful choice

of

> > > > > > > patients for

> > > > > > > > > > > > > > surgery using adrenal venous sampling and CT imaging

> > > > > > > results in

> > > > > > > > > > > > > > excellent blood pressure and potassium outcomes.

> > > > > > > > > > > > > >

> > > > > > > > > > > > > > Graham U, Ellis P, Hunter S, H, Mullan K,

> > > > > > > Atkinson A.

> > > > > > > > > > > > > > Source

> > > > > > > > > > > > > >

> > > > > > > > > > > > > > Regional Centre for Endocrinology and Diabetes,

Royal

> > > > > > >

> > > > > > > > > > > > > > Hospital, Belfast Imaging Centre, Royal

> > > > > > > Hospital, Belfast

> > > > > > > > > > > > > > Regional Endocrine Laboratory, Royal

> > > > > > > Hospital, Belfast.

> > > > > > > > > > > > > >

> > > > > > > > > > > > > > Abstract

> > > > > > > > > > > > > >

Objective:ÃƒÆ'Ã†'Ãƒâ€šÃ‚Â¢ÃƒÆ'Ã‚Â¢ÃƒÂ¢Ã¢â€šÂ¬Ã…Â¡Ãƒâ€šÃ‚Â¬ÃƒÆ'Ã‚Â¢ÃƒÂ¢Ã¢â‚¬Å¡Ã‚Â\

¬Ãƒâ€¦Ã‚Â¡ Patients with primary

> > > > > > > aldosteronism (PA) who are

> > > > > > > > > > > > > > suitable for surgery should undergo adrenal

> > > > > > > computerised tomography

> > > > > > > > > > > > > > (CT) and adrenal venous sampling (AVS). A

> > > > > > > retrospective study was

> > > > > > > > > > > > > > performed of 100 patients with PA. We determined the

> > > > > > > optimal AVS

> > > > > > > > > > > > > > lateralisation ratio for unilateral disease and

reviewed

> > > > > > > > > > > > > > adrenalectomy outcomes evaluating which

> > > > > > > characteristics predicted

> > > > > > > > > > > > > > hypertension cure.

Methods:ÃƒÆ'Ã†'Ãƒâ€šÃ‚Â¢ÃƒÆ'Ã‚Â¢ÃƒÂ¢Ã¢â€šÂ¬Ã…Â¡Ãƒâ€šÃ‚Â¬ÃƒÆ'Ã‚Â¢ÃƒÂ¢Ã¢â‚¬Å¡Ã‚Â¬Ã\

ƒâ€¦Ã‚Â¡ AVS was

> > > > > > > performed in 93 patients.

> > > > > > > > > > > > > > Lateralisation criteria were assessed using ROC

curve

> > > > > > > analysis. The

> > > > > > > > > > > > > > outcome of adrenalectomy was reviewed in 39 patients

> > > > > > > and predictive

> > > > > > > > > > > > > > factors for cure determined using univariate and

> > > > > > > multivariate

> > > > > > > > > > > > > > analysis.

Results:ÃƒÆ'Ã†'Ãƒâ€šÃ‚Â¢ÃƒÆ'Ã‚Â¢ÃƒÂ¢Ã¢â€šÂ¬Ã…Â¡Ãƒâ€šÃ‚Â¬ÃƒÆ'Ã‚Â¢ÃƒÂ¢Ã¢â‚¬Å¡Ã‚Â¬Ã\

ƒâ€¦Ã‚Â¡ Of previously

> > > > > > > published criteria, ROC curve

> > > > > > > > > > > > > > analysis found a cortisol corrected aldosterone

> > > > > > > affected to

> > > > > > > > > > > > > > unaffected (Aldo/Cort A:U) cut-off of 2.0 was the

best

> > > > > > > predictor of

> > > > > > > > > > > > > > adenoma identifying 80.4% of patients. A novel ratio

> > > > > > > calculated by

> > > > > > > > > > > > > > dividing the affected to unaffected ratio by the

> > > > > > > unaffected to

> > > > > > > > > > > > > > peripheral ratio (Aldo/Cort A:U

ÃƒÆ'Ã†'Ãƒâ€ 'ÃƒÆ'Ã¢â‚¬Å¡Ãƒâ€šÃ‚Â· Aldo/Cort

> > > > > > > U:IVC) was successful in

> > > > > > > > > > > > > > identifying 87.0% of patients. Cure rate for blood

> > > > > > > pressure after

> > > > > > > > > > > > > > adrenalectomy was 38.5% with improvement in 59.0%.

On

> > > > > > > univariate

> > > > > > > > > > > > > > analysis, predictors of post-operative hypertension

> > > > > > > were increased

> > > > > > > > > > > > > > weight, raised creatinine, left ventricular

> > > > > > > hypertrophy (LVH) and

> > > > > > > > > > > > > > male sex. On multivariate analysis, male sex and

> > > > > > > higher pre-

> > > > > > > > > > > > > > operative systolic blood pressure were predictive.

> > > > > > >

Conclusions:ÃƒÆ'Ã†'Ãƒâ€šÃ‚Â¢ÃƒÆ'Ã‚Â¢ÃƒÂ¢Ã¢â€šÂ¬Ã…Â¡Ãƒâ€šÃ‚Â¬ÃƒÆ'Ã‚Â¢ÃƒÂ¢Ã¢â‚¬Å¡Ã\

‚Â¬Ãƒâ€¦Ã‚Â¡

> > > > > > > > > > > > > > Patients with PA should have CT scanning and AVS.

Aldo/

> > > > > > > Cort A:U >2.0

> > > > > > > > > > > > > > is the most accurate of previously published ratios

in

> > > > > > > predicting

> > > > > > > > > > > > > > unilateral disease. When patients were carefully

> > > > > > > selected for

> > > > > > > > > > > > > > surgery, 97% had cure or improvement in blood

pressure

> > > > > > > control.

> > > > > > > > > > > > > > Further confirmatory work is required on a novel

ratio

> > > > > > > which was

> > > > > > > > > > > > > > even more predictive in our series.

> > > > > > > > > > > > > >

> > > > > > > > > > > > > > Copyright ÃƒÆ'Ã†'ÃƒÂ¢Ã¢â€šÂ¬Ã…Â¡ÃƒÆ'Ã¢â‚¬Å¡Ãƒâ€šÃ‚Â©

2011 Blackwell Publishing Ltd.

> > > > > > > > > > > > > >

> > > > > > > > > > > > > > PMID:

> > > > > > > > > > > > > > 21767289

> > > > > > > > > > > > > > [PubMed - as supplied by publisher]

> > > > > > > > > > > > > > Related citations

> > > > > > > > > > > > > > 2. J Clin Hypertens (Greenwich). 2011 Jul;13(7):

> > > > > > > 487-91. doi: 10.1111/

> > > > > > > > > > > > > > j.1751-7176.2011.00443.x. Epub 2011 Mar 28.

> > > > > > > > > > > > > > Resistant hypertension and undiagnosed primary

> > > > > > > hyperaldosteronism

> > > > > > > > > > > > > > detected by use of a computerized database.

> > > > > > > > > > > > > >

> > > > > > > > > > > > > > EA, JR, Meier JL, Swislocki AL, Siegel

D.

> > > > > > > > > > > > > > Source

> > > > > > > > > > > > > >

> > > > > > > > > > > > > > From the VA Northern California Health Care System,

> > > > > > > Mather Field,

> > > > > > > > > > > > > > CA;the School of Medicine, University of California,

> > > > > > > , CA.

> > > > > > > > > > > > > >

> > > > > > > > > > > > > > Abstract

> > > > > > > > > > > > > >

> > > > > > > > > > > > > > J Clin Hypertens (Greenwich).

2011;13:487-491.ÃƒÆ'Ã†'ÃƒÂ¢

> > > > > > > > > > > > > > Periodicals, Inc. A pharmacy database was used to

> > > > > > > identify patients

> > > > > > > > > > > > > > with resistant hypertension who could then be tested

> > > > > > > for the

> > > > > > > > > > > > > > presence of primary hyperaldosteronism. Inclusion

> > > > > > > criteria were: (1)

> > > > > > > > > > > > > > resistant hypertension defined as uncontrolled

> > > > > > > hypertension and use

> > > > > > > > > > > > > > of 3 antihypertensive medication classes or

ÃƒÆ'Ã†'Ãƒâ€šÃ‚Â¢ÃƒÆ'Ã‚Â¢ÃƒÂ¢Ã¢â‚¬Å¡Ã‚Â¬Ãƒâ€š

> > > > > > > Ã‚Â°ÃƒÆ'Ã¢â‚¬Å¡Ãƒâ€šÃ‚Â¥4 antihypertensive

> > > > > > > > > > > > > > classes regardless of blood pressure; (2) low or

> > > > > > > normal potassium

> > > > > > > > > > > > > > levels

(ÃƒÆ'Ã†'Ãƒâ€šÃ‚Â¢ÃƒÆ'Ã‚Â¢ÃƒÂ¢Ã¢â‚¬Å¡Ã‚Â¬Ãƒâ€šÃ‚Â°ÃƒÆ'Ã¢â‚¬Å¡Ãƒâ€šÃ‚Â¤4.9ÃƒÆ'Ã†'Ã\

ƒâ€šÃ‚Â¢ÃƒÆ'Ã‚Â¢ÃƒÂ¢Ã¢â€šÂ¬Ã…Â¡Ãƒâ€šÃ‚Â¬ÃƒÆ'Ã¢â‚¬ 'mEq/L); and

> > > > > > > (3) continuous health care from October

> > > > > > > > > > > > > > 1, 2008, to February 28, 2009. Exclusion criteria

> > > > > > > were: (1) past or

> > > > > > > > > > > > > > current use of an aldosterone antagonist, or (2) a

> > > > > > > medication

> > > > > > > > > > > > > > possession ratio (adherence) <80% for any

> > > > > > > antihypertensive drug.

> > > > > > > > > > > > > > Hyperaldosteronism was classified as an aldosterone/

> > > > > > > renin ratio

> > > > > > > > > > > > > > (ARR)

ÃƒÆ'Ã†'Ãƒâ€šÃ‚Â¢ÃƒÆ'Ã‚Â¢ÃƒÂ¢Ã¢â‚¬Å¡Ã‚Â¬Ãƒâ€šÃ‚Â°ÃƒÆ'Ã¢â‚¬Å¡Ãƒâ€šÃ‚Â¥30. Using

the computer, 746

> > > > > > > patients were identified who met

> > > > > > > > > > > > > > criteria. After manual chart review to verify

> > > > > > > inclusion and

> > > > > > > > > > > > > > exclusion criteria, 333 patients remained. Of 184

> > > > > > > individuals in

> > > > > > > > > > > > > > whom an ARR was obtained, 39 (21.2%) had a ratio of

ÃƒÆ'Ã†'Ãƒâ€š

> > > > > > > Ã‚Â¢ÃƒÆ'Ã‚Â¢ÃƒÂ¢Ã¢â‚¬Å¡Ã‚Â¬Ãƒâ€šÃ‚Â°ÃƒÆ'Ã¢â‚¬Å¡Ãƒâ€šÃ‚Â¥30. A

computer

> > > > > > > > > > > > > > database is useful to identify patients with

resistant

> > > > > > > hypertension

> > > > > > > > > > > > > > and those who may have primary aldosteronism.

> > > > > > > > > > > > > >

Wiley Periodicals, Inc.

> > > > > > > > > > > > > >

> > > > > > > > > > > > > > PMID:

> > > > > > > > > > > > > > 21762361

> > > > > > > > > > > > > > [PubMed - in process]

> > > > > > > > > > > > > > Related citations

> > > > > > > > > > > > > >

> > > > > > > > > > > > > > 3. Eur J Endocrinol. 2011 Jul 13. [Epub ahead of

print]

> > > > > > > > > > > > > > PHENOTYPE-GENOTYPE CORRELATION AND FOLLOW-UP IN

ADULT

> > > > > > > PATIENTS WITH

> > > > > > > > > > > > > > HYPOKALAEMIA OF RENAL ORIGIN SUGGESTING GITELMAN

> > > > > > > SYNDROME.

> > > > > > > > > > > > > >

> > > > > > > > > > > > > > Balavoine AS, Bataille P, Vanhille P, Azar R,

> > > > > > > NoÃƒÆ'Ã†'Ãƒâ€ 'ÃƒÆ'Ã¢â‚¬Å¡Ãƒâ€šÃ‚Â«l C, Asseman P,

> > > > > > > > > > > > > > Soudan B, Wemeau JL, Vantyghem MC.

> > > > > > > > > > > > > > Source

> > > > > > > > > > > > > >

> > > > > > > > > > > > > > A Balavoine, Service Endocrinologie et Maladies

> > > > > > > MÃƒÆ'Ã†'Ãƒâ€ 'ÃƒÆ'Ã¢â‚¬Å¡Ãƒâ€šÃ‚Â©taboliques,

> > > > > > > > > > > > > > Clinique Endocrinologique Marc Linquette, Lille,

59037

> > > > > > > cedex, France.

> > > > > > > > > > > > > >

> > > > > > > > > > > > > > Abstract

> > > > > > > > > > > > > >

> > > > > > > > > > > > > > Gitelman syndrome is a tubulopathy caused by SLC12A3

> > > > > > > gene mutations,

> > > > > > > > > > > > > > which lead to hypokalaemic alkalosis, secondary

> > > > > > > hyperaldosteronism,

> > > > > > > > > > > > > > hypomagnesaemia and hypocalciuria. The aim of this

> > > > > > > study was to

> > > > > > > > > > > > > > assess the prevalence of SLC12A3 gene mutations in

adult

> > > > > > > > > > > > > > hypokalaemic patients; to compare the phenotype of

> > > > > > > homozygous,

> > > > > > > > > > > > > > heterozygous and non-mutated patients; and to

> > > > > > > determine the

> > > > > > > > > > > > > > efficiency of treatment. Methods: Clinical,

biological

> > > > > > > and genetic

> > > > > > > > > > > > > > data were recorded in 26 patients. Results:

Screening

> > > > > > > for the

> > > > > > > > > > > > > > SLC12A3 gene detected 2 mutations in 15 patients (6

> > > > > > > homozygous and 9

> > > > > > > > > > > > > > compound heterozygous), one mutation in 6, and no

> > > > > > > mutation in 5

> > > > > > > > > > > > > > patients. There was no statistical difference in

> > > > > > > clinical symptoms

> > > > > > > > > > > > > > at diagnosis between the 3 groups. Systolic blood

> > > > > > > pressure tended to

> > > > > > > > > > > > > > be lower in patients with 2 mutations (p=0.16).

> > > > > > > Hypertension was

> > > > > > > > > > > > > > unexpectedly detected in 4 patients. Five patients

> > > > > > > with 2 mutated

> > > > > > > > > > > > > > alleles and 2 with heterozygosity had severe

> > > > > > > manifestations of GS.

> > > > > > > > > > > > > > Significant differences were observed between the 3

> > > > > > > groups in blood

> > > > > > > > > > > > > > potassium, chloride, magnesium, supine aldosterone,

24-

> > > > > > > hr urine

> > > > > > > > > > > > > > chloride and magnesium levels, and in MDRD. Mean

blood

> > > > > > > potassium

> > > > > > > > > > > > > > levels increased from

2.8ÃƒÆ'Ã†'ÃƒÂ¢Ã¢â€šÂ¬Ã…Â¡ÃƒÆ'Ã¢â‚¬Å¡Ãƒâ€šÃ‚Â±0.3,

3.5ÃƒÆ'Ã†'ÃƒÂ¢Ã¢â€šÂ¬Ã…Â¡ÃƒÆ'Ã¢â‚¬Å¡Ãƒâ€š

> > > > > > > Ã‚Â±0.5, and 3.2ÃƒÆ'Ã†'ÃƒÂ¢Ã¢â€šÂ¬Ã…Â¡ÃƒÆ'Ã¢â‚¬Å¡Ãƒâ€šÃ‚Â±0.3

before

> > > > > > > > > > > > > > treatment to

3.2ÃƒÆ'Ã†'ÃƒÂ¢Ã¢â€šÂ¬Ã…Â¡ÃƒÆ'Ã¢â‚¬Å¡Ãƒâ€šÃ‚Â±0.5,

3.7ÃƒÆ'Ã†'ÃƒÂ¢Ã¢â€šÂ¬Ã…Â¡ÃƒÆ'Ã¢â‚¬Å¡Ãƒâ€šÃ‚Â±0.6 and

> > > > > > > 3.7ÃƒÆ'Ã†'ÃƒÂ¢Ã¢â€šÂ¬Ã…Â¡ÃƒÆ'Ã¢â‚¬Å¡Ãƒâ€šÃ‚Â±0.3 mmol/l with

treatment in

> > > > > > > > > > > > > > groups with 2 (p=0.003), 1 and no mutated alleles,

> > > > > > > respectively.

> > > > > > > > > > > > > > Conclusion: In adult patients referred for renal

> > > > > > > hypokalaemia, we

> > > > > > > > > > > > > > confirmed the presence of mutations of the SLC12A3

> > > > > > > gene in 80% of

> > > > > > > > > > > > > > cases. GS was more severe in patients with 2 than

with

> > > > > > > 1 or no

> > > > > > > > > > > > > > mutated alleles. High blood pressure should not rule

> > > > > > > out the

> > > > > > > > > > > > > > diagnosis, especially in older patients.

> > > > > > > > > > > > > >

> > > > > > > > > > > > > > PMID:

> > > > > > > > > > > > > > 21753071

> > > > > > > > > > > > > > [PubMed - as supplied by publisher]

> > > > > > > > > > > > > > Related citations

> > > > > > > > > > > > > >

> > > > > > > > > > > > > > 4. J Clin Endocrinol Metab. 2011 Jul 13. [Epub ahead

> > > > > > > of print]

> > > > > > > > > > > > > > Significance of Adrenocorticotropin Stimulation Test

> > > > > > > in the

> > > > > > > > > > > > > > Diagnosis of an Aldosterone-Producing Adenoma.

> > > > > > > > > > > > > >

> > > > > > > > > > > > > > Sonoyama T, Sone M, Miyashita K, Tamura N, Yamahara

K,

> > > > > > > Park K,

> > > > > > > > > > > > > > Oyamada N, Taura D, Inuzuka M, Kojima K, Honda K,

> > > > > > > Fukunaga Y,

> > > > > > > > > > > > > > Kanamoto N, Miura M, Yasoda A, Arai H, Itoh H, Nakao

K.

> > > > > > > > > > > > > > Source

> > > > > > > > > > > > > >

> > > > > > > > > > > > > > Department of Medicine and Clinical Science, Kyoto

> > > > > > > University

> > > > > > > > > > > > > > Graduate School of Medicine, Sakyo-ku, Kyoto

606-8507,

> > > > > > > Japan.

> > > > > > > > > > > > > >

> > > > > > > > > > > > > > Abstract

> > > > > > > > > > > > > >

> > > > > > > > > > > > > > Context: Adrenal venous sampling is the " gold

> > > > > > > standard " test in the

> > > > > > > > > > > > > > diagnosis of an aldosterone-producing adenoma (APA)

> > > > > > > among patients

> > > > > > > > > > > > > > with primary aldosteronism (PA) but is available

only

> > > > > > > in specialized

> > > > > > > > > > > > > > medical centers. Meanwhile, an APA is reported to be

> > > > > > > generally more

> > > > > > > > > > > > > > sensitive to ACTH than idiopathic

hyperaldosteronism.

> > > > > > > Objective: The

> > > > > > > > >

> > > > > > > >

> > > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

>

July 22, 2011

Well, I was raised by my mother and only got second hand smoke once every two

weekends growing up.

> > > > > > > > > > > > > >

> > > > > > > > > > > > > > Perhaps someone, ? ?, can summarize the

ones on

> > > > > > > > surgery and

> > > > > > > > > > > > > > someone on the Dx issues.

> > > > > > > > > > > > > >

> > > > > > > > > > > > > > I would do an excel set up

> > > > > > > > > > > > > >

> > > > > > > > > > > > > > Paste abstract in first cell then summarize in

columns

> > > > > > > > next to it.

> > > > > > > > > > > > > > Number of subjects etc. and conclusions. Also upload

all

> > > > > > > > to our

> > > > > > > > > > > > > > references on PA.

> > > > > > > > > > > > > >

> > > > > > > > > > > > > > CE Grim MD

> > > > > > > > > > > > > >

> > > > > > > > > > > > > > Begin forwarded message:

> > > > > > > > > > > > > >

> > > > > > > > > > > > > > > From: Sent by NCBI <nobody@>

> > > > > > > > > > > > > > > Date: July 20, 2011 9:55:01 AM PDT

> > > > > > > > > > > > > > > To: lowerbp2@

> > > > > > > > > > > > > > > Subject: PubMed Search Results

> > > > > > > > > > > > > > >

> > > > > > > > > > > > > > > This message contains search results from the

National

> > > > > > > > Center for

> > > > > > > > > > > > > > > Biotechnology Information (NCBI) at the U.S.

National

> > > > > > > > Library of

> > > > > > > > > > > > > > > Medicine (NLM). Do not reply directly to this

message

> > > > > > > > > > > > > > >

> > > > > > > > > > > > > > > Sender's message: PA refs to July 11

> > > > > > > > > > > > > > >

> > > > > > > > > > > > > > > Sent on: Wed Jul 20 12:52:12 2011

> > > > > > > > > > > > > > > 106 selected items

> > > > > > > > > > > > > > >

> > > > > > > > > > > > > > > pubmed Results

> > > > > > > > > > > > > > > Items 1 -106 of 106

> > > > > > > > > > > > > > >

> > > > > > > > > > > > > > > 1. Clin Endocrinol (Oxf). 2011 Jul 18. doi:

10.1111/j.

> > > > > > > > > > > > > > > 1365-2265.2011.04177.x. [Epub ahead of print]

> > > > > > > > > > > > > > > 100 cases of primary aldosteronism. Careful choice

of

> > > > > > > > patients for

> > > > > > > > > > > > > > > surgery using adrenal venous sampling and CT

imaging

> > > > > > > > results in

> > > > > > > > > > > > > > > excellent blood pressure and potassium outcomes.

> > > > > > > > > > > > > > >

> > > > > > > > > > > > > > > Graham U, Ellis P, Hunter S, H, Mullan K,

> > > > > > > > Atkinson A.

> > > > > > > > > > > > > > > Source

> > > > > > > > > > > > > > >

> > > > > > > > > > > > > > > Regional Centre for Endocrinology and Diabetes,

Royal

> > > > > > > >

> > > > > > > > > > > > > > > Hospital, Belfast Imaging Centre, Royal

> > > > > > > > Hospital, Belfast

> > > > > > > > > > > > > > > Regional Endocrine Laboratory, Royal

> > > > > > > > Hospital, Belfast.

> > > > > > > > > > > > > > >

> > > > > > > > > > > > > > > Abstract

> > > > > > > > > > > > > > >

Objective:ÃƒÆ'Ã†'Ãƒâ€šÃ‚Â¢ÃƒÆ'Ã‚Â¢ÃƒÂ¢Ã¢â€šÂ¬Ã…Â¡Ãƒâ€šÃ‚Â¬ÃƒÆ'Ã‚Â¢ÃƒÂ¢Ã¢â‚¬Å¡Ã‚Â\

¬Ãƒâ€¦Ã‚Â¡ Patients with primary

> > > > > > > > aldosteronism (PA) who are

> > > > > > > > > > > > > > > suitable for surgery should undergo adrenal

> > > > > > > > computerised tomography

> > > > > > > > > > > > > > > (CT) and adrenal venous sampling (AVS). A

> > > > > > > > retrospective study was

> > > > > > > > > > > > > > > performed of 100 patients with PA. We determined

the

> > > > > > > > optimal AVS

> > > > > > > > > > > > > > > lateralisation ratio for unilateral disease and

reviewed

> > > > > > > > > > > > > > > adrenalectomy outcomes evaluating which

> > > > > > > > characteristics predicted

> > > > > > > > > > > > > > > hypertension cure.

Methods:ÃƒÆ'Ã†'Ãƒâ€šÃ‚Â¢ÃƒÆ'Ã‚Â¢ÃƒÂ¢Ã¢â€šÂ¬Ã…Â¡Ãƒâ€šÃ‚Â¬ÃƒÆ'Ã‚Â¢ÃƒÂ¢Ã¢â‚¬Å¡Ã‚Â¬Ã\

ƒâ€¦Ã‚Â¡ AVS was

> > > > > > > > performed in 93 patients.

> > > > > > > > > > > > > > > Lateralisation criteria were assessed using ROC

curve

> > > > > > > > analysis. The

> > > > > > > > > > > > > > > outcome of adrenalectomy was reviewed in 39

patients

> > > > > > > > and predictive

> > > > > > > > > > > > > > > factors for cure determined using univariate and

> > > > > > > > multivariate

> > > > > > > > > > > > > > > analysis.

Results:ÃƒÆ'Ã†'Ãƒâ€šÃ‚Â¢ÃƒÆ'Ã‚Â¢ÃƒÂ¢Ã¢â€šÂ¬Ã…Â¡Ãƒâ€šÃ‚Â¬ÃƒÆ'Ã‚Â¢ÃƒÂ¢Ã¢â‚¬Å¡Ã‚Â¬Ã\

ƒâ€¦Ã‚Â¡ Of previously

> > > > > > > > published criteria, ROC curve

> > > > > > > > > > > > > > > analysis found a cortisol corrected aldosterone

> > > > > > > > affected to

> > > > > > > > > > > > > > > unaffected (Aldo/Cort A:U) cut-off of 2.0 was the

best

> > > > > > > > predictor of

> > > > > > > > > > > > > > > adenoma identifying 80.4% of patients. A novel

ratio

> > > > > > > > calculated by

> > > > > > > > > > > > > > > dividing the affected to unaffected ratio by the

> > > > > > > > unaffected to

> > > > > > > > > > > > > > > peripheral ratio (Aldo/Cort A:U

ÃƒÆ'Ã†'Ãƒâ€ 'ÃƒÆ'Ã¢â‚¬Å¡Ãƒâ€šÃ‚Â· Aldo/Cort

> > > > > > > > U:IVC) was successful in

> > > > > > > > > > > > > > > identifying 87.0% of patients. Cure rate for blood

> > > > > > > > pressure after

> > > > > > > > > > > > > > > adrenalectomy was 38.5% with improvement in 59.0%.

On

> > > > > > > > univariate

> > > > > > > > > > > > > > > analysis, predictors of post-operative

hypertension

> > > > > > > > were increased

> > > > > > > > > > > > > > > weight, raised creatinine, left ventricular

> > > > > > > > hypertrophy (LVH) and

> > > > > > > > > > > > > > > male sex. On multivariate analysis, male sex and

> > > > > > > > higher pre-

> > > > > > > > > > > > > > > operative systolic blood pressure were predictive.

> > > > > > > >

Conclusions:ÃƒÆ'Ã†'Ãƒâ€šÃ‚Â¢ÃƒÆ'Ã‚Â¢ÃƒÂ¢Ã¢â€šÂ¬Ã…Â¡Ãƒâ€šÃ‚Â¬ÃƒÆ'Ã‚Â¢ÃƒÂ¢Ã¢â‚¬Å¡Ã\

‚Â¬Ãƒâ€¦Ã‚Â¡

> > > > > > > > > > > > > > > Patients with PA should have CT scanning and AVS.

Aldo/

> > > > > > > > Cort A:U >2.0

> > > > > > > > > > > > > > > is the most accurate of previously published

ratios in

> > > > > > > > predicting

> > > > > > > > > > > > > > > unilateral disease. When patients were carefully

> > > > > > > > selected for

> > > > > > > > > > > > > > > surgery, 97% had cure or improvement in blood

pressure

> > > > > > > > control.

> > > > > > > > > > > > > > > Further confirmatory work is required on a novel

ratio

> > > > > > > > which was

> > > > > > > > > > > > > > > even more predictive in our series.

> > > > > > > > > > > > > > >

> > > > > > > > > > > > > > > Copyright

> > > > > > > > > > > > > > >

> > > > > > > > > > > > > > > PMID:

> > > > > > > > > > > > > > > 21767289

> > > > > > > > > > > > > > > [PubMed - as supplied by publisher]

> > > > > > > > > > > > > > > Related citations

> > > > > > > > > > > > > > > 2. J Clin Hypertens (Greenwich). 2011 Jul;13(7):

> > > > > > > > 487-91. doi: 10.1111/

> > > > > > > > > > > > > > > j.1751-7176.2011.00443.x. Epub 2011 Mar 28.

> > > > > > > > > > > > > > > Resistant hypertension and undiagnosed primary

> > > > > > > > hyperaldosteronism

> > > > > > > > > > > > > > > detected by use of a computerized database.

> > > > > > > > > > > > > > >

> > > > > > > > > > > > > > > EA, JR, Meier JL, Swislocki AL,

Siegel D.

> > > > > > > > > > > > > > > Source

> > > > > > > > > > > > > > >

> > > > > > > > > > > > > > > From the VA Northern California Health Care

System,

> > > > > > > > Mather Field,

> > > > > > > > > > > > > > > CA;the School of Medicine, University of

California,

> > > > > > > > , CA.

> > > > > > > > > > > > > > >

> > > > > > > > > > > > > > > Abstract

> > > > > > > > > > > > > > >

> > > > > > > > > > > > > > > J Clin Hypertens (Greenwich).

2011;13:487-491.ÃƒÆ'Ã†'ÃƒÂ¢

> > > > > > > > > > > > > > > Periodicals, Inc. A pharmacy database was used to

> > > > > > > > identify patients

> > > > > > > > > > > > > > > with resistant hypertension who could then be

tested

> > > > > > > > for the

> > > > > > > > > > > > > > > presence of primary hyperaldosteronism. Inclusion

> > > > > > > > criteria were: (1)

> > > > > > > > > > > > > > > resistant hypertension defined as uncontrolled

> > > > > > > > hypertension and use

> > > > > > > > > > > > > > > of 3 antihypertensive medication classes or

ÃƒÆ'Ã†'Ãƒâ€šÃ‚Â¢ÃƒÆ'Ã‚Â¢ÃƒÂ¢Ã¢â‚¬Å¡Ã‚Â¬Ãƒâ€š

> > > > > > > > Ã‚Â°ÃƒÆ'Ã¢â‚¬Å¡Ãƒâ€šÃ‚Â¥4 antihypertensive

> > > > > > > > > > > > > > > classes regardless of blood pressure; (2) low or

> > > > > > > > normal potassium

> > > > > > > > > > > > > > > levels

(ÃƒÆ'Ã†'Ãƒâ€šÃ‚Â¢ÃƒÆ'Ã‚Â¢ÃƒÂ¢Ã¢â‚¬Å¡Ã‚Â¬Ãƒâ€šÃ‚Â°ÃƒÆ'Ã¢â‚¬Å¡Ãƒâ€šÃ‚Â¤4.9ÃƒÆ'Ã†'Ã\

ƒâ€šÃ‚Â¢ÃƒÆ'Ã‚Â¢ÃƒÂ¢Ã¢â€šÂ¬Ã…Â¡Ãƒâ€šÃ‚Â¬ÃƒÆ'Ã¢â‚¬ 'mEq/L); and

> > > > > > > > (3) continuous health care from October

> > > > > > > > > > > > > > > 1, 2008, to February 28, 2009. Exclusion criteria

> > > > > > > > were: (1) past or

> > > > > > > > > > > > > > > current use of an aldosterone antagonist, or (2) a

> > > > > > > > medication

> > > > > > > > > > > > > > > possession ratio (adherence) <80% for any

> > > > > > > > antihypertensive drug.

> > > > > > > > > > > > > > > Hyperaldosteronism was classified as an

aldosterone/

> > > > > > > > renin ratio

> > > > > > > > > > > > > > > (ARR)

ÃƒÆ'Ã†'Ãƒâ€šÃ‚Â¢ÃƒÆ'Ã‚Â¢ÃƒÂ¢Ã¢â‚¬Å¡Ã‚Â¬Ãƒâ€šÃ‚Â°ÃƒÆ'Ã¢â‚¬Å¡Ãƒâ€šÃ‚Â¥30. Using

the computer, 746

> > > > > > > > patients were identified who met

> > > > > > > > > > > > > > > criteria. After manual chart review to verify

> > > > > > > > inclusion and

> > > > > > > > > > > > > > > exclusion criteria, 333 patients remained. Of 184

> > > > > > > > individuals in

> > > > > > > > > > > > > > > whom an ARR was obtained, 39 (21.2%) had a ratio

of ÃƒÆ'Ã†'Ãƒâ€š

> > > > > > > > Ã‚Â¢ÃƒÆ'Ã‚Â¢ÃƒÂ¢Ã¢â‚¬Å¡Ã‚Â¬Ãƒâ€šÃ‚Â°ÃƒÆ'Ã¢â‚¬Å¡Ãƒâ€šÃ‚Â¥30. A

computer

> > > > > > > > > > > > > > > database is useful to identify patients with

resistant

> > > > > > > > hypertension

> > > > > > > > > > > > > > > and those who may have primary aldosteronism.

> > > > > > > > > > > > > > >

Wiley Periodicals, Inc.

> > > > > > > > > > > > > > >

> > > > > > > > > > > > > > > PMID:

> > > > > > > > > > > > > > > 21762361

> > > > > > > > > > > > > > > [PubMed - in process]

> > > > > > > > > > > > > > > Related citations

> > > > > > > > > > > > > > >

> > > > > > > > > > > > > > > 3. Eur J Endocrinol. 2011 Jul 13. [Epub ahead of

print]

> > > > > > > > > > > > > > > PHENOTYPE-GENOTYPE CORRELATION AND FOLLOW-UP IN

ADULT

> > > > > > > > PATIENTS WITH

> > > > > > > > > > > > > > > HYPOKALAEMIA OF RENAL ORIGIN SUGGESTING GITELMAN

> > > > > > > > SYNDROME.

> > > > > > > > > > > > > > >

> > > > > > > > > > > > > > > Balavoine AS, Bataille P, Vanhille P, Azar R,

> > > > > > > > NoÃƒÆ'Ã†'Ãƒâ€ 'ÃƒÆ'Ã¢â‚¬Å¡Ãƒâ€šÃ‚Â«l C, Asseman P,

> > > > > > > > > > > > > > > Soudan B, Wemeau JL, Vantyghem MC.

> > > > > > > > > > > > > > > Source

> > > > > > > > > > > > > > >

> > > > > > > > > > > > > > > A Balavoine, Service Endocrinologie et Maladies

> > > > > > > > MÃƒÆ'Ã†'Ãƒâ€ 'ÃƒÆ'Ã¢â‚¬Å¡Ãƒâ€šÃ‚Â©taboliques,

> > > > > > > > > > > > > > > Clinique Endocrinologique Marc Linquette, Lille,

59037

> > > > > > > > cedex, France.

> > > > > > > > > > > > > > >

> > > > > > > > > > > > > > > Abstract

> > > > > > > > > > > > > > >

> > > > > > > > > > > > > > > Gitelman syndrome is a tubulopathy caused by

SLC12A3

> > > > > > > > gene mutations,

> > > > > > > > > > > > > > > which lead to hypokalaemic alkalosis, secondary

> > > > > > > > hyperaldosteronism,

> > > > > > > > > > > > > > > hypomagnesaemia and hypocalciuria. The aim of this

> > > > > > > > study was to

> > > > > > > > > > > > > > > assess the prevalence of SLC12A3 gene mutations in

adult

> > > > > > > > > > > > > > > hypokalaemic patients; to compare the phenotype of

> > > > > > > > homozygous,

> > > > > > > > > > > > > > > heterozygous and non-mutated patients; and to

> > > > > > > > determine the

> > > > > > > > > > > > > > > efficiency of treatment. Methods: Clinical,

biological

> > > > > > > > and genetic

> > > > > > > > > > > > > > > data were recorded in 26 patients. Results:

Screening

> > > > > > > > for the

> > > > > > > > > > > > > > > SLC12A3 gene detected 2 mutations in 15 patients

(6

> > > > > > > > homozygous and 9

> > > > > > > > > > > > > > > compound heterozygous), one mutation in 6, and no

> > > > > > > > mutation in 5

> > > > > > > > > > > > > > > patients. There was no statistical difference in

> > > > > > > > clinical symptoms

> > > > > > > > > > > > > > > at diagnosis between the 3 groups. Systolic blood

> > > > > > > > pressure tended to

> > > > > > > > > > > > > > > be lower in patients with 2 mutations (p=0.16).

> > > > > > > > Hypertension was

> > > > > > > > > > > > > > > unexpectedly detected in 4 patients. Five patients

> > > > > > > > with 2 mutated

> > > > > > > > > > > > > > > alleles and 2 with heterozygosity had severe

> > > > > > > > manifestations of GS.

> > > > > > > > > > > > > > > Significant differences were observed between the

3

> > > > > > > > groups in blood

> > > > > > > > > > > > > > > potassium, chloride, magnesium, supine

aldosterone, 24-

> > > > > > > > hr urine

> > > > > > > > > > > > > > > chloride and magnesium levels, and in MDRD. Mean

blood

> > > > > > > > potassium

> > > > > > > > > > > > > > > levels increased from

2.8ÃƒÆ'Ã†'ÃƒÂ¢Ã¢â€šÂ¬Ã…Â¡ÃƒÆ'Ã¢â‚¬Å¡Ãƒâ€šÃ‚Â±0.3,

3.5ÃƒÆ'Ã†'ÃƒÂ¢Ã¢â€šÂ¬Ã…Â¡ÃƒÆ'Ã¢â‚¬Å¡Ãƒâ€š

> > > > > > > > Ã‚Â±0.5, and 3.2ÃƒÆ'Ã†'ÃƒÂ¢Ã¢â€šÂ¬Ã…Â¡ÃƒÆ'Ã¢â‚¬Å¡Ãƒâ€šÃ‚Â±0.3

before

> > > > > > > > > > > > > > > treatment to

3.2ÃƒÆ'Ã†'ÃƒÂ¢Ã¢â€šÂ¬Ã…Â¡ÃƒÆ'Ã¢â‚¬Å¡Ãƒâ€šÃ‚Â±0.5,

3.7ÃƒÆ'Ã†'ÃƒÂ¢Ã¢â€šÂ¬Ã…Â¡ÃƒÆ'Ã¢â‚¬Å¡Ãƒâ€šÃ‚Â±0.6 and

> > > > > > > > 3.7ÃƒÆ'Ã†'ÃƒÂ¢Ã¢â€šÂ¬Ã…Â¡ÃƒÆ'Ã¢â‚¬Å¡Ãƒâ€šÃ‚Â±0.3 mmol/l with

treatment in

> > > > > > > > > > > > > > > groups with 2 (p=0.003), 1 and no mutated alleles,

> > > > > > > > respectively.

> > > > > > > > > > > > > > > Conclusion: In adult patients referred for renal

> > > > > > > > hypokalaemia, we

> > > > > > > > > > > > > > > confirmed the presence of mutations of the SLC12A3

> > > > > > > > gene in 80% of

> > > > > > > > > > > > > > > cases. GS was more severe in patients with 2 than

with

> > > > > > > > 1 or no

> > > > > > > > > > > > > > > mutated alleles. High blood pressure should not

rule

> > > > > > > > out the

> > > > > > > > > > > > > > > diagnosis, especially in older patients.

> > > > > > > > > > > > > > >

> > > > > > > > > > > > > > > PMID:

> > > > > > > > > > > > > > > 21753071

> > > > > > > > > > > > > > > [PubMed - as supplied by publisher]

> > > > > > > > > > > > > > > Related citations

> > > > > > > > > > > > > > >

> > > > > > > > > > > > > > > 4. J Clin Endocrinol Metab. 2011 Jul 13. [Epub

ahead

> > > > > > > > of print]

> > > > > > > > > > > > > > > Significance of Adrenocorticotropin Stimulation

Test

> > > > > > > > in the

> > > > > > > > > > > > > > > Diagnosis of an Aldosterone-Producing Adenoma.

> > > > > > > > > > > > > > >

> > > > > > > > > > > > > > > Sonoyama T, Sone M, Miyashita K, Tamura N,

Yamahara K,

> > > > > > > > Park K,

> > > > > > > > > > > > > > > Oyamada N, Taura D, Inuzuka M, Kojima K, Honda K,

> > > > > > > > Fukunaga Y,

> > > > > > > > > > > > > > > Kanamoto N, Miura M, Yasoda A, Arai H, Itoh H,

Nakao K.

> > > > > > > > > > > > > > > Source

> > > > > > > > > > > > > > >

> > > > > > > > > > > > > > > Department of Medicine and Clinical Science, Kyoto

> > > > > > > > University

> > > > > > > > > > > > > > > Graduate School of Medicine, Sakyo-ku, Kyoto

606-8507,

> > > > > > > > Japan.

> > > > > > > > > > > > > > >

> > > > > > > > > > > > > > > Abstract

> > > > > > > > > > > > > > >

> > > > > > > > > > > > > > > Context: Adrenal venous sampling is the " gold

> > > > > > > > standard " test in the

> > > > > > > > > > > > > > > diagnosis of an aldosterone-producing adenoma

(APA)

> > > > > > > > among patients

> > > > > > > > > > > > > > > with primary aldosteronism (PA) but is available

only

> > > > > > > > in specialized

> > > > > > > > > > > > > > > medical centers. Meanwhile, an APA is reported to

be

> > > > > > > > generally more

> > > > > > > > > > > > > > > sensitive to ACTH than idiopathic

hyperaldosteronism.

> > > > > > > > Objective: The

> > > > > > > > > >

> > > > > > > > >

> > > > > > > >

> > > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

>

July 23, 2011

Hi ,

Thanks for your explanation!! I like the Grim Reality term. That

is great.

Keep up the excitement too - that is awesome.

Kellie

Kellie, If I've said it once, I've said it 100 times,

"The only dumb question is the one that is NOT asked!"

My version of outsalting: I was DXed with PA about 13mos

ago when ARR = 50, adnoma in rt. adrenal and the doc put

me on 25mg of Spiro. My BP dropped instantly to a point

where I called and asked how low was safe, Endo responded

not to worry, I was just where a normal man should be!

One symptom I had was rt. flank pain that radiated to my

rt testicle. I was sure it was somehow related to that

nasty little (12x13mm) adnoma. I found this site just

after the first of the year I think and I kept seeing

"flank pain". All but one of the doctors I "saw"

discounted my theory (this included PCP, Nepr, Endo!) Dr.

Grim remained neutral and wanted to get me off my 6BP meds

and Potassium Supl. and titrate Spiro up and let it work.

My NA was high (for me) early in treatment, 5/26/2010 =

141 & 7/8 = 142. Starting in December I finally got

the message (maybe it was the Grim Reality!) I had 5

readings between 12/14/2010 & 5/12/2011:

136,135,135,137,137 with a range of 135-145. On Apr. 23,

2011 I was more active than normal which I attribute to

"Kicking Spiro into HIGH Gear". While Narcotics, Oxycodone

and Methadone, made the pain bearable I was still in pain

but suddenly after the 23d the pain was gone. In addition

the trips to pee were greatly reduced (from often hourly

and up 4 times at night to every 6 - 8 hrs during the day

and sleeping thru the night!)

I think I've set the stage, everything was going

swimmingly until early June. We've done low salt at home

for years but I was out-n-about a little more and snuck in

a couple fast food and suddenly realized I eas feeling my

flank pain starting to return! You guessed it, NA was 140

when they tested it on June 7th!

The term "Out-Salting" was Dr. Grim's term. He said I had

been out-salting the Spiro until April 23d. My local docs

were probably right in that it wasn't the adnoma causing

the pain it was the excess aldosterone (that's what your

teenager would tell you!)

All I know is that I was bound and determined I was going

to prove Dr. G. wrong and show him that meds and surgery

did not accomplish the same results, I even had a surgeon

ready to go! I now admit he is right and can hardly

contain my excitement as I start to identify other

improvements to my systems!

Hope this helps but if it generates mor questions, ask

away! I love to share my excitement!

- 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma

with previous rt. flank & testicle pain. I have

decided against an adrenalectomy at this time since Meds.

are working so well. Current BP: 130/77

Other Issues/Opportunities: COPD w/ft Oxygen, OSA w Bi-Pap

settings 13/19, DM2. and PTSD

Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol

Tartrate 200 MG, Metformin 2000MG and Spironolactone 75

MG.

> > > > > > > >

> > > > > > > > Perhaps someone,

? ?, can summarize the ones on

> > surgery and

> > > > > > > > someone on the Dx

issues.

> > > > > > > >

> > > > > > > > I would do an

excel set up

> > > > > > > >

> > > > > > > > Paste abstract in

first cell then summarize in columns

> > next to it.

> > > > > > > > Number of subjects

etc. and conclusions. Also upload all

> > to our

> > > > > > > > references on PA.

> > > > > > > >

> > > > > > > > CE Grim MD

> > > > > > > >

> > > > > > > > Begin forwarded

message:

> > > > > > > >

> > > > > > > > > From: Sent by

NCBI <nobody@>

> > > > > > > > > Date: July

20, 2011 9:55:01 AM PDT

> > > > > > > > > To: lowerbp2@

> > > > > > > > > Subject:

PubMed Search Results

> > > > > > > > >

> > > > > > > > > This message

contains search results from the National

> > Center for

> > > > > > > > > Biotechnology

Information (NCBI) at the U.S. National

> > Library of

> > > > > > > > > Medicine

(NLM). Do not reply directly to this message

> > > > > > > > >

> > > > > > > > > Sender's

message: PA refs to July 11

> > > > > > > > >

> > > > > > > > > Sent on: Wed

Jul 20 12:52:12 2011

> > > > > > > > > 106 selected

items

> > > > > > > > >

> > > > > > > > > pubmed

Results

> > > > > > > > > Items 1 -106

of 106

> > > > > > > > >

> > > > > > > > > 1. Clin

Endocrinol (Oxf). 2011 Jul 18. doi: 10.1111/j.

> > > > > > > > >

1365-2265.2011.04177.x. [Epub ahead of print]

> > > > > > > > > 100 cases of

primary aldosteronism. Careful choice of

> > patients for

> > > > > > > > > surgery using

adrenal venous sampling and CT imaging

> > results in

> > > > > > > > > excellent

blood pressure and potassium outcomes.

> > > > > > > > >

> > > > > > > > > Graham U,

Ellis P, Hunter S, H, Mullan K, Atkinson A.

> > > > > > > > > Source

> > > > > > > > >

> > > > > > > > > Regional

Centre for Endocrinology and Diabetes, Royal

> >

> > > > > > > > > Hospital,

Belfast Imaging Centre, Royal

> > Hospital, Belfast

> > > > > > > > > Regional

Endocrine Laboratory, Royal Hospital,

> > Belfast.

> > > > > > > > >

> > > > > > > > > Abstract

> > > > > > > > >

Objective:ÃfÂ¢Ã¢âEURs(Â¬Ã¢â,¬Å¡ Patients with primary

> > aldosteronism (PA) who are

> > > > > > > > > suitable for

surgery should undergo adrenal computerised

> > tomography

> > > > > > > > > (CT) and

adrenal venous sampling (AVS). A retrospective

> > study was

> > > > > > > > > performed of

100 patients with PA. We determined the

> > optimal AVS

> > > > > > > > >

lateralisation ratio for unilateral disease and reviewed

> > > > > > > > > adrenalectomy

outcomes evaluating which characteristics

> > predicted

> > > > > > > > > hypertension

cure. Methods:ÃfÂ¢Ã¢âEURs(Â¬Ã¢â,¬Å¡ AVS was

> > performed in 93 patients.

> > > > > > > > >

Lateralisation criteria were assessed using ROC curve

> > analysis. The

> > > > > > > > > outcome of

adrenalectomy was reviewed in 39 patients and

> > predictive

> > > > > > > > > factors for

cure determined using univariate and

> > multivariate

> > > > > > > > > analysis.

Results:ÃfÂ¢Ã¢âEURs(Â¬Ã¢â,¬Å¡ Of previously

> > published criteria, ROC curve

> > > > > > > > > analysis

found a cortisol corrected aldosterone affected to

> > > > > > > > > unaffected

(Aldo/Cort A:U) cut-off of 2.0 was the best

> > predictor of

> > > > > > > > > adenoma

identifying 80.4% of patients. A novel ratio

> > calculated by

> > > > > > > > > dividing the

affected to unaffected ratio by the

> > unaffected to

> > > > > > > > > peripheral

ratio (Aldo/Cort A:U ÃfÆ'Ã,Â· Aldo/Cort

> > U:IVC) was successful in

> > > > > > > > > identifying

87.0% of patients. Cure rate for blood

> > pressure after

> > > > > > > > > adrenalectomy

was 38.5% with improvement in 59.0%. On

> > univariate

> > > > > > > > > analysis,

predictors of post-operative hypertension were

> > increased

> > > > > > > > > weight,

raised creatinine, left ventricular hypertrophy

> > (LVH) and

> > > > > > > > > male sex. On

multivariate analysis, male sex and higher

> > pre-

> > > > > > > > > operative

systolic blood pressure were predictive.

> > Conclusions:ÃfÂ¢Ã¢âEURs(Â¬Ã¢â,¬Å¡

> > > > > > > > > Patients with

PA should have CT scanning and AVS.

> > Aldo/Cort A:U >2.0

> > > > > > > > > is the most

accurate of previously published ratios in

> > predicting

> > > > > > > > > unilateral

disease. When patients were carefully

> > selected for

> > > > > > > > > surgery, 97%

had cure or improvement in blood pressure

> > control.

> > > > > > > > > Further

confirmatory work is required on a novel ratio

> > which was

> > > > > > > > > even more

predictive in our series.

> > > > > > > > >

> > > > > > > > > Copyright

> > > > > > > > >

> > > > > > > > > PMID:

> > > > > > > > > 21767289

> > > > > > > > > [PubMed - as

supplied by publisher]

> > > > > > > > > Related

citations

> > > > > > > > > 2. J Clin

Hypertens (Greenwich). 2011 Jul;13(7):487-91.

> > doi: 10.1111/

> > > > > > > > >

j.1751-7176.2011.00443.x. Epub 2011 Mar 28.

> > > > > > > > > Resistant

hypertension and undiagnosed primary

> > hyperaldosteronism

> > > > > > > > > detected by

use of a computerized database.

> > > > > > > > >

> > > > > > > > > EA,

JR, Meier JL, Swislocki AL, Siegel D.

> > > > > > > > > Source

> > > > > > > > >

> > > > > > > > > From the VA

Northern California Health Care System,

> > Mather Field,

> > > > > > > > > CA;the School

of Medicine, University of California,

> > , CA.

> > > > > > > > >

> > > > > > > > > Abstract

> > > > > > > > >

> > > > > > > > > J Clin

Hypertens (Greenwich).

> > > > > > > > > Periodicals,

Inc. A pharmacy database was used to

> > identify patients

> > > > > > > > > with

resistant hypertension who could then be tested for

> > the

> > > > > > > > > presence of

primary hyperaldosteronism. Inclusion

> > criteria were: (1)

> > > > > > > > > resistant

hypertension defined as uncontrolled

> > hypertension and use

> > > > > > > > > of 3

antihypertensive medication classes or

> > ÃfÂ¢Ã¢â,¬Â°Ã,Â¥4 antihypertensive

> > > > > > > > > classes

regardless of blood pressure; (2) low or normal

> > potassium

> > > > > > > > > levels

(ÃfÂ¢Ã¢â,¬Â°Ã,Â¤4.9ÃfÂ¢Ã¢âEURs(Â¬Ã+'mEq/L); and

> > (3) continuous health care from October

> > > > > > > > > 1, 2008, to

February 28, 2009. Exclusion criteria were:

> > (1) past or

> > > > > > > > > current use

of an aldosterone antagonist, or (2) a

> > medication

> > > > > > > > > possession

ratio (adherence) <80% for any

> > antihypertensive drug.

> > > > > > > > >

Hyperaldosteronism was classified as an

> > aldosterone/renin ratio

> > > > > > > > > (ARR)

ÃfÂ¢Ã¢â,¬Â°Ã,Â¥30. Using the computer, 746

> > patients were identified who met

> > > > > > > > > criteria.

After manual chart review to verify inclusion and

> > > > > > > > > exclusion

criteria, 333 patients remained. Of 184

> > individuals in

> > > > > > > > > whom an ARR

was obtained, 39 (21.2%) had a ratio of

> > ÃfÂ¢Ã¢â,¬Â°Ã,Â¥30. A computer

> > > > > > > > > database is

useful to identify patients with resistant

> > hypertension

> > > > > > > > > and those who

may have primary aldosteronism.

> > > > > > > > >

> > > > > > > > > ÃfâEURs(Ã,Â©

2011 Wiley Periodicals, Inc.

> > > > > > > > >

> > > > > > > > > PMID:

> > > > > > > > > 21762361

> > > > > > > > > [PubMed - in

process]

> > > > > > > > > Related

citations

> > > > > > > > >

> > > > > > > > > 3. Eur J

Endocrinol. 2011 Jul 13. [Epub ahead of print]

> > > > > > > > >

PHENOTYPE-GENOTYPE CORRELATION AND FOLLOW-UP IN ADULT

> > PATIENTS WITH

> > > > > > > > > HYPOKALAEMIA

OF RENAL ORIGIN SUGGESTING GITELMAN SYNDROME.

> > > > > > > > >

> > > > > > > > > Balavoine AS,

Bataille P, Vanhille P, Azar R,

> > NoÃfÆ'Ã,Â«l C, Asseman P,

> > > > > > > > > Soudan B,

Wemeau JL, Vantyghem MC.

> > > > > > > > > Source

> > > > > > > > >

> > > > > > > > > A Balavoine,

Service Endocrinologie et Maladies

> > MÃfÆ'Ã,Â©taboliques,

> > > > > > > > > Clinique

Endocrinologique Marc Linquette, Lille, 59037

> > cedex, France.

> > > > > > > > >

> > > > > > > > > Abstract

> > > > > > > > >

> > > > > > > > > Gitelman

syndrome is a tubulopathy caused by SLC12A3

> > gene mutations,

> > > > > > > > > which lead to

hypokalaemic alkalosis, secondary

> > hyperaldosteronism,

> > > > > > > > >

hypomagnesaemia and hypocalciuria. The aim of this study

> > was to

> > > > > > > > > assess the

prevalence of SLC12A3 gene mutations in adult

> > > > > > > > > hypokalaemic

patients; to compare the phenotype of

> > homozygous,

> > > > > > > > > heterozygous

and non-mutated patients; and to determine the

> > > > > > > > > efficiency of

treatment. Methods: Clinical, biological

> > and genetic

> > > > > > > > > data were

recorded in 26 patients. Results: Screening

> > for the

> > > > > > > > > SLC12A3 gene

detected 2 mutations in 15 patients (6

> > homozygous and 9

> > > > > > > > > compound

heterozygous), one mutation in 6, and no

> > mutation in 5

> > > > > > > > > patients.

There was no statistical difference in

> > clinical symptoms

> > > > > > > > > at diagnosis

between the 3 groups. Systolic blood

> > pressure tended to

> > > > > > > > > be lower in

patients with 2 mutations (p=0.16).

> > Hypertension was

> > > > > > > > > unexpectedly

detected in 4 patients. Five patients with

> > 2 mutated

> > > > > > > > > alleles and 2

with heterozygosity had severe

> > manifestations of GS.

> > > > > > > > > Significant

differences were observed between the 3

> > groups in blood

> > > > > > > > > potassium,

chloride, magnesium, supine aldosterone,

> > 24-hr urine

> > > > > > > > > chloride and

magnesium levels, and in MDRD. Mean blood

> > potassium

> > > > > > > > > levels

increased from 2.8ÃfâEURs(Ã,Â±0.3,

> > 3.5ÃfâEURs(Ã,Â±0.5, and 3.2ÃfâEURs(Ã,Â±0.3

before

> > > > > > > > > treatment to

3.2ÃfâEURs(Ã,Â±0.5, 3.7ÃfâEURs(Ã,Â±0.6 and

> > 3.7ÃfâEURs(Ã,Â±0.3 mmol/l with treatment in

> > > > > > > > > groups with 2

(p=0.003), 1 and no mutated alleles,

> > respectively.

> > > > > > > > > Conclusion:

In adult patients referred for renal

> > hypokalaemia, we

> > > > > > > > > confirmed the

presence of mutations of the SLC12A3 gene

> > in 80% of

> > > > > > > > > cases. GS was

more severe in patients with 2 than with 1

> > or no

> > > > > > > > > mutated

alleles. High blood pressure should not rule out

> > the

> > > > > > > > > diagnosis,

especially in older patients.

> > > > > > > > >

> > > > > > > > > PMID:

> > > > > > > > > 21753071

> > > > > > > > > [PubMed - as

supplied by publisher]

> > > > > > > > > Related

citations

> > > > > > > > >

> > > > > > > > > 4. J Clin

Endocrinol Metab. 2011 Jul 13. [Epub ahead of

> > print]

> > > > > > > > > Significance

of Adrenocorticotropin Stimulation Test in the

> > > > > > > > > Diagnosis of

an Aldosterone-Producing Adenoma.

> > > > > > > > >

> > > > > > > > > Sonoyama T,

Sone M, Miyashita K, Tamura N, Yamahara K,

> > Park K,

> > > > > > > > > Oyamada N,

Taura D, Inuzuka M, Kojima K, Honda K,

> > Fukunaga Y,

> > > > > > > > > Kanamoto N,

Miura M, Yasoda A, Arai H, Itoh H, Nakao K.

> > > > > > > > > Source

> > > > > > > > >

> > > > > > > > > Department of

Medicine and Clinical Science, Kyoto

> > University

> > > > > > > > > Graduate

School of Medicine, Sakyo-ku, Kyoto 606-8507,

> > Japan.

> > > > > > > > >

> > > > > > > > > Abstract

> > > > > > > > >

> > > > > > > > > Context:

Adrenal venous sampling is the "gold standard"

> > test in the

> > > > > > > > > diagnosis of

an aldosterone-producing adenoma (APA)

> > among patients

> > > > > > > > > with primary

aldosteronism (PA) but is available only in

> > specialized

> > > > > > > > > medical

centers. Meanwhile, an APA is reported to be

> > generally more

> > > > > > > > > sensitive to

ACTH than idiopathic hyperaldosteronism.

> > Objective: The

> > > >

> > >

> >

>

July 23, 2011

Blood Na tells little about body sodium. Full blown PA is associated with high plasma sodium. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

Hi ,

Thanks for your explanation!! I like the Grim Reality term. That

is great.

Keep up the excitement too - that is awesome.

Kellie

Kellie, If I've said it once, I've said it 100 times,

"The only dumb question is the one that is NOT asked!"

My version of outsalting: I was DXed with PA about 13mos

ago when ARR = 50, adnoma in rt. adrenal and the doc put

me on 25mg of Spiro. My BP dropped instantly to a point

where I called and asked how low was safe, Endo responded

not to worry, I was just where a normal man should be!

One symptom I had was rt. flank pain that radiated to my

rt testicle. I was sure it was somehow related to that

nasty little (12x13mm) adnoma. I found this site just

after the first of the year I think and I kept seeing

"flank pain". All but one of the doctors I "saw"

discounted my theory (this included PCP, Nepr, Endo!) Dr.

Grim remained neutral and wanted to get me off my 6BP meds

and Potassium Supl. and titrate Spiro up and let it work.

My NA was high (for me) early in treatment, 5/26/2010 =

141 & 7/8 = 142. Starting in December I finally got

the message (maybe it was the Grim Reality!) I had 5

readings between 12/14/2010 & 5/12/2011:

136,135,135,137,137 with a range of 135-145. On Apr. 23,

2011 I was more active than normal which I attribute to

"Kicking Spiro into HIGH Gear". While Narcotics, Oxycodone

and Methadone, made the pain bearable I was still in pain

but suddenly after the 23d the pain was gone. In addition

the trips to pee were greatly reduced (from often hourly

and up 4 times at night to every 6 - 8 hrs during the day

and sleeping thru the night!)

I think I've set the stage, everything was going

swimmingly until early June. We've done low salt at home

for years but I was out-n-about a little more and snuck in

a couple fast food and suddenly realized I eas feeling my

flank pain starting to return! You guessed it, NA was 140

when they tested it on June 7th!

The term "Out-Salting" was Dr. Grim's term. He said I had

been out-salting the Spiro until April 23d. My local docs

were probably right in that it wasn't the adnoma causing

the pain it was the excess aldosterone (that's what your

teenager would tell you!)

All I know is that I was bound and determined I was going

to prove Dr. G. wrong and show him that meds and surgery

did not accomplish the same results, I even had a surgeon

ready to go! I now admit he is right and can hardly

contain my excitement as I start to identify other

improvements to my systems!

Hope this helps but if it generates mor questions, ask

away! I love to share my excitement!

- 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma

with previous rt. flank & testicle pain. I have

decided against an adrenalectomy at this time since Meds.

are working so well. Current BP: 130/77

Other Issues/Opportunities: COPD w/ft Oxygen, OSA w Bi-Pap

settings 13/19, DM2. and PTSD

Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol

Tartrate 200 MG, Metformin 2000MG and Spironolactone 75

MG.

> > > > > > > >

> > > > > > > > Perhaps someone,

? ?, can summarize the ones on

> > surgery and

> > > > > > > > someone on the Dx

issues.

> > > > > > > >

> > > > > > > > I would do an

excel set up

> > > > > > > >

> > > > > > > > Paste abstract in

first cell then summarize in columns

> > next to it.

> > > > > > > > Number of subjects

etc. and conclusions. Also upload all

> > to our

> > > > > > > > references on PA.

> > > > > > > >

> > > > > > > > CE Grim MD

> > > > > > > >

> > > > > > > > Begin forwarded

message:

> > > > > > > >

> > > > > > > > > From: Sent by

NCBI <nobody@>

> > > > > > > > > Date: July

20, 2011 9:55:01 AM PDT

> > > > > > > > > To: lowerbp2@

> > > > > > > > > Subject:

PubMed Search Results

> > > > > > > > >

> > > > > > > > > This message

contains search results from the National

> > Center for

> > > > > > > > > Biotechnology

Information (NCBI) at the U.S. National

> > Library of

> > > > > > > > > Medicine

(NLM). Do not reply directly to this message

> > > > > > > > >

> > > > > > > > > Sender's

message: PA refs to July 11

> > > > > > > > >

> > > > > > > > > Sent on: Wed

Jul 20 12:52:12 2011

> > > > > > > > > 106 selected

items

> > > > > > > > >

> > > > > > > > > pubmed

Results

> > > > > > > > > Items 1 -106

of 106

> > > > > > > > >

> > > > > > > > > 1. Clin

Endocrinol (Oxf). 2011 Jul 18. doi: 10.1111/j.

> > > > > > > > >

1365-2265.2011.04177.x. [Epub ahead of print]

> > > > > > > > > 100 cases of

primary aldosteronism. Careful choice of

> > patients for

> > > > > > > > > surgery using

adrenal venous sampling and CT imaging

> > results in

> > > > > > > > > excellent

blood pressure and potassium outcomes.

> > > > > > > > >

> > > > > > > > > Graham U,

Ellis P, Hunter S, H, Mullan K, Atkinson A.

> > > > > > > > > Source

> > > > > > > > >

> > > > > > > > > Regional

Centre for Endocrinology and Diabetes, Royal

> >

> > > > > > > > > Hospital,

Belfast Imaging Centre, Royal

> > Hospital, Belfast

> > > > > > > > > Regional

Endocrine Laboratory, Royal Hospital,

> > Belfast.

> > > > > > > > >

> > > > > > > > > Abstract

> > > > > > > > >

Objective:ÃƒfÃ‚Â¢ÃƒÂ¢Ã¢EURs(Ã‚Â¬ÃƒÂ¢Ã¢,Â¬Ã…Â¡ Patients with primary

> > aldosteronism (PA) who are

> > > > > > > > > suitable for

surgery should undergo adrenal computerised

> > tomography

> > > > > > > > > (CT) and

adrenal venous sampling (AVS). A retrospective

> > study was

> > > > > > > > > performed of

100 patients with PA. We determined the

> > optimal AVS

> > > > > > > > >

lateralisation ratio for unilateral disease and reviewed

> > > > > > > > > adrenalectomy

outcomes evaluating which characteristics

> > predicted

> > > > > > > > > hypertension

cure. Methods:ÃƒfÃ‚Â¢ÃƒÂ¢Ã¢EURs(Ã‚Â¬ÃƒÂ¢Ã¢,Â¬Ã…Â¡ AVS was

> > performed in 93 patients.

> > > > > > > > >

Lateralisation criteria were assessed using ROC curve

> > analysis. The

> > > > > > > > > outcome of

adrenalectomy was reviewed in 39 patients and

> > predictive

> > > > > > > > > factors for

cure determined using univariate and

> > multivariate

> > > > > > > > > analysis.

Results:ÃƒfÃ‚Â¢ÃƒÂ¢Ã¢EURs(Ã‚Â¬ÃƒÂ¢Ã¢,Â¬Ã…Â¡ Of previously

> > published criteria, ROC curve

> > > > > > > > > analysis

found a cortisol corrected aldosterone affected to

> > > > > > > > > unaffected

(Aldo/Cort A:U) cut-off of 2.0 was the best

> > predictor of

> > > > > > > > > adenoma

identifying 80.4% of patients. A novel ratio

> > calculated by

> > > > > > > > > dividing the

affected to unaffected ratio by the

> > unaffected to

> > > > > > > > > peripheral

ratio (Aldo/Cort A:U ÃƒfÃ†'Ãƒ,Ã‚Â· Aldo/Cort

> > U:IVC) was successful in

> > > > > > > > > identifying

87.0% of patients. Cure rate for blood

> > pressure after

> > > > > > > > > adrenalectomy

was 38.5% with improvement in 59.0%. On

> > univariate

> > > > > > > > > analysis,

predictors of post-operative hypertension were

> > increased

> > > > > > > > > weight,

raised creatinine, left ventricular hypertrophy

> > (LVH) and

> > > > > > > > > male sex. On

multivariate analysis, male sex and higher

> > pre-

> > > > > > > > > operative

systolic blood pressure were predictive.

> > Conclusions:ÃƒfÃ‚Â¢ÃƒÂ¢Ã¢EURs(Ã‚Â¬ÃƒÂ¢Ã¢,Â¬Ã…Â¡

> > > > > > > > > Patients with

PA should have CT scanning and AVS.

> > Aldo/Cort A:U >2.0

> > > > > > > > > is the most

accurate of previously published ratios in

> > predicting

> > > > > > > > > unilateral

disease. When patients were carefully

> > selected for

> > > > > > > > > surgery, 97%

had cure or improvement in blood pressure

> > control.

> > > > > > > > > Further

confirmatory work is required on a novel ratio

> > which was

> > > > > > > > > even more

predictive in our series.

> > > > > > > > >

> > > > > > > > > Copyright

> > > > > > > > >

> > > > > > > > > PMID:

> > > > > > > > > 21767289

> > > > > > > > > [PubMed - as

supplied by publisher]

> > > > > > > > > Related

citations

> > > > > > > > > 2. J Clin

Hypertens (Greenwich). 2011 Jul;13(7):487-91.

> > doi: 10.1111/

> > > > > > > > >

j.1751-7176.2011.00443.x. Epub 2011 Mar 28.

> > > > > > > > > Resistant

hypertension and undiagnosed primary

> > hyperaldosteronism

> > > > > > > > > detected by

use of a computerized database.

> > > > > > > > >

> > > > > > > > > EA,

JR, Meier JL, Swislocki AL, Siegel D.

> > > > > > > > > Source

> > > > > > > > >

> > > > > > > > > From the VA

Northern California Health Care System,

> > Mather Field,

> > > > > > > > > CA;the School

of Medicine, University of California,

> > , CA.

> > > > > > > > >

> > > > > > > > > Abstract

> > > > > > > > >

> > > > > > > > > J Clin

Hypertens (Greenwich).

> > > > > > > > > Periodicals,

Inc. A pharmacy database was used to

> > identify patients

> > > > > > > > > with

resistant hypertension who could then be tested for

> > the

> > > > > > > > > presence of

primary hyperaldosteronism. Inclusion

> > criteria were: (1)

> > > > > > > > > resistant

hypertension defined as uncontrolled

> > hypertension and use

> > > > > > > > > of 3

antihypertensive medication classes or

> > ÃƒfÃ‚Â¢ÃƒÂ¢Ã¢,Â¬Ã‚Â°Ãƒ,Ã‚Â¥4 antihypertensive

> > > > > > > > > classes

regardless of blood pressure; (2) low or normal

> > potassium

> > > > > > > > > levels

(ÃƒfÃ‚Â¢ÃƒÂ¢Ã¢,Â¬Ã‚Â°Ãƒ,Ã‚Â¤4.9ÃƒfÃ‚Â¢ÃƒÂ¢Ã¢EURs(Ã‚Â¬Ãƒ+'mEq/L); and

> > (3) continuous health care from October

> > > > > > > > > 1, 2008, to

February 28, 2009. Exclusion criteria were:

> > (1) past or

> > > > > > > > > current use

of an aldosterone antagonist, or (2) a

> > medication

> > > > > > > > > possession

ratio (adherence) <80% for any

> > antihypertensive drug.

> > > > > > > > >

Hyperaldosteronism was classified as an

> > aldosterone/renin ratio

> > > > > > > > > (ARR)

ÃƒfÃ‚Â¢ÃƒÂ¢Ã¢,Â¬Ã‚Â°Ãƒ,Ã‚Â¥30. Using the computer, 746

> > patients were identified who met

> > > > > > > > > criteria.

After manual chart review to verify inclusion and

> > > > > > > > > exclusion

criteria, 333 patients remained. Of 184

> > individuals in

> > > > > > > > > whom an ARR

was obtained, 39 (21.2%) had a ratio of

> > ÃƒfÃ‚Â¢ÃƒÂ¢Ã¢,Â¬Ã‚Â°Ãƒ,Ã‚Â¥30. A computer

> > > > > > > > > database is

useful to identify patients with resistant

> > hypertension

> > > > > > > > > and those who

may have primary aldosteronism.

> > > > > > > > >

> > > > > > > > > ÃƒfÃ¢EURs(Ãƒ,Ã‚Â©

2011 Wiley Periodicals, Inc.

> > > > > > > > >

> > > > > > > > > PMID:

> > > > > > > > > 21762361

> > > > > > > > > [PubMed - in

process]

> > > > > > > > > Related

citations

> > > > > > > > >

> > > > > > > > > 3. Eur J

Endocrinol. 2011 Jul 13. [Epub ahead of print]

> > > > > > > > >

PHENOTYPE-GENOTYPE CORRELATION AND FOLLOW-UP IN ADULT

> > PATIENTS WITH

> > > > > > > > > HYPOKALAEMIA

OF RENAL ORIGIN SUGGESTING GITELMAN SYNDROME.

> > > > > > > > >

> > > > > > > > > Balavoine AS,

Bataille P, Vanhille P, Azar R,

> > NoÃƒfÃ†'Ãƒ,Ã‚Â«l C, Asseman P,

> > > > > > > > > Soudan B,

Wemeau JL, Vantyghem MC.

> > > > > > > > > Source

> > > > > > > > >

> > > > > > > > > A Balavoine,

Service Endocrinologie et Maladies

> > MÃƒfÃ†'Ãƒ,Ã‚Â©taboliques,

> > > > > > > > > Clinique

Endocrinologique Marc Linquette, Lille, 59037

> > cedex, France.

> > > > > > > > >

> > > > > > > > > Abstract

> > > > > > > > >

> > > > > > > > > Gitelman

syndrome is a tubulopathy caused by SLC12A3

> > gene mutations,

> > > > > > > > > which lead to

hypokalaemic alkalosis, secondary

> > hyperaldosteronism,

> > > > > > > > >

hypomagnesaemia and hypocalciuria. The aim of this study

> > was to

> > > > > > > > > assess the

prevalence of SLC12A3 gene mutations in adult

> > > > > > > > > hypokalaemic

patients; to compare the phenotype of

> > homozygous,

> > > > > > > > > heterozygous

and non-mutated patients; and to determine the

> > > > > > > > > efficiency of

treatment. Methods: Clinical, biological

> > and genetic

> > > > > > > > > data were

recorded in 26 patients. Results: Screening

> > for the

> > > > > > > > > SLC12A3 gene

detected 2 mutations in 15 patients (6

> > homozygous and 9

> > > > > > > > > compound

heterozygous), one mutation in 6, and no

> > mutation in 5

> > > > > > > > > patients.

There was no statistical difference in

> > clinical symptoms

> > > > > > > > > at diagnosis

between the 3 groups. Systolic blood

> > pressure tended to

> > > > > > > > > be lower in

patients with 2 mutations (p=0.16).

> > Hypertension was

> > > > > > > > > unexpectedly

detected in 4 patients. Five patients with

> > 2 mutated

> > > > > > > > > alleles and 2

with heterozygosity had severe

> > manifestations of GS.

> > > > > > > > > Significant

differences were observed between the 3

> > groups in blood

> > > > > > > > > potassium,

chloride, magnesium, supine aldosterone,

> > 24-hr urine

> > > > > > > > > chloride and

magnesium levels, and in MDRD. Mean blood

> > potassium

> > > > > > > > > levels

increased from 2.8ÃƒfÃ¢EURs(Ãƒ,Ã‚Â±0.3,

> > 3.5ÃƒfÃ¢EURs(Ãƒ,Ã‚Â±0.5, and 3.2ÃƒfÃ¢EURs(Ãƒ,Ã‚Â±0.3

before

> > > > > > > > > treatment to

3.2ÃƒfÃ¢EURs(Ãƒ,Ã‚Â±0.5, 3.7ÃƒfÃ¢EURs(Ãƒ,Ã‚Â±0.6 and

> > 3.7ÃƒfÃ¢EURs(Ãƒ,Ã‚Â±0.3 mmol/l with treatment in

> > > > > > > > > groups with 2

(p=0.003), 1 and no mutated alleles,

> > respectively.

> > > > > > > > > Conclusion:

In adult patients referred for renal

> > hypokalaemia, we

> > > > > > > > > confirmed the

presence of mutations of the SLC12A3 gene

> > in 80% of

> > > > > > > > > cases. GS was

more severe in patients with 2 than with 1

> > or no

> > > > > > > > > mutated

alleles. High blood pressure should not rule out

> > the

> > > > > > > > > diagnosis,

especially in older patients.

> > > > > > > > >

> > > > > > > > > PMID:

> > > > > > > > > 21753071

> > > > > > > > > [PubMed - as

supplied by publisher]

> > > > > > > > > Related

citations

> > > > > > > > >

> > > > > > > > > 4. J Clin

Endocrinol Metab. 2011 Jul 13. [Epub ahead of

> > print]

> > > > > > > > > Significance

of Adrenocorticotropin Stimulation Test in the

> > > > > > > > > Diagnosis of

an Aldosterone-Producing Adenoma.

> > > > > > > > >

> > > > > > > > > Sonoyama T,

Sone M, Miyashita K, Tamura N, Yamahara K,

> > Park K,

> > > > > > > > > Oyamada N,

Taura D, Inuzuka M, Kojima K, Honda K,

> > Fukunaga Y,

> > > > > > > > > Kanamoto N,

Miura M, Yasoda A, Arai H, Itoh H, Nakao K.

> > > > > > > > > Source

> > > > > > > > >

> > > > > > > > > Department of

Medicine and Clinical Science, Kyoto

> > University

> > > > > > > > > Graduate

School of Medicine, Sakyo-ku, Kyoto 606-8507,

> > Japan.

> > > > > > > > >

> > > > > > > > > Abstract

> > > > > > > > >

> > > > > > > > > Context:

Adrenal venous sampling is the "gold standard"

> > test in the

> > > > > > > > > diagnosis of

an aldosterone-producing adenoma (APA)

> > among patients

> > > > > > > > > with primary

aldosteronism (PA) but is available only in

> > specialized

> > > > > > > > > medical

centers. Meanwhile, an APA is reported to be

> > generally more

> > > > > > > > > sensitive to

ACTH than idiopathic hyperaldosteronism.

> > Objective: The

> > > >

> > >

> >

>

July 23, 2011

Dr. Grim, The numbers for NA that I have been reporting are listed under

" Chemistry (Plasma) " in my lab results. Is this the right one? I haven't

noticed any other NA in the reports but have a lot of pages to review! Thanks.

- 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank &

testicle pain. I have decided against an adrenalectomy at this time since

Meds. are working so well. Current BP: 130/77

Other Issues/Opportunities: COPD w/ft Oxygen, OSA w Bi-Pap settings 13/19, DM2.

and PTSD

Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG,

Metformin 2000MG and Spironolactone 75 MG.

> >> > > > > > > > >

> >> > > > > > > > > Perhaps someone, ? ?, can summarize the ones on

> >> > > surgery and

> >> > > > > > > > > someone on the Dx issues.

> >> > > > > > > > >

> >> > > > > > > > > I would do an excel set up

> >> > > > > > > > >

> >> > > > > > > > > Paste abstract in first cell then summarize in columns

> >> > > next to it.

> >> > > > > > > > > Number of subjects etc. and conclusions. Also upload all

> >> > > to our

> >> > > > > > > > > references on PA.

> >> > > > > > > > >

> >> > > > > > > > > CE Grim MD

> >> > > > > > > > >

> >> > > > > > > > > Begin forwarded message:

> >> > > > > > > > >

> >> > > > > > > > > > From: Sent by NCBI <nobody@>

> >> > > > > > > > > > Date: July 20, 2011 9:55:01 AM PDT

> >> > > > > > > > > > To: lowerbp2@

> >> > > > > > > > > > Subject: PubMed Search Results

> >> > > > > > > > > >

> >> > > > > > > > > > This message contains search results from the National

> >> > > Center for

> >> > > > > > > > > > Biotechnology Information (NCBI) at the U.S. National

> >> > > Library of

> >> > > > > > > > > > Medicine (NLM). Do not reply directly to this message

> >> > > > > > > > > >

> >> > > > > > > > > > Sender's message: PA refs to July 11

> >> > > > > > > > > >

> >> > > > > > > > > > Sent on: Wed Jul 20 12:52:12 2011

> >> > > > > > > > > > 106 selected items

> >> > > > > > > > > >

> >> > > > > > > > > > pubmed Results

> >> > > > > > > > > > Items 1 -106 of 106

> >> > > > > > > > > >

> >> > > > > > > > > > 1. Clin Endocrinol (Oxf). 2011 Jul 18. doi: 10.1111/j.

> >> > > > > > > > > > 1365-2265.2011.04177.x. [Epub ahead of print]

> >> > > > > > > > > > 100 cases of primary aldosteronism. Careful choice of

> >> > > patients for

> >> > > > > > > > > > surgery using adrenal venous sampling and CT imaging

> >> > > results in

> >> > > > > > > > > > excellent blood pressure and potassium outcomes.

> >> > > > > > > > > >

> >> > > > > > > > > > Graham U, Ellis P, Hunter S, H, Mullan K, Atkinson

A.

> >> > > > > > > > > > Source

> >> > > > > > > > > >

> >> > > > > > > > > > Regional Centre for Endocrinology and Diabetes, Royal

> >> > >

> >> > > > > > > > > > Hospital, Belfast Imaging Centre, Royal

> >> > > Hospital, Belfast

> >> > > > > > > > > > Regional Endocrine Laboratory, Royal Hospital,

> >> > > Belfast.

> >> > > > > > > > > >

> >> > > > > > > > > > Abstract

> >> > > > > > > > > >

> >> > > > > > > > > > Objective:ÃƒfÃ‚Â¢ÃƒÂ¢Ã¢EURs(Ã‚Â¬ÃƒÂ¢Ã¢,Â¬Ã…Â¡ Patients

with primary

> >> > > aldosteronism (PA) who are

> >> > > > > > > > > > suitable for surgery should undergo adrenal computerised

> >> > > tomography

> >> > > > > > > > > > (CT) and adrenal venous sampling (AVS). A retrospective

> >> > > study was

> >> > > > > > > > > > performed of 100 patients with PA. We determined the

> >> > > optimal AVS

> >> > > > > > > > > > lateralisation ratio for unilateral disease and reviewed

> >> > > > > > > > > > adrenalectomy outcomes evaluating which characteristics

> >> > > predicted

> >> > > > > > > > > > hypertension cure.

Methods:ÃƒfÃ‚Â¢ÃƒÂ¢Ã¢EURs(Ã‚Â¬ÃƒÂ¢Ã¢,Â¬Ã…Â¡ AVS was

> >> > > performed in 93 patients.

> >> > > > > > > > > > Lateralisation criteria were assessed using ROC curve

> >> > > analysis. The

> >> > > > > > > > > > outcome of adrenalectomy was reviewed in 39 patients and

> >> > > predictive

> >> > > > > > > > > > factors for cure determined using univariate and

> >> > > multivariate

> >> > > > > > > > > > analysis. Results:ÃƒfÃ‚Â¢ÃƒÂ¢Ã¢EURs(Ã‚Â¬ÃƒÂ¢Ã¢,Â¬Ã…Â¡ Of

previously

> >> > > published criteria, ROC curve

> >> > > > > > > > > > analysis found a cortisol corrected aldosterone affected

to

> >> > > > > > > > > > unaffected (Aldo/Cort A:U) cut-off of 2.0 was the best

> >> > > predictor of

> >> > > > > > > > > > adenoma identifying 80.4% of patients. A novel ratio

> >> > > calculated by

> >> > > > > > > > > > dividing the affected to unaffected ratio by the

> >> > > unaffected to

> >> > > > > > > > > > peripheral ratio (Aldo/Cort A:U ÃƒfÃ†'Ãƒ,Ã‚Â· Aldo/Cort

> >> > > U:IVC) was successful in

> >> > > > > > > > > > identifying 87.0% of patients. Cure rate for blood

> >> > > pressure after

> >> > > > > > > > > > adrenalectomy was 38.5% with improvement in 59.0%. On

> >> > > univariate

> >> > > > > > > > > > analysis, predictors of post-operative hypertension were

> >> > > increased

> >> > > > > > > > > > weight, raised creatinine, left ventricular hypertrophy

> >> > > (LVH) and

> >> > > > > > > > > > male sex. On multivariate analysis, male sex and higher

> >> > > pre-

> >> > > > > > > > > > operative systolic blood pressure were predictive.

> >> > > Conclusions:ÃƒfÃ‚Â¢ÃƒÂ¢Ã¢EURs(Ã‚Â¬ÃƒÂ¢Ã¢,Â¬Ã…Â¡

> >> > > > > > > > > > Patients with PA should have CT scanning and AVS.

> >> > > Aldo/Cort A:U >2.0

> >> > > > > > > > > > is the most accurate of previously published ratios in

> >> > > predicting

> >> > > > > > > > > > unilateral disease. When patients were carefully

> >> > > selected for

> >> > > > > > > > > > surgery, 97% had cure or improvement in blood pressure

> >> > > control.

> >> > > > > > > > > > Further confirmatory work is required on a novel ratio

> >> > > which was

> >> > > > > > > > > > even more predictive in our series.

> >> > > > > > > > > >

Ltd.

> >> > > > > > > > > >

> >> > > > > > > > > > PMID:

> >> > > > > > > > > > 21767289

> >> > > > > > > > > > [PubMed - as supplied by publisher]

> >> > > > > > > > > > Related citations

> >> > > > > > > > > > 2. J Clin Hypertens (Greenwich). 2011 Jul;13(7):487-91.

> >> > > doi: 10.1111/

> >> > > > > > > > > > j.1751-7176.2011.00443.x. Epub 2011 Mar 28.

> >> > > > > > > > > > Resistant hypertension and undiagnosed primary

> >> > > hyperaldosteronism

> >> > > > > > > > > > detected by use of a computerized database.

> >> > > > > > > > > >

> >> > > > > > > > > > EA, JR, Meier JL, Swislocki AL, Siegel D.

> >> > > > > > > > > > Source

> >> > > > > > > > > >

> >> > > > > > > > > > From the VA Northern California Health Care System,

> >> > > Mather Field,

> >> > > > > > > > > > CA;the School of Medicine, University of California,

> >> > > , CA.

> >> > > > > > > > > >

> >> > > > > > > > > > Abstract

> >> > > > > > > > > >

> >> > > > > > > > > > J Clin Hypertens (Greenwich).

> >> > > > > > > > > > Periodicals, Inc. A pharmacy database was used to

> >> > > identify patients

> >> > > > > > > > > > with resistant hypertension who could then be tested for

> >> > > the

> >> > > > > > > > > > presence of primary hyperaldosteronism. Inclusion

> >> > > criteria were: (1)

> >> > > > > > > > > > resistant hypertension defined as uncontrolled

> >> > > hypertension and use

> >> > > > > > > > > > of 3 antihypertensive medication classes or

> >> > > ÃƒfÃ‚Â¢ÃƒÂ¢Ã¢,Â¬Ã‚Â°Ãƒ,Ã‚Â¥4 antihypertensive

> >> > > > > > > > > > classes regardless of blood pressure; (2) low or normal

> >> > > potassium

> >> > > > > > > > > > levels

(ÃƒfÃ‚Â¢ÃƒÂ¢Ã¢,Â¬Ã‚Â°Ãƒ,Ã‚Â¤4.9ÃƒfÃ‚Â¢ÃƒÂ¢Ã¢EURs(Ã‚Â¬Ãƒ+'mEq/L); and

> >> > > (3) continuous health care from October

> >> > > > > > > > > > 1, 2008, to February 28, 2009. Exclusion criteria were:

> >> > > (1) past or

> >> > > > > > > > > > current use of an aldosterone antagonist, or (2) a

> >> > > medication

> >> > > > > > > > > > possession ratio (adherence) <80% for any

> >> > > antihypertensive drug.

> >> > > > > > > > > > Hyperaldosteronism was classified as an

> >> > > aldosterone/renin ratio

> >> > > > > > > > > > (ARR) ÃƒfÃ‚Â¢ÃƒÂ¢Ã¢,Â¬Ã‚Â°Ãƒ,Ã‚Â¥30. Using the computer,

746

> >> > > patients were identified who met

> >> > > > > > > > > > criteria. After manual chart review to verify inclusion

and

> >> > > > > > > > > > exclusion criteria, 333 patients remained. Of 184

> >> > > individuals in

> >> > > > > > > > > > whom an ARR was obtained, 39 (21.2%) had a ratio of

> >> > > ÃƒfÃ‚Â¢ÃƒÂ¢Ã¢,Â¬Ã‚Â°Ãƒ,Ã‚Â¥30. A computer

> >> > > > > > > > > > database is useful to identify patients with resistant

> >> > > hypertension

> >> > > > > > > > > > and those who may have primary aldosteronism.

> >> > > > > > > > > >

> >> > > > > > > > > > PMID:

> >> > > > > > > > > > 21762361

> >> > > > > > > > > > [PubMed - in process]

> >> > > > > > > > > > Related citations

> >> > > > > > > > > >

> >> > > > > > > > > > 3. Eur J Endocrinol. 2011 Jul 13. [Epub ahead of print]

> >> > > > > > > > > > PHENOTYPE-GENOTYPE CORRELATION AND FOLLOW-UP IN ADULT

> >> > > PATIENTS WITH

> >> > > > > > > > > > HYPOKALAEMIA OF RENAL ORIGIN SUGGESTING GITELMAN

SYNDROME.

> >> > > > > > > > > >

> >> > > > > > > > > > Balavoine AS, Bataille P, Vanhille P, Azar R,

> >> > > NoÃƒfÃ†'Ãƒ,Ã‚Â«l C, Asseman P,

> >> > > > > > > > > > Soudan B, Wemeau JL, Vantyghem MC.

> >> > > > > > > > > > Source

> >> > > > > > > > > >

> >> > > > > > > > > > A Balavoine, Service Endocrinologie et Maladies

> >> > > MÃƒfÃ†'Ãƒ,Ã‚Â©taboliques,

> >> > > > > > > > > > Clinique Endocrinologique Marc Linquette, Lille, 59037

> >> > > cedex, France.

> >> > > > > > > > > >

> >> > > > > > > > > > Abstract

> >> > > > > > > > > >

> >> > > > > > > > > > Gitelman syndrome is a tubulopathy caused by SLC12A3

> >> > > gene mutations,

> >> > > > > > > > > > which lead to hypokalaemic alkalosis, secondary

> >> > > hyperaldosteronism,

> >> > > > > > > > > > hypomagnesaemia and hypocalciuria. The aim of this study

> >> > > was to

> >> > > > > > > > > > assess the prevalence of SLC12A3 gene mutations in adult

> >> > > > > > > > > > hypokalaemic patients; to compare the phenotype of

> >> > > homozygous,

> >> > > > > > > > > > heterozygous and non-mutated patients; and to determine

the

> >> > > > > > > > > > efficiency of treatment. Methods: Clinical, biological

> >> > > and genetic

> >> > > > > > > > > > data were recorded in 26 patients. Results: Screening

> >> > > for the

> >> > > > > > > > > > SLC12A3 gene detected 2 mutations in 15 patients (6

> >> > > homozygous and 9

> >> > > > > > > > > > compound heterozygous), one mutation in 6, and no

> >> > > mutation in 5

> >> > > > > > > > > > patients. There was no statistical difference in

> >> > > clinical symptoms

> >> > > > > > > > > > at diagnosis between the 3 groups. Systolic blood

> >> > > pressure tended to

> >> > > > > > > > > > be lower in patients with 2 mutations (p=0.16).

> >> > > Hypertension was

> >> > > > > > > > > > unexpectedly detected in 4 patients. Five patients with

> >> > > 2 mutated

> >> > > > > > > > > > alleles and 2 with heterozygosity had severe

> >> > > manifestations of GS.

> >> > > > > > > > > > Significant differences were observed between the 3

> >> > > groups in blood

> >> > > > > > > > > > potassium, chloride, magnesium, supine aldosterone,

> >> > > 24-hr urine

> >> > > > > > > > > > chloride and magnesium levels, and in MDRD. Mean blood

> >> > > potassium

> >> > > > > > > > > > levels increased from 2.8ÃƒfÃ¢EURs(Ãƒ,Ã‚Â±0.3,

> >> > > 3.5ÃƒfÃ¢EURs(Ãƒ,Ã‚Â±0.5, and 3.2ÃƒfÃ¢EURs(Ãƒ,Ã‚Â±0.3 before

> >> > > > > > > > > > treatment to 3.2ÃƒfÃ¢EURs(Ãƒ,Ã‚Â±0.5,

3.7ÃƒfÃ¢EURs(Ãƒ,Ã‚Â±0.6 and

> >> > > 3.7ÃƒfÃ¢EURs(Ãƒ,Ã‚Â±0.3 mmol/l with treatment in

> >> > > > > > > > > > groups with 2 (p=0.003), 1 and no mutated alleles,

> >> > > respectively.

> >> > > > > > > > > > Conclusion: In adult patients referred for renal

> >> > > hypokalaemia, we

> >> > > > > > > > > > confirmed the presence of mutations of the SLC12A3 gene

> >> > > in 80% of

> >> > > > > > > > > > cases. GS was more severe in patients with 2 than with 1

> >> > > or no

> >> > > > > > > > > > mutated alleles. High blood pressure should not rule out

> >> > > the

> >> > > > > > > > > > diagnosis, especially in older patients.

> >> > > > > > > > > >

> >> > > > > > > > > > PMID:

> >> > > > > > > > > > 21753071

> >> > > > > > > > > > [PubMed - as supplied by publisher]

> >> > > > > > > > > > Related citations

> >> > > > > > > > > >

> >> > > > > > > > > > 4. J Clin Endocrinol Metab. 2011 Jul 13. [Epub ahead of

> >> > > print]

> >> > > > > > > > > > Significance of Adrenocorticotropin Stimulation Test in

the

> >> > > > > > > > > > Diagnosis of an Aldosterone-Producing Adenoma.

> >> > > > > > > > > >

> >> > > > > > > > > > Sonoyama T, Sone M, Miyashita K, Tamura N, Yamahara K,

> >> > > Park K,

> >> > > > > > > > > > Oyamada N, Taura D, Inuzuka M, Kojima K, Honda K,

> >> > > Fukunaga Y,

> >> > > > > > > > > > Kanamoto N, Miura M, Yasoda A, Arai H, Itoh H, Nakao K.

> >> > > > > > > > > > Source

> >> > > > > > > > > >

> >> > > > > > > > > > Department of Medicine and Clinical Science, Kyoto

> >> > > University

> >> > > > > > > > > > Graduate School of Medicine, Sakyo-ku, Kyoto 606-8507,

> >> > > Japan.

> >> > > > > > > > > >

> >> > > > > > > > > > Abstract

> >> > > > > > > > > >

> >> > > > > > > > > > Context: Adrenal venous sampling is the " gold standard "

> >> > > test in the

> >> > > > > > > > > > diagnosis of an aldosterone-producing adenoma (APA)

> >> > > among patients

> >> > > > > > > > > > with primary aldosteronism (PA) but is available only in

> >> > > specialized

> >> > > > > > > > > > medical centers. Meanwhile, an APA is reported to be

> >> > > generally more

> >> > > > > > > > > > sensitive to ACTH than idiopathic hyperaldosteronism.

> >> > > Objective: The

> >> > > > >

> >> > > >

> >> > >

> >> >

> >>

> >

>

July 23, 2011

Thanks for the articles AND discussion it will take long to read all that...

>

> Perhaps someone, ? ?, can summarize the ones on surgery and

> someone on the Dx issues.

>

> I would do an excel set up

>

> Paste abstract in first cell then summarize in columns next to it.

> Number of subjects etc. and conclusions. Also upload all to our

> references on PA.

>

> CE Grim MD

>

> Begin forwarded message:

>

> >

> > Date: July 20, 2011 9:55:01 AM PDT

> > To: lowerbp2@...

> > Subject: PubMed Search Results

> >

> > This message contains search results from the National Center for

> > Biotechnology Information (NCBI) at the U.S. National Library of

> > Medicine (NLM). Do not reply directly to this message

> >

> > Sender's message: PA refs to July 11

> >

> > Sent on: Wed Jul 20 12:52:12 2011

> > 106 selected items

> >

> > pubmed Results

> > Items 1 -106 of 106

> >

> > 1. Clin Endocrinol (Oxf). 2011 Jul 18. doi: 10.1111/j.

> > 1365-2265.2011.04177.x. [Epub ahead of print]

> > 100 cases of primary aldosteronism. Careful choice of patients for

> > surgery using adrenal venous sampling and CT imaging results in

> > excellent blood pressure and potassium outcomes.

> >

> > Graham U, Ellis P, Hunter S, H, Mullan K, Atkinson A.

> > Source

> >

> > Regional Centre for Endocrinology and Diabetes, Royal

> > Hospital, Belfast Imaging Centre, Royal Hospital, Belfast

> > Regional Endocrine Laboratory, Royal Hospital, Belfast.

> >

> > Abstract

> >

> > Objective:â€‚ Patients with primary aldosteronism (PA) who are

> > suitable for surgery should undergo adrenal computerised tomography

> > (CT) and adrenal venous sampling (AVS). A retrospective study was

> > performed of 100 patients with PA. We determined the optimal AVS

> > lateralisation ratio for unilateral disease and reviewed

> > adrenalectomy outcomes evaluating which characteristics predicted

> > hypertension cure. Methods:â€‚ AVS was performed in 93 patients.

> > Lateralisation criteria were assessed using ROC curve analysis. The

> > outcome of adrenalectomy was reviewed in 39 patients and predictive

> > factors for cure determined using univariate and multivariate

> > analysis. Results:â€‚ Of previously published criteria, ROC curve

> > analysis found a cortisol corrected aldosterone affected to

> > unaffected (Aldo/Cort A:U) cut-off of 2.0 was the best predictor of

> > adenoma identifying 80.4% of patients. A novel ratio calculated by

> > dividing the affected to unaffected ratio by the unaffected to

> > peripheral ratio (Aldo/Cort A:U Ã· Aldo/Cort U:IVC) was successful in

> > identifying 87.0% of patients. Cure rate for blood pressure after

> > adrenalectomy was 38.5% with improvement in 59.0%. On univariate

> > analysis, predictors of post-operative hypertension were increased

> > weight, raised creatinine, left ventricular hypertrophy (LVH) and

> > male sex. On multivariate analysis, male sex and higher pre-

> > operative systolic blood pressure were predictive. Conclusions:â€‚

> > Patients with PA should have CT scanning and AVS. Aldo/Cort A:U >2.0

> > is the most accurate of previously published ratios in predicting

> > unilateral disease. When patients were carefully selected for

> > surgery, 97% had cure or improvement in blood pressure control.

> > Further confirmatory work is required on a novel ratio which was

> > even more predictive in our series.

> >

> > PMID:

> > 21767289

> > [PubMed - as supplied by publisher]

> > Related citations

> > 2. J Clin Hypertens (Greenwich). 2011 Jul;13(7):487-91. doi: 10.1111/

> > j.1751-7176.2011.00443.x. Epub 2011 Mar 28.

> > Resistant hypertension and undiagnosed primary hyperaldosteronism

> > detected by use of a computerized database.

> >

> > EA, JR, Meier JL, Swislocki AL, Siegel D.

> > Source

> >

> > From the VA Northern California Health Care System, Mather Field,

> > CA;the School of Medicine, University of California, , CA.

> >

> > Abstract

> >

> > Periodicals, Inc. A pharmacy database was used to identify patients

> > with resistant hypertension who could then be tested for the

> > presence of primary hyperaldosteronism. Inclusion criteria were: (1)

> > resistant hypertension defined as uncontrolled hypertension and use

> > of 3 antihypertensive medication classes or â‰¥4 antihypertensive

> > classes regardless of blood pressure; (2) low or normal potassium

> > levels (â‰¤4.9â€ƒmEq/L); and (3) continuous health care from October

> > 1, 2008, to February 28, 2009. Exclusion criteria were: (1) past or

> > current use of an aldosterone antagonist, or (2) a medication

> > possession ratio (adherence) <80% for any antihypertensive drug.

> > Hyperaldosteronism was classified as an aldosterone/renin ratio

> > (ARR) â‰¥30. Using the computer, 746 patients were identified who met

> > criteria. After manual chart review to verify inclusion and

> > exclusion criteria, 333 patients remained. Of 184 individuals in

> > whom an ARR was obtained, 39 (21.2%) had a ratio of â‰¥30. A computer

> > database is useful to identify patients with resistant hypertension

> > and those who may have primary aldosteronism.

> >

> > PMID:

> > 21762361

> > [PubMed - in process]

> > Related citations

> >

> > 3. Eur J Endocrinol. 2011 Jul 13. [Epub ahead of print]

> > PHENOTYPE-GENOTYPE CORRELATION AND FOLLOW-UP IN ADULT PATIENTS WITH

> > HYPOKALAEMIA OF RENAL ORIGIN SUGGESTING GITELMAN SYNDROME.

> >

> > Balavoine AS, Bataille P, Vanhille P, Azar R, NoÃ«l C, Asseman P,

> > Soudan B, Wemeau JL, Vantyghem MC.

> > Source

> >

> > A Balavoine, Service Endocrinologie et Maladies MÃ©taboliques,

> > Clinique Endocrinologique Marc Linquette, Lille, 59037 cedex, France.

> >

> > Abstract

> >

> > Gitelman syndrome is a tubulopathy caused by SLC12A3 gene mutations,

> > which lead to hypokalaemic alkalosis, secondary hyperaldosteronism,

> > hypomagnesaemia and hypocalciuria. The aim of this study was to

> > assess the prevalence of SLC12A3 gene mutations in adult

> > hypokalaemic patients; to compare the phenotype of homozygous,

> > heterozygous and non-mutated patients; and to determine the

> > efficiency of treatment. Methods: Clinical, biological and genetic

> > data were recorded in 26 patients. Results: Screening for the

> > SLC12A3 gene detected 2 mutations in 15 patients (6 homozygous and 9

> > compound heterozygous), one mutation in 6, and no mutation in 5

> > patients. There was no statistical difference in clinical symptoms

> > at diagnosis between the 3 groups. Systolic blood pressure tended to

> > be lower in patients with 2 mutations (p=0.16). Hypertension was

> > unexpectedly detected in 4 patients. Five patients with 2 mutated

> > alleles and 2 with heterozygosity had severe manifestations of GS.

> > Significant differences were observed between the 3 groups in blood

> > potassium, chloride, magnesium, supine aldosterone, 24-hr urine

> > chloride and magnesium levels, and in MDRD. Mean blood potassium

> > levels increased from 2.8Â±0.3, 3.5Â±0.5, and 3.2Â±0.3 before

> > treatment to 3.2Â±0.5, 3.7Â±0.6 and 3.7Â±0.3 mmol/l with treatment in

> > groups with 2 (p=0.003), 1 and no mutated alleles, respectively.

> > Conclusion: In adult patients referred for renal hypokalaemia, we

> > confirmed the presence of mutations of the SLC12A3 gene in 80% of

> > cases. GS was more severe in patients with 2 than with 1 or no

> > mutated alleles. High blood pressure should not rule out the

> > diagnosis, especially in older patients.

> >

> > PMID:

> > 21753071

> > [PubMed - as supplied by publisher]

> > Related citations

> >

> > 4. J Clin Endocrinol Metab. 2011 Jul 13. [Epub ahead of print]

> > Significance of Adrenocorticotropin Stimulation Test in the

> > Diagnosis of an Aldosterone-Producing Adenoma.

> >

> > Sonoyama T, Sone M, Miyashita K, Tamura N, Yamahara K, Park K,

> > Oyamada N, Taura D, Inuzuka M, Kojima K, Honda K, Fukunaga Y,

> > Kanamoto N, Miura M, Yasoda A, Arai H, Itoh H, Nakao K.

> > Source

> >

> > Department of Medicine and Clinical Science, Kyoto University

> > Graduate School of Medicine, Sakyo-ku, Kyoto 606-8507, Japan.

> >

> > Abstract

> >

> > Context: Adrenal venous sampling is the " gold standard " test in the

> > diagnosis of an aldosterone-producing adenoma (APA) among patients

> > with primary aldosteronism (PA) but is available only in specialized

> > medical centers. Meanwhile, an APA is reported to be generally more

> > sensitive to ACTH than idiopathic hyperaldosteronism. Objective: The

> > aim was to evaluate the diagnostic accuracy of the ACTH stimulation

> > test in the diagnosis of an APA among those with suspicion of PA.

> > Patients and Setting: Fifty-nine patients admitted to Kyoto

> > University Hospital on suspicion of PA were included in the study.

> > Interventions: ACTH stimulation tests with 1-mg dexamethasone

> > suppression were performed. Main Outcome Measure: Plasma aldosterone

> > concentrations (PAC) were examined every 30 min after ACTH

> > stimulation. Receiver-operated characteristics curve analysis was

> > used to evaluate the diagnostic accuracy. Results: PAC after ACTH

> > stimulations were significantly higher in patients with an APA than

> > in patients with idiopathic hyperaldosteronism or non-PA. Receiver-

> > operated characteristics curve analyses showed that the PAC after

> > ACTH stimulation was effective for the diagnosis of an APA among

> > patients suspected of PA. The diagnostic accuracy was highest at 90

> > min after ACTH injection, with the optimal cutoff value greater than

> > 37.9 ng/dl corresponding with sensitivity and specificity of 91.3

> > and 80.6% for the diagnosis of an APA. Conclusions: Our study

> > indicates that the ACTH stimulation test is useful in the diagnosis

> > of an APA among patients suspected of PA. This test can be used to

> > select patients who are highly suspected of an APA and definitely

> > require adrenal venous sampling.

> >

> > PMID:

> > 21752891

> > [PubMed - as supplied by publisher]

> > Related citations

> >

> > 5. Postgrad Med J. 2011 Jul 11. [Epub ahead of print]

> > Secondary hypertension: a condition not to be missed.

> >

> > Sukor N.

> > Source

> >

> > Endocrine Unit, Department of Medicine, Universiti Kebangsaan

> > Malaysia Medical Centre, Kuala Lumpur, Malaysia.

> >

> > Abstract

> >

> > Hypertension is a chronic disorder which often entails debilitating

> > cardiovascular and renal complications. Hypertension mostly arises

> > as a complex quantitative trait that is affected by varying

> > combinations of genetic and environmental factors. Secondary

> > hypertension has been encountered with increasing frequency. The

> > common causes of secondary hypertension include renal parenchymal

> > disease, renal artery stenosis, primary aldosteronism,

> > phaeochromocytoma, and Cushing's syndrome. The detection of a

> > secondary cause is of the utmost importance because it provides an

> > opportunity to convert an incurable disease into a potentially

> > curable one. Early identification and treatment will provide a

> > better opportunity for cure, prevent target organ damage, reduce

> > socioeconomic burden and health expenditure associated with drug

> > costs, and improve patients' quality of life. Hence, it is a

> > condition not to be missed.

> >

> > PMID:

> > 21746730

> > [PubMed - as supplied by publisher]

> > Related citations

> > 6. J Hypertens. 2011 Jul 6. [Epub ahead of print]

> > Primary aldosteronism: changes in cystatin C-based kidney

> > filtration, proteinuria, and renal duplex indices with treatment.

> >

> > Wu VC, Kuo CC, Wang SM, Liu KL, Huang KH, Lin YH, Chu TS, Chang HW,

> > Lin CY, Tsai CT, Lin LY, Chueh SC, Kao TW, Chen YM, Chiang WC, Tsai

> > TJ, Ho YL, Lin SL, Wang WJ, Wu KD; the TAIPAI Study Group.

> > Source

> >

> > aDepartment of Internal Medicine bDepartment of Yun-Lin Branch

> > cDepartment of Urology dDepartment of Medical Image, National Taiwan

> > University Hospital eDepartment of Internal Medicine, En- Chu- Kong

> > Hospital, Taipei County, Taipei, Taiwan fCleveland Clinic Glickman

> > Urological and Kidney Institute, Cleveland, Ohio, USA gDepartment of

> > Internal Medicine, Tao-Yuan General Hospital, Tao-Yuan, Taiwan.

> >

> > Abstract

> >

> > OBJECTIVES:

> >

> > To obtain information about the effect of prolonged aldosterone

> > excess on kidney function.

> >

> > METHODS:

> >

> > We determined kidney function changes defined by cystatin C-based

> > estimations of glomerular filtration rate (CysC-GFR). Pretreatment

> > proteinuria and intrarenal Doppler velocimetric indices in primary

> > aldosteronism were examined and followed after adrenalectomy or

> > spironolactone treatment.

> >

> > RESULTS:

> >

> > This prospective, multicenter study included 130 primary

> > aldosteronism patients (56 men; age, 49.9â€ŠÂ±â€Š13.4 years: 100 with

> > adenoma and 30 with idiopathic hyperaldosteronism) and 73 essential

> > hypertension patients (36 men; age, 51.4â€ŠÂ±â€Š14.8 years) as

> > controls. Patients with primary aldosteronism had higher CysC-GFR

> > (Pâ€Š<â€Š0.05) and heavier proteinuria (0.042) than those with

> > essential hypertension. With primary aldosteronism, a higher

> > aldosterone-renin ratio (odds ratio, ORâ€Š=â€Š7.85, Pâ€Š=â€Š0.008)

> > was independently related to pretreatment CysC-GFR. The factors

> > related to pretreatment proteinuria included CysC-GFR (OR, -0.006,

> > Pâ€Š=â€Š0.001), plasma aldosterone concentration (OR, 0.004, Pâ€Š=â€Š

> > 0.002), and duration of hypertension (OR, 0.016, Pâ€Š=â€Š0.032).

> > Duration of hypertension was also independently correlated with the

> > pretreatment resistive index among primary aldosteronism patients

> > (OR, 0.004, Pâ€Š=â€Š0.035). CysC-GFR (all, Pâ€Š<â€Š0.05), proteinuria

> > (Pâ€Š<â€Š0.001), and resistive index (Pâ€Š<â€Š0.001) decreased 1 year

> > after adrenalectomy but not with spironolactone treatment.

> >

> > CONCLUSION:

> >

> > Our data suggest that prolonged hyperaldosteronism will cause

> > relative kidney hyperfiltration and reversible intrarenal vascular

> > structural changes, which disguise the consequent renal injury,

> > including declining GFR and proteinuria. Adrenalectomy and

> > spironolactone treatment exert different clinical impacts toward

> > kidney damage even with a similar blood pressure-lowering effect.

> >

> > PMID:

> > 21738054

> > [PubMed - as supplied by publisher]

> > Related citations

> > 7. Urol Int. 2011 Jul 7. [Epub ahead of print]

> > Lumbar Incisional Hernia of the Kidney after Laparoscopic

> > Adrenalectomy in a Patient with Cushing's Syndrome.

> >

> > Miyazato M, Yamada S, Kaiho Y, Ito A, Ishidoya S, Arai Y.

> > Source

> >

> > Department of Urology, Tohoku University Graduate School of

> > Medicine, Sendai, Japan.

> >

> > Abstract

> >

> > We report a first case of lumbar herniation of a kidney after

> > laparoscopic adrenalectomy in a patient with Cushing's syndrome. A

> > 59-year-old woman underwent separate laparoscopic adrenalectomies

> > for right adrenal Cushing's syndrome and left primary aldosteronism.

> > She consulted our department with a 6-month history of intermittent

> > left back pain, starting 8 months after the second operation.

> > Magnetic resonance imaging showed herniation of the left kidney

> > through a defect of the lumbodorsal fascia.

> >

> > PMID:

> > 21734358

> > [PubMed - as supplied by publisher]

> > Related citations

> >

> > 8. Iran J Kidney Dis. 2011 Jul;5(4):215-27.

> > Update on diagnosis and treatment of resistant hypertension.

> >

> > Pimenta E.

> > Source

> >

> > Endocrine Hypertension Research Centre and Clinical Centre of

> > Research Excellence in Cardiovascular Disease and Metabolic

> > Disorders, University of Queensland School of Medicine, Princess

> > andra Hospital, Brisbane, Queensland, Australia. e.pimenta@...

> > .

> >

> > Abstract

> >

> > Resistant hypertension is an increasingly common medical problem,

> > and patients with this condition are at a high risk of

> > cardiovascular events. The prevalence of resistant hypertension is

> > unknown, but data from clinical trials suggest that 20% to 30% of

> > hypertensive individuals may be resistant to antihypertensive

> > treatment. The evaluation of these patients is focused on

> > identifying true resistant hypertension and contributing and

> > secondary causes of hypertension, including hyperaldosteronism,

> > obstructive sleep apnea, chronic kidney disease, renal artery

> > stenosis, and pheochromocytoma. Treatment includes removal of

> > contributing factors, appropriate management of secondary causes,

> > and use of effective multidrug regimens. More established

> > approaches, such as low dietary salt and mineralocorticoid receptor

> > blockers, and new technologies, such as carotid stimulation and

> > renal denervation, have been used in the management of patients with

> > resistant hypertension.

> >

> > Free Article

> > PMID:

> > 21725176

> > [PubMed - in process]

> > Related citations

> >

> > 9. J Hypertens. 2011 Aug;29(8):1553-9.

> > Positive relationship of sleep apnea to hyperaldosteronism in an

> > ethnically diverse population.

> >

> > Sim JJ, Yan EH, Liu IL, Rasgon SA, Kalantar-Zadeh K, Calhoun DA,

> > Derose SF.

> > Source

> >

> > aDivision of Nephrology and Hypertension, Kaiser Permanente Los

> > Angeles Medical Center, Los Angeles bDepartment of Research and

> > Evaluation, Kaiser Permanente Southern California, Pasadena cHarold

> > Center for Kidney Disease Research and Epidemiology, Harbor

> > UCLA Medical Center, Torrance, California dDepartment of

> > Cardiovascular Medicine, University of Alabama at Birmingham,

> > Birmingham, Alabama, USA.

> >

> > Abstract

> >

> > OBJECTIVE:

> >

> > Approximately, 50-60% of patients with sleep apnea have

> > hypertension. To explore a mechanism of this relationship, we

> > compared its prevalence in a hypertensive population with and

> > without hyperaldosteronism.

> >

> > METHODS:

> >

> > Using the Kaiser Permanente Southern California database,

> > hypertensive individuals who had plasma aldosterone and plasma renin

> > activity measured between 1 January 2006 and 31 December 2007 were

> > evaluated. Hyperaldosteronism was defined as an aldosteroneâ€Š:â€Š

> > renin ratio more than 30 and plasma aldosterone more than 20â€Šng/dl

> > or an aldosteroneâ€Š:â€Šrenin ratio more than 50â€Š(ng/dlâ€Š:â€Šng/ml

> > per h). Hypertension was identified by International Classification

> > of Disease, Ninth Revision (ICD-9) coding and sleep apnea was

> > defined by ICD-9 coding or procedural coding for dispensation of

> > positive airway devices.

> >

> > RESULTS:

> >

> > Of 3428 hypertensive patients, 575 (17%) had hyperaldosteronism.

> > Sleep apnea was present in 18% (105) with hyperaldosteronism vs. 9%

> > (251) without hyperaldosteronism (Pâ€Š<â€Š0.001). Odds ratio for

> > sleep apnea in patients with hyperaldosteronism was 1.8 (95%

> > confidence interval 1.3-2.6) after controlling for other sleep apnea

> > risk factors. No ethnic group was at greater risk for sleep apnea.

> >

> > CONCLUSION:

> >

> > The prevalence of sleep apnea in a diverse hypertensive population

> > is increased in patients with hyperaldosteronism, even when

> > controlling for other sleep apnea risk factors.

> >

> > PMID:

> > 21720263

> > [PubMed - in process]

> > Related citations

> >

> > 10. J Hypertens. 2011 Jun 30. [Epub ahead of print]

> > Concurrent primary aldosteronism and subclinical cortisol

> > hypersecretion: a prospective study.

> >

> > Fallo F, Bertello C, Tizzani D, Fassina A, Boulkroun S, Sonino N,

> > Monticone S, Viola A, Veglio F, Mulatero P.

> > Source

> >

> > aDepartment of Medical and Surgical Sciences, University of Padova,

> > Padova bDivision of Internal Medicine and Hypertension, Department

> > of Medicine and Experimental Oncology, University of Torino, Turin

> > cSurgical Pathology and Cytopathology Unit, University of Padova,

> > Padova, Italy dINSERM, U970, Paris Cardiovascular Research Center,

> > University Paris Descartes, Paris, France eDepartment of Statistical

> > Sciences, University of Padova, Padova, Italy.

> >

> > Abstract

> >

> > BACKGROUND:

> >

> > Primary aldosteronism is the most frequent cause of secondary

> > hypertension and is responsible for an increased risk of

> > cardiometabolic complications. A concomitant subtle cortisol

> > hyperproduction could enhance cardiovascular risk. We prospectively

> > estimated the occurrence of subclinical hypercortisolism in primary

> > aldosteronism patients.

> >

> > METHODS:

> >

> > In a large population of hypertensive patients without clinical

> > signs of hypercortisolism, 76 consecutive patients with primary

> > aldosteronism were investigated. Differential diagnosis between

> > unilateral and bilateral aldosterone hypersecretion was made by

> > computed tomography/MRI and/or adrenal venous sampling (AVS).

> > Subclinical hypercortisolism was defined as failure to suppress

> > plasma cortisol to less than 50â€Šnmol/l after 1â€Šmg-overnight

> > dexamethasone, used as screening test, and at least one of two other

> > abnormal hormonal parameters, that is, adrenocorticotrophin (ACTH)

> > less than 2â€Špmol/l and urinary cortisol more than 694â€Šnmol/24â€Šh.

> >

> > RESULTS:

> >

> > Three out of 76 patients had postdexamethasone plasma cortisol more

> > than 50â€Šnmol/l. Only one also showed low-normal ACTH and mildly

> > elevated urinary cortisol. The patient had a right 4â€Šcm adrenal

> > mass. Laparoscopic adrenalectomy was followed by short-term steroid

> > replacement to prevent adrenal insufficiency. In-situ hybridization

> > showed CYP11B1 expression exclusively in tumoral tissue, whereas

> > CYP11B2 was expressed only in a peritumoral region composed of zona

> > glomerulosa-like cells, suggesting the co-existence of a cortisol-

> > producing adenoma and an aldosterone-producing hyperplasia in the

> > same adrenal. The restoration of hormone abnormalities to normal

> > levels was confirmed at 12 months of follow-up.

> >

> > CONCLUSION:

> >

> > Concurrent aldosterone and subclinical cortisol hypersecretion seems

> > to be a rare event in primary aldosteronism patients; however, its

> > detection by appropriate testing is important to avoid AVS

> > misinterpretation.

> >

> > PMID:

> > 21720261

> > [PubMed - as supplied by publisher]

> > Related citations

> > 11. Psychother Psychosom. 2011 Jun 30;80(5):306-307. [Epub ahead of

> > print]

> > Episodic Rage Associated with Primary Aldosteronism Resolved with

> > Adrenalectomy.

> >

> > Houlihan DJ.

> > Source

> >

> > Veterans Affairs Medical Center, Tomah, Wisc., USA.

> >

> > Abstract

> >

> > No abstract available.

> >

> > PMID:

> > 21720192

> > [PubMed - as supplied by publisher]

> > Related citations

> >

> > 12. QJM. 2011 Jun 25. [Epub ahead of print]

> > Does hypokalaemia cause nephropathy? an observational study of renal

> > function in patients with Bartter or Gitelman syndrome.

> >

> > Walsh SB, Unwin E, Vargas-Poussou R, Houillier P, Unwin R.

> > Source

> >

> > From the UCL Centre for Nephrology, University College London,

> > London, UK, Department of Physiology and Department of Genetics,

> > Paris Descartes University and Hopital EuropÃ©en s Pompidou,

> > Paris, France.

> >

> > Abstract

> >

> > BACKGROUND:

> >

> > Hypokalaemic nephropathy has been described in patients with chronic

> > potassium depletion; it is a condition in which proximal tubular

> > vacuolization and interstitial fibrosis occur, resulting in a

> > decline in glomerular filtration rate (GFR) and, in some cases,

> > renal failure. It has been described in patients with chronic

> > diarrhoea, eating disorders, laxative abuse and primary

> > hyperaldosteronism; also occasionally in Bartter syndrome (BS), in

> > which severe hypokalaemia accompanies significant renal sodium and

> > water losses, though rarely in Gitelman syndrome (GS), in which

> > there is equally severe hypokalaemia, but only modest sodium losses.

> >

> > AIM:

> >

> > We hypothesized that hypokalaemic nephropathy may not be due to

> > potassium depletion per se, but persistently elevated circulating

> > levels of aldosterone, possibly with superimposed episodes of renal

> > hypoperfusion. Design and methods: We searched UK and European data

> > sets to retrospectively compare serum and urinary parameters in

> > patients with GS and BS.

> >

> > RESULTS:

> >

> > The patients with GS often had lower serum potassium concentrations

> > than patients with BS, but the BS patients had significantly higher

> > serum creatinine concentrations and lower estimated GFRs (eGFR). BS

> > patients had significantly higher fractional excretions of sodium

> > compared with GS patients, as well as higher plasma renin activities

> > and serum aldosterone levels.

> >

> > CONCLUSION:

> >

> > These findings show that in genetically confirmed cases of BS and

> > GS, the degree of hypokalaemia (as an index of chronic potassium

> > depletion) does not correlate with GFR, and that on-going sodium and

> > water losses, and consequent secondary hyperaldosteronism, may play

> > a more important role in the aetiology of hypokalaemic nephropathy.

> >

> > PMID:

> > 21705784

> > [PubMed - as supplied by publisher]

> > Related citations

> >

> > 13. Am Surg. 2011 May;77(5):592-6.

> > Laparoscopic approach to adrenalectomy: review of perioperative

> > outcomes in a single center.

> >

> > Nguyen PH, Keller JE, Novitsky YW, Heniford BT, Kercher KW.

> > Abstract

> >

> > Laparoscopic expertise increases the volume of adrenalectomies at

> > referral centers. We report our 10-year experience with laparoscopic

> > adrenalectomy. All laparoscopic adrenalectomies at a single

> > institution were prospectively recorded in a surgical outcomes

> > database. Patient demographics, operative/perioperative outcomes,

> > and adrenal pathology were reviewed retrospectively. From March 1999

> > through July 2009, 154 laparoscopic adrenalectomies were performed

> > in 150 patients. Average patient age was 49.9 years (range 15-82);

> > mean body mass index was 31.1 kg/m(2) (range 17-56). Pathologic

> > diagnoses included hyperaldosteronism (n = 69), nonfunctional

> > adenoma (n = 28), pheochromocytoma (n = 23), hypercortisolism (n =

> > 14), malignancy (primary n = 3, metastasis n = 9), and cyst (n = 4).

> > Seventy-three per cent (n = 110) occurred on the left, 23 per cent

> > (n = 35) on the right, 2.6 per cent (n = 4) bilateral, and 0.6 per

> > cent (n = 1) as extra-adrenal. The average tumor measured 3.6 cm

> > (range 0.4-12). The average operative time was 156 minutes (range

> > 62-409), the mean estimated blood loss was 60 mL (range 10-400), and

> > mean American Society of Anesthesiologists score was 2.6 (range

> > 1-4). Three operations (0.2%) were converted to open. Three patients

> > (0.2%) experienced perioperative complications (respiratory failure,

> > urinary tract infection, line sepsis, and readmission within 30

> > days). The average length of stay was 3.4 days (range 1-44) and mean

> > follow-up was 96.9 days (5-2567). No wound-related complications or

> > deaths occurred. Pathologic diagnosis was not associated with a

> > particular side or development of a complication (P > 0.5). Patients

> > with pheochromocytomas had the longest operative times, highest

> > estimated blood loss, and highest American Society of

> > Anesthesiologists scores (218.2 minutes, 128 mL, 3.0; P < 0.004).

> > Laparoscopic adrenalectomy is safe and effective. Removal of

> > pheochromocytomas is more challenging and may be more appropriate

> > for referral to a specialized center for optimal outcomes.

> >

> > PMID:

> > 21679593

> > [PubMed - in process]

> > Related citations

> >

> > 14. Hypertens Res. 2011 Jun 16. doi: 10.1038/hr.2011.77. [Epub ahead

> > of print]

> > Ventricular repolarization before and after treatment in patients

> > with secondary hypertension due to renal-artery stenosis and primary

> > aldosteronism.

> >

> > Maule S, Bertello C, Rabbia F, Milan A, Mulatero P, Milazzo V,

> > Papotti G, Veglio F.

> > Source

> >

> > Department of Medicine and Experimental Oncology, Hypertension

> > Centre, S. Giovanni Battista Hospital, University of Turin, Turin,

> > Italy.

> >

> > Abstract

> >

> > A prolonged QT interval is a risk factor for ischemic heart disease

> > in hypertensive subjects. Patients with renal-artery stenosis and

> > primary aldosteronism (PA) are at increased risk of cardiovascular

> > events. The objective of the present study was to evaluate the QT

> > interval in patients with renovascular hypertension (RV) and PA

> > before and after treatment. A total of 24 patients with RV and 38

> > with PA were studied; 89 patients with essential hypertension (EH)

> > served as control group. Corrected QT intervals (QTcH) were measured

> > from a 12-lead ECG. Basal QTcH was longer in RV (429Â±30â€‰ms) and PA

> > (423Â±23â€‰ms) compared with EH controls (407Â±18â€‰ms; P<0.001). The

> > prevalence of QTcH >440â€‰ms was higher in RV (29%) and PA patients

> > (29%) compared with EH controls (4%; P<0.001). QTcH interval was

> > evaluated after treatment in 19 RV and 15 PA patients. QTcH was

> > reduced after renal-artery angioplasty in RV patients (419Â±14â€‰ms;

> > P=0.02), and after spironolactone or adrenalectomy in PA (403Â±12â€‰

> > ms; P=0.01). In conclusion, QT interval was prolonged in patients

> > with RV and PA compared with controls with EH. After angioplasty of

> > renal-artery stenosis in RV, and treatment with spironolactone or

> > adrenalectomy in PA, the cardiovascular risk of such patients may be

> > reduced by concomitant blood pressure lowering and QT duration

> > shortening.Hypertension Research advance online publication, 16 June

> > 2011; doi:10.1038/hr.2011.77.

> >

> > PMID:

> > 21677661

> > [PubMed - as supplied by publisher]

> > Related citations

> >

> > 15. Circ Res. 2011 Jun 10;108(12):1417-8.

> > Mutations in KCNJ5 Gene Cause Hyperaldosteronism.

> >

> > Zennaro MC, Jeunemaitre X.

> > Source

> >

> > PhD or Xavier Jeunemaitre, MD, INSERM U970-PARCC, 56 rue Leblanc,

> > 75015 Paris, France. maria-christina.zennaro@...; or xavier.jeunemaitre@...

> > .

> >

> > PMID:

> > 21659651

> > [PubMed - in process]

> > Related citations

> >

> > 16. J Hum Hypertens. 2011 Jun 9. doi: 10.1038/jhh.2011.47. [Epub

> > ahead of print]

> > Resistant hypertension, obstructive sleep apnoea and aldosterone.

> >

> > Dudenbostel T, Calhoun DA.

> > Source

> >

> > Vascular Biology and Hypertension Program, Department of Medicine,

> > Division of Cardiovascular Disease, University of Alabama at

> > Birmingham, Birmingham, AL, USA.

> >

> > Abstract

> >

> > Obstructive sleep apnoea (OSA) and hypertension commonly coexist.

> > Observational studies indicate that untreated OSA is strongly

> > associated with an increased risk of prevalent hypertension, whereas

> > prospective studies of normotensive cohorts suggest that OSA may

> > increase the risk of incident hypertension. Randomized evaluations

> > of continuous positive airway pressure (CPAP) indicate an overall

> > modest effect on blood pressure (BP). Determining why OSA is so

> > strongly linked to having hypertension in cross-sectional studies,

> > but yet CPAP therapy has limited BP benefit needs further

> > exploration. The CPAP studies do, however, indicate a wide variation

> > in the BP effects of CPAP, with some patients manifesting a large

> > antihypertensive benefit such that a meaningful BP effect can be

> > anticipated in some individuals. OSA is particularly common in

> > patients with resistant hypertension (RHTN). The reason for this

> > high prevalence of OSA is not fully explained, but data suggest that

> > it may be related to the high occurrence of hyperaldosteronism in

> > patients with RHTN. In patients with RHTN, it has been shown that

> > aldosterone levels correlate with severity of OSA and that blockade

> > of aldosterone reduces the severity of OSA. Overall, these findings

> > are consistent with aldosterone excess contributing to worsening of

> > underlying OSA. We hypothesize that aldosterone excess worsens OSA

> > by promoting accumulation of fluid within the neck, which then

> > contributes to increased upper airway resistance.Journal of Human

> > Hypertension advance online publication, 9 June 2011; doi:10.1038/

> > jhh.2011.47.

> >

> > PMID:

> > 21654850

> > [PubMed - as supplied by publisher]

> > Related citations

> >

> > 17. J Clin Endocrinol Metab. 2011 Jun 1. [Epub ahead of print]

> > Cardiac Dimensions Are Largely Determined by Dietary Salt in

> > Patients with Primary Aldosteronism: Results of a Case-Control Study.

> >

> > Pimenta E, Gordon RD, Ahmed AH, Cowley D, Leano R, Marwick TH,

> > Stowasser M.

> > Source

> >

> > Endocrine Hypertension Research Centre (E.P., R.D.G., A.H.A., D.C.,

> > M.S.) and Clinical Centre of Research Excellence in Cardiovascular

> > Disease and Metabolic Disorders (E.P., D.C., R.L., M.S.), University

> > of Queensland School of Medicine, Princess andra Hospital,

> > Brisbane, Queensland 4102, Australia; and Center for Cardiovascular

> > Imaging (T.H.M.), Cleveland Clinic, Cleveland, Ohio 44195.

> >

> > Abstract

> >

> > Context: Animal studies have demonstrated that dietary sodium intake

> > is a major influence in the pathogenesis of aldosterone-induced

> > effects in the heart such as left ventricular (LV) hypertrophy and

> > fibrosis. LV hypertrophy is an important predictor for

> > cardiovascular morbidity and mortality. Objective: We aimed to

> > investigate the relationships between aldosterone and dietary salt

> > and LV dimensions in patients with primary aldosteronism (PA).

> > Design and Participants: This case-control study included 21

> > patients with confirmed PA and 21 control patients with essential

> > hypertension matched for age, gender, duration of hypertension, and

> > 24-h systolic and diastolic blood pressure. Main Outcome Measures:

> > Patients were evaluated by echocardiography and 24-h urinary sodium

> > (UNa) excretion while consuming their usual diets. Results: Patients

> > with PA had significantly greater mean LV end-diastolic diameter,

> > interventricular septum and posterior wall thicknesses, LV mass

> > (LVM) and LV mass index, and end systolic and diastolic volumes than

> > control patients. UNa significantly positively correlated with

> > interventricular septum, posterior wall thicknesses, and LVM in the

> > patients with PA but not in control patients. In a multivariate

> > analysis, UNa was an independent predictor for LV wall thickness and

> > LV mass among the patients with PA but not in patients with

> > essential hypertension. Conclusions: These findings emphasize the

> > importance of dietary sodium in determining the degree of cardiac

> > damage in those patients with PA, and we suggest that aldosterone

> > excess may play a permissive role. In patients with PA, because a

> > high-salt diet is associated with greater LVM, dietary salt

> > restriction might reduce cardiovascular risk.

> >

> > PMID:

> > 21632817

> > [PubMed - as supplied by publisher]

> > Related citations

> >

> > 18. J Clin Endocrinol Metab. 2011 Jul;96(7):2004-15. Epub 2011 Jun 1.

> > Medical and surgical evaluation and treatment of adrenal

> > incidentalomas.

> >

> > Zeiger MA, Siegelman SS, Hamrahian AH.

> > Source

> >

> > Chief of Endocrine Surgery, The s Hopkins University School of

> > Medicine, Blalock 606 600 N Wolfe Street, Baltimore, land 21287.

mzeiger@...

> > .

> >

> > Abstract

> >

> > Introduction: Adrenal incidentalomas are detected in approximately

> > 4% of patients undergoing high-resolution abdominal imaging studies.

> > The majority of adrenal incidentalomas are benign, but careful

> > evaluation of all patients is warranted to be certain that primary

> > adrenocortical carcinoma and functional adenomas are not missed.

> > Methods: The diagnostic approach in patients with adrenal

> > incidentalomas should focus on two main questions: whether the

> > lesion is malignant, and whether it is hormonally active.

> > Radiological evaluation including noncontrast and contrast computed

> > tomography attenuation values expressed in Hounsfield units is the

> > best tool to differentiate between benign and malignant adrenal

> > masses. All adrenal tumors with suspicious radiological findings,

> > most functional tumors, and all tumors more than 4 cm in size that

> > lack characteristic benign imaging features should be surgically

> > excised. All patients should undergo hormonal evaluation for

> > subclinical Cushing's syndrome and pheochromocytoma, and those with

> > hypertension should also be evaluated for hyperaldosteronism.

> > Combined 1-mg dexamethasone suppression test, plasma metanephrines,

> > and aldosterone/plasma renin activity measurements (if hypertensive)

> > are reasonable initial hormonal evaluations. Results: Annual

> > biochemical follow-up of most patients with adrenal incidentalomas,

> > especially if the tumor is more than 3 cm in size, for up to 5 yr

> > may be reasonable. Patients with adrenal masses less than 4 cm in

> > size and a noncontrast attenuation value of more than 10 Hounsfield

> > units should have a repeat computed tomography study in 3-6 months

> > and then yearly for 2 yr. Adrenal tumors with indeterminate

> > radiological features that grow to at least 0.8 cm over 3-12 months

> > may be considered for surgical resection.

> >

> > PMID:

> > 21632813

> > [PubMed - in process]

> > Related citations

> >

> > 19. Int J Hypertens. 2011;2011:368140. Epub 2011 Mar 23.

> > Long-term use of aldosterone-receptor antagonists in uncontrolled

> > hypertension: a retrospective analysis.

> >

> > Jansen PM, Verdonk K, Imholz BP, Jan Danser AH, van den Meiracker AH.

> > Source

> >

> > Division of Pharmacology, Vascular and Metabolic Diseases,

> > Department of Internal Medicine, Erasmus Medical Center, 3015 CE

> > Rotterdam, The Netherlands.

> >

> > Abstract

> >

> > Background. The long-term efficacy of aldosterone-receptor

> > antagonists (ARAs) as add-on treatment in uncontrolled hypertension

> > has not yet been reported. Methods. Data from 123 patients (21 with

> > primary aldosteronism, 102 with essential hypertension) with

> > difficult-to-treat hypertension who received an ARA between May 2005

> > and September 2009 were analyzed retrospectively for their blood

> > pressure (BP) and biochemical response at first followup after start

> > with ARA and the last follow-up available. Results. Systolic BP

> > decreased by 22 Â± 20 and diastolic BP by 9.4 Â± 12â€‰mmHg after a

> > median treatment duration of 25 months. In patients that received

> > treatment >5 years, SBP was 33 Â± 20 and DBP was 16 Â± 13â€‰mmHg

> > lower than at baseline. Multivariate analysis revealed that baseline

> > BP and follow-up duration were positively correlated with BP

> > response. Conclusion. Add-on ARA treatment in difficult-to-treat

> > hypertension results in a profound and sustained BP reduction.

> >

> > PMCID: PMC3095958

> > Free PMC Article

> > PMID:

> > 21629869

> > [PubMed]

> > Related citations

> >

> > 20. Horm Res Paediatr. 2011 May 27. [Epub ahead of print]

> > Diagnosis of Glucocorticoid-Remediable Aldosteronism in Hypertensive

> > Children.

> >

> > Kamrath C, Maser-Gluth C, Haag C, Schulze E.

> > Source

> >

> > Department of Paediatrics, Division of Paediatric Endocrinology,

> > Justus Liebig University, Giessen, Germany.

> >

> > Abstract

> >

> > Objective: Glucocorticoid-remediable aldosteronism (GRA) is caused

> > by the presence of a chimeric gene originating from an unequal cross-

> > over between the CYP11B1 and CYP11B2 genes. Aldosterone suppression

> > by dexamethasone and high 18-hydroxycortisol (18-OHF) levels have

> > been used to differentiate GRA from the other forms of primary

> > aldosteronism. Methods: A dexamethasone suppression test including

> > serum 18-OHF determination and the measurement of urinary excretion

> > of aldosterone, its metabolites and 18-OHF were performed in 3

> > children of a family with primary aldosteronism. Polymerase chain

> > reactions were performed to identify the chimeric gene. Results: The

> > chimeric gene was identified in 2 children, their mother and

> > grandmother. The affected children had an aldosterone-to-plasma

> > renin activity ratio >30, elevated serum 18-OHF concentration and

> > increased urinary excretion of aldosterone, its metabolites, and 18-

> > OHF. Post-dexamethasone concentrations of serum aldosterone and 18-

> > OHF concentrations were suppressed. Conclusion: Although very rare,

> > the possible diagnosis of GRA should be considered in all children

> > or young adults with low-renin hypertension. Since genetic testing

> > is more specific than biochemical testing, a definitive diagnosis

> > can only be obtained by identification of the CYP11B1/CYP11B2

> > chimeric gene.

> >

> > PMID:

> > 21625068

> > [PubMed - as supplied by publisher]

> > Related citations

> >

> > 21. Clin Chim Acta. 2011 Aug 17;412(17-18):1637-1642. Epub 2011 May

> > 19.

> > Combining body mass index and serum potassium to urine potassium

> > clearance ratio is an alternative method to predict primary

> > aldosteronism.

> >

> > Kuo CC, Wu VC, Tsai CW, Huang KH, Wang SM, Li BC, Chang CC, Lu CC,

> > Yang WS, Chao CT, Tsai IC, Lai CF, Lin WC, Wu MS, Lin YH, Lin CY,

> > Chang HW, Wang WJ, Chiang WC, Kao TW, Chueh SC, Chu TS, Tsai TJ, Wu

> > KD; the TAIPAI Study Group.

> > Source

> >

> > Department of Internal Medicine, National Taiwan University

> > Hospital, College of Medicine, National Taiwan University, Taipei,

> > Taiwan; Department of Internal Medicine, National Taiwan University

> > Hospital Yun-Lin Branch, Yun-Lin, Taiwan.

> >

> > Abstract

> >

> > BACKGROUND:

> >

> > Though aldosterone-renin ratio (ARR) is the current routine

> > screening method for suspicious primary aldosteronism, we

> > hypothesized that the simple formula combining body mass index (BMI)

> > and serum potassium to urine potassium clearance (PUKC) ratio was

> > comparable to ARR.

> >

> > METHODS:

> >

> > Records of patients who were referred to the National Taiwan

> > University Hospital for investigation of primary aldosteronism from

> > January 1995 through December 2007 were retrieved. Primary

> > aldosteronism was diagnosed based on the modified 4-corners

> > criteria, otherwise essential hypertension was diagnosed. In both

> > groups, the PUKC/BMI ratio was determined as well as the ARR. Bland-

> > Altman and mountain-plot analysis were used to validate the

> > agreement between ARR and PUKC/BMI. Receiver operating

> > characteristic (ROC) curves were used to compare the sensitivity and

> > specificity of PUKC/BMI and ARR.

> >

> > RESULTS:

> >

> > The records for urinary potassium were analyzed for 177 hypertensive

> > patients (134 patients with primary aldosteronism). ROC curves

> > showed comparable areas under the curves of both methods (95% CI:

> > -0.029 to 0.183; p=0.186). Bland-Altman analysis further supported

> > the agreement between ARR and PUKC/BMI ratio.

> >

> > CONCLUSIONS:

> >

> > We found that the screening power of PUKC/BMI was as good as that of

> > conventional ARR. With the quick and extensive availability of the

> > PUKC/BMI method and its equivalence to ARR, this screening strategy

> > would be a good first-line tool for massive community-based primary

> > aldosteronism surveys.

> >

> > PMID:

> > 21621528

> > [PubMed - as supplied by publisher]

> > Related citations

> >

> > 22. Eur J Radiol. 2011 May 25. [Epub ahead of print]

> > Adrenal venous sampling using Dyna-CT-A practical guide.

> >

> > Plank C, Wolf F, Langenberger H, Loewe C, Schoder M, Lammer J.

> > Source

> >

> > Division of Cardiovascular and Interventional Radiology, Department

> > of Radiology, Medical University of Vienna, Waehringer Guertel

> > 18-20, A-1090 Vienna, Austria.

> >

> > Abstract

> >

> > Primary hyperaldosteronism due to aldosterone secreting adrenal

> > adenomas is an important and potentially curable cause for

> > hypertension. The differentiation between unilateral or bilateral

> > adrenal adenomas is crucial, as unilateral adenomas can easily be

> > cured by surgery whereas bilateral adenomas have to be treated

> > conservatively. Exact diagnosis can be made when unilateral or

> > bilateral hormone production is proven with adrenal vein sampling.

> > We present an effective step-by-step technique how to perform an

> > adrenal vein sampling with a special emphasis on how to reliably

> > catheterize the right adrenal vein using Dyna CT.

> >

> > PMID:

> > 21620601

> > [PubMed - as supplied by publisher]

> > Related citations

> >

> > 23. Br J Surg. 2011 May 27. doi: 10.1002/bjs.7566. [Epub ahead of

> > print]

> > Cohort study of patients with adrenal lesions discovered incidentally.

> >

> > Muth A, Hammarstedt L, HellstrÃ¶m M, SigurjÃ³nsdÃ³ttir HA, Almqvist

> > E, WÃ¤ngberg B.

> > Source

> >

> > Department of Surgery, Department of Endocrinology, Sahlgrenska

> > University Hospital, Sahlgrenska Academy at the University of

> > Gothenburg, Gothenburg, Sweden. andreas.muth@...

> >

> > Abstract

> >

> > BACKGROUND:

> >

> > This prospective cohort study investigated the incidence, clinical

> > features and natural history of incidentally discovered adrenal mass

> > lesions (adrenal incidentaloma, AI) in an unselected population

> > undergoing radiological examination.

> >

> > METHODS:

> >

> > During an 18-month period, all patients with AI were reported

> > prospectively from all 19 radiology departments in western Sweden.

> > Inclusion criteria were: incidentally discovered adrenal enlargement

> > or mass lesion in patients without extra-adrenal malignancy on

> > detection. Clinical and biochemical evaluation was performed on

> > inclusion and after 24 months. Computed tomography (CT) of the

> > adrenals was scheduled at 4, 12 and 24 months. Magnetic resonance

> > imaging was performed for lesions larger than 20 mm. The indications

> > for surgical excision were: hormone activity, lesion diameter more

> > than 30 mm, lesion growth or other radiological features suspicious

> > of malignancy.

> >

> > RESULTS:

> >

> > Of 534 patients assessed for eligibility, 226 (mean age 67 years,

> > 62Â·4 per cent women; mean lesion diameter 23Â·9 mm, 22Â·6 per cent

> > bilateral) fulfilled the inclusion criteria. Mean follow-up was 19Â·0

> > months. After baseline evaluation, 14 patients had surgery owing to

> > primary hyperaldosteronism (3), catecholamine-producing tumour (1),

> > tumour size (6), size and indication of subclinical hypercortisolism

> > (3) and metastasis (1). No hypersecreting lesions were confirmed

> > during follow-up; one patient underwent adrenalectomy for a

> > suspected phaeochromocytoma (adrenocortical adenoma at

> > histopathology). No primary adrenal malignancy was found.

> >

> > CONCLUSION:

> >

> > In this prospective cohort study 6Â·6 per cent of patients with an AI

> > had surgery and benign hormone-producing tumours were verified in

> > 3Â·1 per cent. Repeat CT and hormone evaluation after 2 years did not

> > increase the sensitivity for diagnosis of malignant or hormone-

> > Society Ltd. Published by Wiley & Sons, Ltd.

> >

> > by Wiley & Sons, Ltd.

> >

> > PMID:

> > 21618498

> > [PubMed - as supplied by publisher]

> > Related citations

> >

> > 24. Nat Rev Endocrinol. 2011 May 24. [Epub ahead of print]

> > A comprehensive review of the clinical aspects of primary

> > aldosteronism.

> >

> > Rossi GP; Medscape.

> > Source

> >

> > Department of Clinical and Experimental Medicine (DMCS) 'Gino

> > Patrassi', Internal Medicine 4, Policlinico Universitario, Via

> > Giustiniani 2, 35126 Padova, Italy. gianpaolo.rossi@...

> >

> > Abstract

> >

> > Primary aldosteronism is much more common than previously thought.

> > The high prevalence of primary aldosteronism, the damage this

> > condition does to the heart, blood vessels and kidneys (which causes

> > a high rate of cardiovascular events), along with the notion that a

> > timely diagnosis followed by an appropriate therapy can correct the

> > arterial hypertension and hypokalemia, justify efforts to search for

> > primary aldosteronism in many patients with hypertension. Most

> > centers can use a cost-effective strategy to screen for patients

> > with primary aldosteronism. By contrast, the identification of

> > primary aldosteronism subtypes, which involves adrenal-vein

> > sampling, should only be undertaken at tertiary referral centers

> > that have experience in performing and interpreting this test. The

> > identification of a curable form of primary aldosteronism can be

> > beneficial for the patient. In some subgroups of patients with

> > hypertension who are at high risk of primary aldosteronism or can

> > benefit most from an accurate diagnosis, an aggressive diagnostic

> > approach is necessary.

> >

> > PMID:

> > 21610687

> > [PubMed - as supplied by publisher]

> > Related citations

> >

> > 25. Eur J Endocrinol. 2011 Aug;165(2):301-6. Epub 2011 May 20.

> > Adrenal vein sampling using rapid cortisol assays in primary

> > aldosteronism is useful in centers with low success rates.

> >

> > Betz MJ, Degenhart C, Fischer E, Pallauf A, Brand V, Linsenmaier U,

> > Beuschlein F, Bidlingmaier M, Reincke M.

> > Source

> >

> > Department of Medicine, University Hospital Innenstadt, Ludwig

> > Maximilians University, Ziemssenstrasse 1, D-80336 Munich, Germany

> > Department of Clinical Radiology, University Hospital Innenstadt,

> > Ludwig Maximilians University, Nussbaumstrasse 20, D-80336 Munich,

> > Germany.

> >

> > Abstract

> >

> > Objective Adrenal vein sampling (AVS) is considered the gold

> > standard in the differential diagnosis of primary aldosteronism

> > (PA), but success rates vary between centers. We hypothesized that

> > rapid (intraprocedure) cortisol measurement can improve performance

> > in a center with initially low AVS success rate. Design We analyzed

> > 46 patients with confirmed PA studied between 2008 and 2010. Forty-

> > seven PA patients studied between 2004 and 2008 identified by

> > retrospective chart review served as controls. All patients were

> > treated at a single tertiary care university hospital. Methods

> > Starting in 2008, rapid cortisol assays (RCA) were performed in all

> > patients during the AVS procedure. A cortisol gradient of â‰¥2.0

> > between adrenal vein and a femoral vein sample was used as success

> > criterion. Up to two repeat samples were drawn if adrenal vein

> > cortisol was below this threshold. Results During the control period

> > 26 of 47 AVS were successful (55%). After introduction of RCA, 39

> > out of 46 AVS (85%) were successful (P=0.003). In 21 of the 46 cases

> > (46%) a resampling was necessary. The increase in overall success

> > was due to an increase in successful right AVS (85 vs 62% before

> > introduction of RCA; P=0.02) and a training effect (P=0.024 for

> > trend). Conclusion RCA during AVS are useful in centers with an

> > initially low AVS success rate.

> >

> > PMID:

> > 21602315

> > [PubMed - in process]

> > Related citations

> >

> > 26. Top Companion Anim Med. 2011 May;26(2):45-51.

> > When normal is abnormal: keys to laboratory diagnosis of hidden

> > endocrine disease.

> >

> > Graves TK.

> > Source

> >

> > Chicago Center for Veterinary Medicine, Chicago, IL, USA. tgraves@...

> >

> > Abstract

> >

> > Although veterinary clinicians commonly rely on panels of laboratory

> > tests with individual results flagged when abnormal, care should be

> > taken in interpreting normal test results as well. There are several

> > examples of this in evaluating patients with endocrine disease. The

> > finding of a normal leukogram (absence of a stress leukogram) can be

> > indicative of adrenal insufficiency in dogs, and this disorder can

> > be especially elusive when there are no overt indicators of

> > mineralocorticoid deficiency. Cats with hyperthyroidism can have

> > normal serum thyroid hormone concentrations, normal hematocrits, and

> > normal serum concentrations of creatinine despite the presence of

> > disease that affects these parameters. A normal serum phosphorus

> > concentration, in the face of azotemia, isosthenuria, and

> > hypertension can point a clinician toward a diagnosis of primary

> > hyperaldosteronism rather than primary renal disease. A normal serum

> > parathyroid hormone concentration in the face of hypercalcemia is

> > inappropriate and can indicate the presence of primary

> > hyperparathyroidism. Similarly, hypoglycemia accompanied by a normal

> > serum insulin concentration can be found in cases of

> > hyperinsulinism. These normal findings in abnormal patients, and

> > their mechanisms, are reviewed.

> >

> > PMID:

> > 21596344

> > [PubMed - in process]

> > Related citations

> >

> > 27. J Clin Endocrinol Metab. 2011 May 18. [Epub ahead of print]

> > Cardiovascular Complications of Patients with Aldosteronism

> > Associated with Autonomous Cortisol Secretion.

> >

> > Nakajima Y, Yamada M, Taguchi R, Satoh T, Hashimoto K, Ozawa A,

> > Shibusawa N, Okada S, Monden T, Mori M.

> > Source

> >

> > Department of Medicine and Molecular Science, Gunma University

> > Graduate School of Medicine, Maebashi 371-8511, Japan.

> >

> > Abstract

> >

> > Context: Primary aldosteronism (PA) is sometimes associated with the

> > autonomous secretion of cortisol. Objective: Our objective was to

> > investigate the effect of autonomous cortisol secretion on the

> > prevalence of cardiovascular events (CVE) in patients with PA.

> > Design: This was a retrospective cross-sectional study of cases

> > collected from Gunma University Hospital between 2002 and 2010.

> > Patients: Seventy-six consecutive patients hospitalized for an

> > evaluation of PA were analyzed. Main Outcome Measures: Rates of CVE

> > dependent on autonomous cortisol secretion were examined. Results:

> > Of the 76 patients with PA, 21 (28%) had a history of CVE, including

> > 14 with stroke, one with myocardial infarction, and six with atrial

> > fibrillation. The multivariate logistic-regression and receiver

> > operating characteristic analyses revealed that PA patients with CVE

> > had significantly higher midnight cortisol levels than those without

> > CVE; the adjusted odds ratio with a cutoff value of 7.4 Î¼ g/dl was

> > 7.0 (95% confidence interval, 1.8-30.6; P = 0.006). In addition,

> > results of the 1-mg dexamethasone suppression test with a cutoff

> > value of 3.0 Î¼ g/dl differed significantly (odds ratio, 5.0; 95%

> > confidence interval, 1.4-20.7; P = 0.018). Conversely, 67 and 50% of

> > the PA patients with a midnight cortisol level of at least 7.4 Î¼ g/

> > dl and 1-mg dexamethasone suppression test of at least 3.0 Î¼ g/dl

> > had a history of CVE. Other factors such as age, expected glomerular

> > filtration rate, blood pressure, glucose intolerance, the serum

> > aldosterone concentration, plasma renin activity, and the duration

> > of hypertension had no effect. Conclusion: The patients with PA

> > associated with autonomous cortisol secretion had high incidence of

> > CVE, and this association may further increase the risk of CVE in

> > patients with PA.

> >

> > PMID:

> > 21593113

> > [PubMed - as supplied by publisher]

> > Related citations

> >

> > 28. J Clin Endocrinol Metab. 2011 May 18. [Epub ahead of print]

> > 18-Oxocortisol Measurement in Adrenal Vein Sampling as a Biomarker

> > for Subclassifying Primary Aldosteronism.

> >

> > Nakamura Y, Satoh F, Morimoto R, Kudo M, Takase K, Gomez- CE,

> > Honma S, Okuyama M, Yamashita K, Rainey WE, Sasano H, Ito S.

> > Source

> >

> > Division of Nephrology, Endocrinology, and Vascular Medicine,

> > Department of Medicine (F.S., R.M., M.K., S.I.), Department of

> > Pathology (Y.N., H.S.), and Department of Radiology (K.T.), Tohoku

> > University Hospital, Sendai 980-8574, Japan; Division of

> > Endocrinology, G. V. Montgomery VA Medical Center (C.E.G.-S.), and

> > the University of Mississippi Medical Center (C.E.G.-S.), ,

> > Mississippi 39216; Aska Pharma Medical Co. Ltd. (S.H., M.O.),

> > Kawasaki 213-8522, Japan; Faculty of Pharmaceutical Science (K.Y.),

> > Tohoku Pharmaceutical University, Sendai 981-8558, Japan; and

> > Department of Physiology (W.E.R.), Georgia Health Sciences

> > University, Augusta, Georgia 30912.

> >

> > Abstract

> >

> > Context: 18-Oxocortisol (18-oxoF) is a derivative of cortisol (F)

> > that is produced by aldosterone synthase (CYP11B2). The potential

> > for this steroid as a biomarker for differentiating patients with

> > aldosterone-producing adenoma (APA) from those with idiopathic

> > hyperaldosteronism (IHA) has not been examined. Objectives: We

> > measured 18-oxoF, aldosterone, and F in plasma from adrenal vein

> > sampling (AVS) of patients with primary aldosteronism. We compared

> > 18-oxoF levels and 18-oxoF/F ratios for their potential to

> > differentiate APA from IHA. Design, Setting, and Subjects: This

> > study measured 18-oxoF, F, and aldosterone in AVS obtained from

> > patients with unilateral APA (14 cases) or bilateral IHA (seven

> > cases, 14 samples total) using liquid chromatography-tandem mass

> > spectrometry and RIA analyses. Results: The levels of 18-oxoF and

> > the ratios of 18-oxoF/F, before and after ACTH stimulation, were

> > significantly higher in blood-draining APA than in those from the

> > contralateral adrenal glands and from adrenal glands with IHA.

> > Conclusions: The 18-oxoF levels and ratios of 18-oxoF/F in AVS

> > samples can be a clinically useful biomarker for differentiating APA

> > from IHA and for determining the localization or lateralization of

> > APA in patients with primary aldosteronism.

> >

> > PMID:

> > 21593107

> > [PubMed - as supplied by publisher]

> > Related citations

> >

> > 29. Endocrinol Metab Clin North Am. 2011 Jun;40(2):343-68, viii.

> > Familial or genetic primary aldosteronism and gordon syndrome.

> >

> > Stowasser M, Pimenta E, Gordon RD.

> > Source

> >

> > Endocrine Hypertension Research Center, University of Queensland

> > School of Medicine, Princess andra Hospital, Ipswich Road,

> > Woolloongabba, Brisbane 4102, Australia. m.stowasser@...

> >

> > Abstract

> >

> > Salt-sensitive forms of hypertension have received considerable

> > renewed attention in recent years. This article focuses on 2 main

> > forms of salt-sensitive hypertension (familial or genetic primary

> > aldosteronism [PA] and Gordon syndrome) and the current state of

> > knowledge regarding their genetic bases. The glucocorticoid-

> > remediable form of familial PA (familial hyperaldosteronism type I)

> > is dealt with only briefly because it is covered in depth elsewhere.

> >

> > PMID:

> > 21565671

> > [PubMed - in process]

> > Related citations

> >

> > 30. Endocrinol Metab Clin North Am. 2011 Jun;40(2):333-41, viii.

> > Glucocorticoid-remediable aldosteronism.

> >

> > Halperin F, Dluhy RG.

> > Source

> >

> > Division of Endocrinology, Diabetes and Hypertension, Harvard

> > Medical School, Brigham and Women's Hospital, 221 Longwood Avenue,

> > Boston, MA 02115, USA.

> >

> > Abstract

> >

> > Glucocorticoid-remediable aldosteronism (GRA) is a hereditary form

> > of primary hyperaldosteronism and the most common monogenic cause of

> > hypertension. A chimeric gene duplication leads to ectopic

> > aldosterone synthase activity in the cortisol-producing zona

> > fasciculata of the adrenal cortex, under the regulation of

> > adrenocorticotropin (ACTH). Hypertension typically develops in

> > childhood, and may be refractory to standard therapies. Hypokalemia

> > is uncommon in the absence of treatment with diuretics. The

> > discovery of the genetic basis of the disorder has permitted the

> > development of accurate diagnostic testing. Glucocorticoid

> > suppression of ACTH is the mainstay of treatment; alternative

> > treatments include mineralocorticoid receptor antagonists.

> >

> > PMID:

> > 21565670

> > [PubMed - in process]

> > Related citations

> >

> > 31. Endocrinol Metab Clin North Am. 2011 Jun;40(2):313-32, vii-viii.

> > Diagnosis and treatment of primary aldosteronism.

> >

> > Rossi GP.

> > Source

> >

> > Molecular Hypertension Laboratory, Dipartimento di Medicina Clinica

> > e Sperimentale G. Patrassi - Internal Medicine 4, University of

> > Padua, University Hospital Padua, Via Giustiniani, 2, 35126 Padua,

> > Italy. gianpaolo.rossi@...

> >

> > Abstract

> >

> > A few simple rules can allow physicians to successfully identify

> > many patients with arterial hypertension caused by PA among the so-

> > called essential hypertensive patients. The hyperaldosteronism and

> > the hypokalemia can be cured with adrenalectomy in practically all

> > of these patients. Moreover, in a substantial proportion of them,

> > the blood pressure can be normalized or markedly lowered if a

> > unilateral cause of PA is discovered. Hence, the screening for PA

> > can be rewarding both for the patient and for the clinician,

> > particularly in those cases where hypertension is severe and/or

> > resistant to treatment, in which the removal of an APA can allow

> > blood pressure to be brought under control despite withdrawal of, or

> > a prominent reduction in, the number and doses of antihypertensive

> > medications.

> >

> > PMID:

> > 21565669

> > [PubMed - in process]

> > Related citations

> >

> > 32. Endocrinol Metab Clin North Am. 2011 Jun;40(2):279-94, vii.

> > Screening for adrenal-endocrine hypertension: overview of accuracy

> > and cost-effectiveness.

> >

> > Schwartz GL.

> > Source

> >

> > Division of Nephrology and Hypertension, College of Medicine, Mayo

> > Clinic, West 19, Mayo Building, 200 First Street SW, Rochester, MN

> > 55905, USA. schwartz.gary@...

> >

> > Abstract

> >

> > Formal studies have not been performed to assess the cost-

> > effectiveness of screening strategies for endocrine causes of

> > hypertension. However, an understanding of the diagnostic accuracy

> > of available screening tests and the clinical settings where disease

> > identification will lead to improved health outcomes form the basis

> > for a cost-effective strategy. Primary aldosteronism screening

> > should be selective and restricted to settings where knowledge of

> > the diagnosis has the greatest chance of improving health outcomes.

> > Pheochromocytoma is rare; however, because it is a potentially fatal

> > disease, screening strategies should err on the side of not missing

> > the diagnosis, especially in high-risk clinical settings.

> >

> > PMCID: PMC3094544

> > [Available on 2012/6/1]

> > PMID:

> > 21565667

> > [PubMed - in process]

> > Related citations

> >

> > 33. Joint Bone Spine. 2011 May 4. [Epub ahead of print]

> > Secondary hyperaldosteronism in a patient with polyarteritis nodosa

> > and renal artery aneurysms.

> >

> > Saint-LÃ©zer A, Kostrzewa E, Viallard JF, Grenier N, Doutre MS.

> > Source

> >

> > Service de dermatologie, hÃ´pital Haut-LÃ©vÃªque, CHU de Bordeaux,

> > avenue de Magellan, 33604 Pessac cedex, France.

> >

> > Abstract

> >

> > Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis that

> > affects medium- and small-sized arteries. We report the case of a 32-

> > year-old female with PAN in which renal involvement was revealed by

> > a secondary hyperaldosteronism. Hypokaliemia and arterial

> > hypertension preceded rupture of renal artery aneurysm by several

> > months. We believe that hyperreninemia resulted from diffuse renal

> > necrotizing vasculitis with occlusive but non-stenotic lesions.

> > Angiography or CT scan should be performed systematically in PAN to

> > screen for aneurysms so as to be able to consider prophylactic

> > treatment by embolization and intensification of the general

> > treatment. Hyperaldosteronism may reveal renal involvement in PAN

> > and warrants an angiography if it has not yet been done.

> >

> > PMID:

> > 21549628

> > [PubMed - as supplied by publisher]

> > Related citations

> >

> > 34. J Biomed Biotechnol. 2011;2011:209787. Epub 2011 Apr 7.

> > Diagnostic value of I-131 NP-59 SPECT/CT scintigraphy in patients

> > with subclinical or atypical features of primary aldosteronism.

> >

> > Chen YC, Su YC, Wei CK, Chiu JS, Tseng CE, Chen SJ, Wang YF.

> > Source

> >

> > Division of Nephrology, Department of Internal Medicine, Buddhist

> > Dalin Tzu Chi General Hospital, Chiayi, and School of Medicine, Tzu

> > Chi University, Hualien, Taiwan.

> >

> > Abstract

> >

> > Accumulating evidence has shown the adverse effect of long-term

> > hyperaldosteronism on cardiovascular morbidity that is independent

> > of blood pressure. However, the diagnosis of primary aldosteronism

> > (PA) remains a challenge for patients who present with subtle or

> > atypical features or have chronic kidney disease (CKD). SPECT/CT has

> > proven valuable in the diagnosis of a number of conditions. The aim

> > of this study was to determine the usefulness of I-131 NP-59 SPECT/

> > CT in patients with atypical presentations of PA and in those with

> > CKD. The records of 15 patients with PA were retrospectively

> > analyzed. NP-59 SPECT/CT was able to identify adrenal lesion(s) in

> > CKD patients with suspected PA. Patients using NP-59 SPECT/CT

> > imaging, compared with those not performing this procedure,

> > significantly featured nearly normal serum potassium levels, normal

> > aldosterone-renin ratio, and smaller adrenal size on CT and

> > pathological examination and tended to feature stage 1 hypertension

> > and non-suppressed plasma renin activity. These findings show that

> > noninvasive NP-59 SPECT/CT is a useful tool for diagnosis in

> > patients with subclinical or atypical features of PA and those with

> > CKD.

> >

> > PMCID: PMC3085291

> > Free PMC Article

> > PMID:

> > 21541242

> > [PubMed - in process]

> > Related citations

> >

> > 35. Eur J Clin Invest. 2011 May 3. doi: 10.1111/j.

> > 1365-2362.2011.02531.x. [Epub ahead of print]

> > High prevalence of autonomous aldosterone secretion among patients

> > with essential hypertension.

> >

> > Gouli A, Kaltsas G, Tzonou A, Markou A, Androulakis II, Ragkou D,

> > Vamvakidis K, Zografos G, Kontogeorgos G, Chrousos GP, Piaditis G.

> > Source

> >

> > Department of Endocrinology and Diabetes, General Hospital of Athens

> > 'G. Gennimatas Department of Pathophysiology, Medical School,

> > National and Kapodistrian University of Athens Department of

> > Hygiene, Epidemiology & Medical Statistics, Medical School, National

> > and Kapodistrian University of Athens 3rd Department of Surgery,

> > General Hospital of Athens 'G. Gennimatas Department of

> > Histopathology, General Hospital of Athens 'G. Gennimatas Department

> > of Paediatrics/Endocrinology, Metabolism and Diabetes, Medical

> > School, National and Kapodistrian University of Athens, Athens,

> > Greece.

> >

> > Abstract

> >

> > Eur J Clin Invest 2011 ABSTRACT: Backgroundâ€‚ Previous studies based

> > on standard endocrine testing have generally shown a low prevalence

> > of primary aldosteronism, a form of autonomous aldosterone secretion

> > (AAS), in hypertensive individuals. The purpose of this case-control

> > study was to evaluate whether use of appropriately defined controls

> > and combined testing reveal previously undetected AAS in

> > hypertensives. Materials and methodsâ€‚ We investigated aldosterone

> > secretion in 180 hypertensives with (nâ€ƒ=â€ƒ44) and without (nâ€ƒ=â€ƒ

> > 136) adrenal adenomas on computerized tomography (CT) and 72 matched

> > nonhypertensive individuals with normal adrenal CT. Serum

> > aldosterone and active renin were measured, and the aldosterone/

> > active renin ratio was calculated before and after a modified

> > fludrocortisone-suppression test (FST).In the latter, to eliminate

> > any stimulatory effect of endogenous stress-induced

> > adrenocorticotrophin hormone on aldosterone secretion, we

> > administered 1â€ƒmg of dexamethasone on the last day of the classical

> > FST fludrocortisone/dexamethasone suppression test (FDST). Resultsâ€‚

> > Using the 97Â·5 percentiles of serum aldosterone (74â€ƒpMâ€ƒL(-1) )

> > and the aldosterone/renin ratio (32â€ƒpMâ€ƒL(-1) â€ƒmU(-1) â€ƒL(-1) )

> > values obtained from the controls following the FDST, normal cut-off

> > values indicative of adequate aldosterone suppression were

> > established. Using the combination of these cut-offs, the estimated

> > prevalence of AAS in patients with hypertension was 31%. Multiple

> > linear regression analysis revealed a significant correlation

> > between systolic and/or diastolic arterial blood pressure and the

> > aldosterone value (Pâ€ƒ<â€ƒ0Â·0001 and Pâ€ƒ<â€ƒ0Â·01, respectively)

> > and/or the aldosterone/renin ratio (Pâ€ƒ<â€ƒ0Â·0001 and Pâ€ƒ<â€ƒ

> > 0Â·01, respectively), which were obtained following the FDST.

> > Conclusionsâ€‚ By applying new cut-offs obtained following

> > modification of standard testing, AAS is quite prevalent in

> > hypertensive individuals and correlates highly with arterial blood

> > pressure. This may have relevance for both the aetiology of the

> > hypertension and its optimal therapy.

> >

> > 2011 Stichting European Society for Clinical Investigation Journal

> > Foundation.

> >

> > PMID:

> > 21534948

> > [PubMed - as supplied by publisher]

> > Related citations

> >

> > 36. Curr Cardiol Rev. 2010 May;6(2):119-23.

> > Physiologic tailoring of treatment in resistant hypertension.

> >

> > Spence JD.

> > Source

> >

> > Stroke Prevention & Atherosclerosis Research Centre, 1400 Western

> > Road, London, Ontario, Canada N6G 2V2.

> >

> > Abstract

> >

> > Resistant hypertension is a major opportunity for prevention of

> > cardiovascular disease. Despite widespread dissemination of

> > consensus guidelines, most patients are uncontrolled with approaches

> > that assume that all patients are the same. Causes of resistant

> > hypertension include 1) non-compliance 2) consumption of substances

> > that aggravate hypertension (such as salt, alcohol, nonsteroidal

> > anti-inflammatory drugs, licorice, decongestants) and 3) secondary

> > hypertension. Selecting the appropriate therapy for a patient

> > depends on finding the cause of the hypertension. Once rare causes

> > have been eliminated (such as pheochromocytoma, licorice, adult

> > coarctation of the aorta), the cause will usually be found by

> > intelligent interpretation (in the light of medications then being

> > taken) of plasma renin and aldosterone.If stimulated renin is low

> > and the aldosterone is high, the problem is primary aldosteronism,

> > and the best treatment is usually aldosterone antagonists

> > (spironolactone or eplerenone; high-dose amiloride for men where

> > eplerenone is not available). If the renin is high, with secondary

> > hyperaldosteronism, the best treatment is angiotensin receptor

> > blockers or aliskiren. If the renin and aldosterone are both low the

> > problem is over-activity of renal sodium channels and the treatment

> > is amiloride. This approach is particularly important in patients of

> > African origin, who are more likely to have low-renin hypertension.

> >

> > PMCID: PMC2892077

> > Free PMC Article

> > PMID:

> > 21532778

> > [PubMed]

> >

> > 37. Dtsch Med Wochenschr. 2011 Apr;136(17):882-4. Epub 2011 Apr 26.

> > [Hypertension and hypokalemia - a reninoma as the cause of suspected

> > liquorice-induced arterial hypertension].

> >

> > [Article in German]

> > Schulze zur Wiesch C, Sauer N, Aberle J.

> > Source

> >

> > Zentrum fÃ¼r Innere Medizin, Sektion Endokrinologie und Diabetologie,

> > UniversitÃ¤tsklinikum Hamburg-Eppendorf. cl.schulze-zur-wiesch@...

> > e

> >

> > Abstract

> >

> > HISTORY AND CLINICAL FINDINGS:

> >

> > A 28-year-old woman presented with dizziness and arterial

> > hypertension. She reported a daily intake of 300 mg liquorice.

> >

> > INVESTIGATIONS:

> >

> > Laboratory analysis revealed hypokalaemia of 2.5 mmol/l and an

> > elevated serum renin activity of 18.6 Âµg/l/h. Abdominal ultrasound

> > and magnetic resonance imaging showed a circumscribed non-

> > homogenuous round lesion (18 Ã— 22 mm) in the upper third of the

> > right kidney. Selective catheterization of the renal veins revealed

> > increased renin activity in blood from the right renal vein,

> > suggestive of a renin-producing tumor.

> >

> > TREATMENT AND COURSE:

> >

> > Initially antihypertensive therapy with the direct renin receptor

> > antagonist aliskiren was started and followed by a partial

> > nephrectomy, which brought about adequate blood pressure and

> > potassium levels.

> >

> > CONCLUSION:

> >

> > The constellation of hypokalaemia and hypertension often leads to

> > important causes of secondary hypertension such as primary

> > hyperaldosteronism or renal artery stenosis. But less frequent

> > causes should also be considered in the differential diagnoses, such

> > as liquorice overindulgence or reninoma.

> >

> > Â© Georg Thieme Verlag KG Stuttgart Â· New York.

> >

> > PMID:

> > 21523638

> > [PubMed - indexed for MEDLINE]

> > Related citations

> >

> > 38. Endocr J. 2011 Apr 27. [Epub ahead of print]

> > Clinicopathological features of primary aldosteronism associated

> > with subclinical Cushing's syndrome.

> >

> > Hiraishi K, Yoshimoto T, Tsuchiya K, Minami I, Doi M, Izumiyama H,

> > Sasano H, Hirata Y.

> > Source

> >

> > Department of Clinical and Molecular Endocrinology, Tokyo Medical

> > and Dental University Graduate School, Tokyo 113-8519, Japan.

> >

> > Abstract

> >

> > Primary aldosteronism (PA), an autonomous aldosterone hypersecretion

> > from adrenal adenoma and/or hyperplasia, and subclinical Cushing

> > syndrome (SCS), a mild but autonomous cortisol hypersecretion from

> > adrenal adenoma without signs or symptoms of Cuhing's syndrome, are

> > now well-recognized clinical entities of adrenal incidentaloma.

> > However, the clinicopathological features of PA associated with SCS

> > (PA/SCS) remain unknown. The present study was undertaken to study

> > the prevalence of PA/SCS among PA patients diagnosed at our

> > institute, and characterize their clinicopathlogical features. The

> > prevalence of PA/SCS was 8 of 38 PA patients (21%) studied. These 8

> > PA/SCS patients were significantly older and had larger tumor,

> > higher serum potassium levels, lower basal plasma levels of

> > aldosterone, ACTH and DHEA-S as well as lower response of

> > aldosterone after ACTH stimulation than those in 12 patients with

> > aldosterone-producing adenoma without hypercortisolism. All 8 PA/SCS

> > patients showed unilateral uptake by adrenal scintigraphy at the

> > ipsilateral side, whereas the laterality of aldosterone

> > hypersecretion as determined by adrenal venous sampling varied from

> > ipsilateral (3), contralateral (2), and bilateral side (2). 6 PA/SCS

> > patinets who underwent adrenalectomy required hydrocortisone

> > replacement postoperatively. Histopathological analysis of the

> > resected adrenal tumors from 5 PA/SCS patients revealed a single

> > adenoma in 3, and double adenomas in 2, with varying degrees of

> > positive immunoreactivities for steroidgenic enzymes (3Î²-HSD,

> > P450(C17)) by immunohistochemical study as well as CYP11B2 mRNA

> > expression as measured by real-time RT-PCR. In conclusion, PA/SCS

> > consists of a variety of adrenal pathologies so that therapeutic

> > approach differs depending on the disease subtype.

> >

> > Free Article

> > PMID:

> > 21521926

> > [PubMed - as supplied by publisher]

> > Related citations

> >

> > 39. Surgery. 2011 Apr 22. [Epub ahead of print]

> > Reversal of myocardial fibrosis in patients with unilateral

> > hyperaldosteronism receiving adrenalectomy.

> >

> > Lin YH, Lee HH, Liu KL, Lee JK, Shih SR, Chueh SC, Lin WC, Lin LC,

> > Lin LY, Chung SD, Wu VC, Kuo CC, Ho YL, Chen MF, Wu KD; the TAIPAI

> > Study Group.

> > Source

> >

> > Department of Internal Medicine, National Taiwan University Hospital

> > and National Taiwan University College of Medicine, Taipei, Taiwan.

> >

> > Abstract

> >

> > BACKGROUND:

> >

> > Primary aldosteronism is the most frequent cause of secondary

> > hypertension and is associated with more prominent left ventricular

> > hypertrophy and increased myocardial fibrosis. Unilateral

> > hyperaldosteronism can be cured by adrenalectomy. However, the

> > reversibility of cardiac fibrosis is still unclear.

> >

> > METHODS:

> >

> > We analyzed 11 patients prospectively with unilateral

> > hyperaldosteronism (including 10 aldosterone-producing adenomas and

> > 1 unilateral nodular hyperplasia) who received adrenalectomy from

> > October 2006 to October 2007, and 17 patients with essential

> > hypertension (EH) were enrolled as the control group.

> > Echocardiography included ultrasonic tissue characterization by

> > cyclic variation of integrated backscatter; it was performed in both

> > groups and 1 year after operation in the unilateral

> > hyperaldosteronism group.

> >

> > RESULTS:

> >

> > Patients with unilateral hyperaldosteronism had significantly higher

> > diastolic blood pressure, higher plasma aldosterone concentration,

> > lower serum potassium level, and lower plasma renin activity than

> > patients with EH. In echocardiography, patients with unilateral

> > hyperaldosteronism had thicker interventricular septal thickness,

> > left ventricular posterior wall thickness, and higher left

> > ventricular mass index than EH patients. Patients with unilateral

> > hyperaldosteronism had significant lower cyclic variation of

> > integrated backscatter than EH patients (7.1 Â± 2.1 vs 8.7 Â± 1.5 dB,

> > P = .037). After analyzing the correlation of cyclic variation of

> > integrated backscatter with clinical parameters for all

> > participants, only log-transformed plasma renin activity was

> > correlated significantly with cyclic variation of integrated

> > backscatter. One year after adrenalectomy, interventricular septal

> > thickness, left ventricular posterior wall thickness, and left

> > ventricular mass index decreased significantly. In addition, cyclic

> > variation of integrated backscatter increased significantly after

> > adrenalectomy (7.1 Â± 2.1 to 8.5 Â± 1.5 dB, P = .02).

> >

> > CONCLUSION:

> >

> > Adrenalectomy not only reversed left ventricular geometry but also

> > altered myocardial texture in patients with unilateral

> > hyperaldosteronism. This finding implies that increases in collagen

> > content in the myocardium of patients with unilateral

> > hyperaldosteronism might be reversed by adrenalectomy.

> >

> > PMID:

> > 21514614

> > [PubMed - as supplied by publisher]

> > Related citations

> >

> > 40. J Endocrinol Invest. 2011 Feb;34(2):86-9.

> > Insulin signaling in adipose tissue of patients with primary

> > aldosteronism.

> >

> > Urbanet R, Pilon C, Giorgino F, Vettor R, Fallo F.

> > Source

> >

> > Department of Medical and Surgical Sciences, University of Padova,

> > Via Giustiniani 2, 35128 Padova, Italy.

> >

> > Abstract

> >

> > OBJECTIVE:

> >

> > We studied phosphorylation of insulin-receptors substrate downstream

> > molecules: 1) in the ex-vivo visceral adipose tissue (VAT) of

> > patients with aldosterone-producing adenoma (APA) (no.=7) and non-

> > functioning adenoma (NFA) (no.=7) undergoing laparoscopic

> > adrenalectomy; 2) in aldosterone-treated sc adipocytes of subjects

> > (no.=5) who requested abdominoplasty.

> >

> > PATIENTS AND METHODS:

> >

> > Western blotting was used to detect phosphorylation of Akt and

> > extracellular signal-regulated kinase (ERK) 1/2 in VAT from APA and

> > NFA patients, and in subcutaneous adipocytes pre-treated with

> > different aldosterone concentrations. Phosphorylation of Akt and

> > ERK1/2 was similar in VAT of patients with APA and NFA. Pre-

> > treatment in adipocytes with both physiological (1 nM) and

> > pharmacological (10 Î¼M) doses of aldosterone did not affect basal or

> > insulin-induced phosphorylation of Akt and ERK1/2.

> >

> > CONCLUSIONS:

> >

> > Our data give further evidence that insulin signaling in human VAT

> > is not affected by primary aldosterone overproduction.

> >

> > PMID:

> > 21502795

> > [PubMed - in process]

> > Related citations

> >

> > 41. Hypertension. 2011 Jun;57(6):1117-21. Epub 2011 Apr 18.

> > Frequency of familial hyperaldosteronism type 1 in a hypertensive

> > pediatric population: clinical and biochemical presentation.

> >

> > Aglony M, MartÃnez-Aguayo A, Carvajal CA, Campino C, GarcÃa H,

> > Bancalari R, Bolte L, Avalos C, Loureiro C, Trejo P, Brinkmann K,

> > Giadrosich V, Mericq V, Rocha A, Avila A, V, Inostroza A,

> > Fardella CE.

> > Source

> >

> > Division of Pediatrics, Pontificia Universidad CatÃ³lica de Chile,

> > Santiago, Chile.

> >

> > Comment in

> >

> > Hypertension. 2011 Jun;57(6):1053-5.

> > Abstract

> >

> > Familial hyperaldosteronism type 1 is an autosomal dominant disorder

> > attributed to a chimeric CYP11B1/CYP11B2 gene (CG). Its prevalence

> > and manifestation in the pediatric population has not been

> > established. We aimed to investigate the prevalence of familial

> > hyperaldosteronism type 1 in Chilean hypertensive children and to

> > describe their clinical and biochemical characteristics. We studied

> > 130 untreated hypertensive children (4 to 16 years old). Blood

> > samples for measuring plasma potassium, serum aldosterone, plasma

> > renin activity, aldosterone/renin ratio, and DNA were collected. The

> > detection of CG was performed using long-extension PCR. We found 4

> > (3.08%) of 130 children with CG who belonged to 4 unrelated

> > families. The 4 patients with CG had very high aldosterone/renin

> > ratio (49 to 242). In addition, we found 4 children and 5 adults who

> > were affected among 21 first-degree relatives. Of the 8 affected

> > children, 6 presented severe hypertension, 1 presented

> > prehypertension, and 1 presented normotension. High serum

> > aldosterone levels (>17.7 ng/dL) were detected in 6 of 8 subjects

> > (range: 18.6 to 48.4 ng/dL) and suppressed plasma renin activity

> > (â‰¤0.5 ng/mL per hour) and high aldosterone/renin ratio (>10) in 8

> > of 8 children (range: 49 to 242). Hypokalemia was observed in only 1

> > of 8 children. We demonstrated that the prevalence of familial

> > hyperaldosteronism type 1 in a pediatric hypertensive pediatric

> > population was surprisingly high. We found a high variability in the

> > clinical and biochemical characteristics of the affected patients,

> > which suggests that familial hyperaldosteronism type 1 is a

> > heterogeneous disease with a wide spectrum of presentations even

> > within the same family group.

> >

> > PMID:

> > 21502562

> > [PubMed - in process]

> > Related citations

> >

> > 42. Clin Lab. 2011;57(3-4):245-51.

> > Expression of P-450(c11beta) in adrenal aldosterone-producing

> > adenomas and nodular hyperplasia tissues.

> >

> > Fang Y, Zhao L, Chen S, Cui X, Zang M, Chen S, Di X.

> > Source

> >

> > Department of Internal Medicine, University of Missouri, Columbia,

> > USA. fangy@...

> >

> > Abstract

> >

> > BACKGROUND:

> >

> > Our previous study suggests that decreased P-450(c17alpha)

> > expression correlated with the overproduction of aldosterone in APA

> > and nodular hyperplasia in patients with primary aldosteronism. This

> > study was performed to further investigate if P-450(c11beta)

> > contributes to the overproduction of aldosterone in APA and nodular

> > hyperplasia tissues.

> >

> > METHODS:

> >

> > Total RNA and protein were extracted from 7 cases of APA tissue, 3

> > nodular hyperplasia tissues, 7 normal adrenal glands. P-450(c11beta)

> > mRNA was examined by dot blot and confirmed by Northern blot

> > analysis and by realtime PCR. Protein expression level of

> > P-450(c11beta) was also investigated by immunohistochemical staining

> > and confirmed by Western blot.

> >

> > RESULTS:

> >

> > The relative expression level of P-450(c11beta) mRNA to beta-actin

> > in APA, nodular hyperplasia and the normal adrenal gland group are

> > 47 +/- 22%, 55 +/- 13%, 64 +/- 16% respectively by dot blot and are

> > 94 +/- 18%, 101 +/- 20%, 112 +/- 62% respectively by Northern blot.

> > These results are further confirmed by realtime PCR. This result was

> > also supported by the relative protein expression level of

> > P-450(c11beta) to beta-actin which are 118 +/- 15%, 107 +/- 32%, 108

> > +/- 22% respectively evaluated by Western blot. There was no

> > significant difference in protein expression level of P-450(c11beta)

> > among the normal adrenal gland tissues, APA and adrenal nodular

> > hyperplasia tissue, either (P > 0.05).

> >

> > CONCLUSIONS:

> >

> > These results suggest that P-450(c11beta) is not a key contributor

> > to the overproduction of aldosterone in APA and nodular hyperplasia

> > and can not be considered as a potential marker to differentiate

> > between them in patients with primary aldosteronism.

> >

> > PMID:

> > 21500734

> > [PubMed - indexed for MEDLINE]

> > Related citations

> > 43. Curr Opin Endocrinol Diabetes Obes. 2011 Apr 13. [Epub ahead of

> > print]

> > Inherited forms of mineralocorticoid hypertension.

> >

> > Hassan- Z, PM.

> > Source

> >

> > Centre for Endocrinology, Diabetes and Metabolism, School of

> > Clinical and Experimental Medicine, University of Birmingham,

> > Birmingham, UK.

> >

> > Abstract

> >

> > PURPOSE OF REVIEW:

> >

> > Inherited forms of mineralocorticoid hypertension are a group of

> > monogenic disorders that, although rare, have enlightened our

> > understanding of normal physiology, and subsequent processes

> > implicated in the pathogenesis of 'essential' hypertension. They

> > often present in early life and can be a cause of major morbidity

> > and mortality that can be effectively treated with simple but

> > targeted pharmacological therapy. Interestingly, all the conditions

> > centre on the regulation of sodium transport through its epithelial

> > channel, either directly or through mediators that act via the

> > mineralocorticoid receptor.

> >

> > RECENT FINDINGS:

> >

> > In recent years, molecular mechanisms of these conditions and their

> > functional consequences have been elucidated. Diagnosis has been

> > facilitated by plasma and urinary biomarkers.

> >

> > SUMMARY:

> >

> > We provide an overview and diagnostic approach to apparent

> > mineralocorticoid excess, glucocorticoid remediable aldosteronism,

> > familial hyperaldosteronism type 2, Liddle's syndrome, Gordon's

> > syndrome, activating mutations of the mineralocorticoid receptor,

> > generalized glucocorticoid resistance and hypertensive forms of

> > congenital adrenal hyperplasia.

> >

> > PMID:

> > 21494136

> > [PubMed - as supplied by publisher]

> > Related citations

> > 44. Eur J Endocrinol. 2011 Jul;165(1):85-90. Epub 2011 Apr 13.

> > Subtyping of primary aldosteronism by adrenal vein sampling: effect

> > of acute D2 receptor dopaminergic blockade on adrenal vein cortisol

> > and chromogranin A levels.

> >

> > Seccia TM, Miotto D, De Toni R, Gallina V, Vincenzi M, Pessina AC,

> > Rossi GP.

> > Source

> >

> > DMCS 'G. Patrassi', Internal Medicine 4 Institute of Radiology,

> > University Hospital, University of Padua, via Giustiniani 2, 35126

> > Padova, Italy.

> >

> > Abstract

> >

> > Background Adrenal vein sampling (AVS) is the gold standard for

> > identifying the surgically curable forms of primary aldosteronism.

> > Dopamine modulates adrenocortical steroidogenesis and tonically

> > inhibits aldosterone secretion via D(2) receptor. However, whether

> > it could also affect the release of cortisol and chromogranin A

> > (ChA), which can be used to assess the selectivity of AVS, is

> > unknown. Objective To investigate whether metoclopramide increased

> > the release of cortisol and ChA and could thereby improve assessment

> > of the selectivity at AVS. Design and methods We investigated the

> > effect of acute D(2) antagonism with metoclopramide on cortisol and

> > ChA release from the adrenal gland by comparing the adrenal vein and

> > infrarenal inferior vena cava (IVC) hormone levels at baseline and

> > after metoclopramide administration in 34 consecutive patients

> > undergoing AVS. Results Metoclopramide increased plasma aldosterone

> > in the IVC (P<0.00001) and in the adrenal vein blood (P<0.002) but

> > failed to increase plasma cortisol concentration or ChA levels.

> > Therefore, it did not increase the selectivity index based on the

> > measurement of either hormone. Conclusions This study shows that the

> > release of cortisol and ChA is not subjected to tonic D(2)

> > dopaminergic inhibition. Therefore, these findings lend no evidence

> > for the usefulness of acute metoclopramide administration for

> > enhancing the assessment of the selectivity of blood sampling during

> > AVS with the use of either cortisol or ChA assay.

> >

> > PMID:

> > 21490124

> > [PubMed - in process]

> > Related citations

> >

> > 45. J Am Coll Surg. 2011 Jul;213(1):106-12. Epub 2011 Apr 13.

> > Primary aldosteronism: results of adrenalectomy for nonsingle adenoma.

> >

> > Quillo AR, Grant CS, GB, Farley DR, s ML, Young WF.

> > Source

> >

> > Department of Surgery, University of Louisville, Louisville, KY.

> >

> > Abstract

> >

> > BACKGROUND:

> >

> > Historically, treatment of confirmed primary aldosteronism has been

> > adrenalectomy for unilateral adenoma; bilateral hypersecretion is

> > treated medically. Increasingly, we use adrenal venous sampling

> > (AVS) to define unilateral hypersecretion. Histology of glands

> > resected based on AVS often reveals multiple nodules or hyperplasia.

> > The aim of this study was to compare patients with multiple nodules

> > or hyperplasia with those with single adenoma with regard to cure,

> > preoperative imaging, AVS ratio, and biochemical evaluation to

> > determine if a nonsingle adenoma (NSA) process could be predicted to

> > impact extent of adrenalectomy.

> >

> > STUDY DESIGN:

> >

> > This was a retrospective study reviewing a single-institutional

> > surgical experience at a tertiary academic center from 1993 to 2008,

> > during which 215 patients with primary aldosteronism underwent

> > unilateral adrenalectomy based on imaging of a single adenoma

> > (normal contralateral gland) or AVS ratios. Histology included

> > single adenoma versus NSA; cure was defined as normal immediate

> > postoperative plasma or urine aldosterone level, normal

> > aldosterone:renin ratio, or normotension without antihypertensive

> > medications.

> >

> > RESULTS:

> >

> > Follow-up (mean 13 months, range 0 to 185 months) was available for

> > 167 patients: 132 (79%) single adenoma and 35 (21%) NSA. All 35

> > patients with NSA and 128 patients (97%) with single adenoma were

> > cured. Imaging studies correctly predicted NSA in 29% and 57% when

> > combined with AVS. Identifying patients with NSA preoperatively was

> > impossible biochemically: mean serum and urinary aldosterone levels

> > and AVS ratios were not different than those of the single adenoma

> > group.

> >

> > CONCLUSIONS:

> >

> > Twenty-one percent of patients had NSA, all cured by unilateral

> > adrenalectomy. No preoperative evaluation reliably predicted NSA.

> > Therefore, total unilateral adrenalectomy was safest given the

> > potential for incomplete resection with partial adrenalectomy.

> > Accurate AVS is highly predictive of cure irrespective of the

> > unilateral adrenal histology.

> >

> > PMID:

> > 21489832

> > [PubMed - in process]

> > Related citations

> >

> > 46. Rev Endocr Metab Disord. 2011 Mar;12(1):1.

> > Evolution of how best to manage primary aldosteronism. Foreword.

> >

> > Funder J.

> > Source

> >

> > Prince Henry's Institute of Medical Research, Clayton, ,

> > Australia. john.funder@...

> >

> > PMID:

> > 21484329

> > [PubMed - in process]

> > Related citations

> >

> > 47. J Hypertens. 2011 Jun;29(6):1196-202.

> > Adrenal venous sampling is crucial before an adrenalectomy whatever

> > the adrenal-nodule size on computed tomography.

> >

> > Sarlon-Bartoli G, Michel N, Taieb D, Mancini J, Gonthier C, Silhol

> > F, Muller C, Bartoli JM, Sebag F, Henry JF, Deharo JC, Vaisse B.

> > Source

> >

> > Rythmologie et Hypertension ArtÃ©rielle, Assistance Publique

> > HÃ´pitaux de Marseille, HÃ´pital La Timone, FacultÃ© de MÃ©decine de

> > Marseille, UniversitÃ© de la MÃ©diterranÃ©e, Marseille cedex, France.

gabrielle.sarlon@ap-hm

> > .fr

> >

> > Abstract

> >

> > OBJECTIVE:

> >

> > To assess the additional value of adrenal venous sampling (AVS) to

> > diagnose primary aldosteronism sub-types in patients who have a

> > unilateral nodule detected by computed tomography (CT scan) and who

> > should undergo an adrenalectomy.

> >

> > METHODS:

> >

> > A retrospective study to assess consecutive patients with primary

> > aldosteronism undergoing an adrenal CT scan and AVS. Criterion for

> > selective cannulation was an equal or higher cortisol level in the

> > adrenal vein compared to the inferior vena cava. An adrenal-vein

> > aldosterone-to-cortisol ratio of at least two times higher than the

> > other side defined lateralization of aldosterone production.

> >

> > RESULTS:

> >

> > Sixty-seven patients (mean age 52 years, 39 men) underwent a CT scan

> > and AVS. In nine patients (13%), cannulation of the right adrenal

> > vein led to a technical failure. Both procedures led to diagnosis of

> > 29 patients with adenoma-producing aldosterone (APA; 50%), 23

> > bilateral adrenal hyperplasias (40%), and six unilateral adrenal

> > hyperplasias (10%). Of the 45 patients with a nodule detected by CT,

> > subsequent AVS showed bilateral secretion in 16 patients (36%).

> > Compared to the strategy of coupling CT scans with AVS to diagnosis

> > APA, a CT scan alone had an accuracy of 72.4% (P < 0.001). Among

> > patients with a macronodule detected by CT, 13 (37%) had bilateral

> > secretion as assessed by AVS. The patients with a macronodule

> > detected by CT alone had the same risk of a discrepancy as those

> > with a small nodule (P = 0.99).

> >

> > CONCLUSION:

> >

> > AVS is essential to diagnose the unilateral hypersecretion of

> > aldosterone, even in patients in whom a unilateral macronodule is

> > detected by CT, to avoid unnecessary surgery.

> >

> > PMID:

> > 21478754

> > [PubMed - in process]

> > Related citations

> >

> > 48. Eur J Endocrinol. 2011 Jun;164(6):851-70. Epub 2011 Apr 6.

> > AME position statement on adrenal incidentaloma.

> >

> > Terzolo M, Stigliano A, Chiodini I, Loli P, Furlani L, Arnaldi G,

> > Reimondo G, Pia A, Toscano V, Zini M, Borretta G, Papini E, Garofalo

> > P, Allolio B, Dupas B, Mantero F, Tabarin A.

> > Source

> >

> > Medicine I, AOU San Luigi Gonzaga, University of Turin, Regione

> > Gonzole 10, Orbassano 10043, Italy. terzolo@...

> >

> > Abstract

> >

> > OBJECTIVE:

> >

> > To assess currently available evidence on adrenal incidentaloma and

> > provide recommendations for clinical practice.

> >

> > DESIGN:

> >

> > A panel of experts (appointed by the Italian Association of Clinical

> > Endocrinologists (AME)) appraised the methodological quality of the

> > relevant studies, summarized their results, and discussed the

> > evidence reports to find consensus. RADIOLOGICAL ASSESSMENT:

> > Unenhanced computed tomography (CT) is recommended as the initial

> > test with the use of an attenuation value of â‰¤10 Hounsfield units

> > (HU) to differentiate between adenomas and non-adenomas. For tumors

> > with a higher baseline attenuation value, we suggest considering

> > delayed contrast-enhanced CT studies. Positron emission tomography

> > (PET) or PET/CT should be considered when CT is inconclusive,

> > whereas fine needle aspiration biopsy may be used only in selected

> > cases suspicious of metastases (after biochemical exclusion of

> > pheochromocytoma). HORMONAL ASSESSMENT: Pheochromocytoma and

> > excessive overt cortisol should be ruled out in all patients,

> > whereas primary aldosteronism has to be considered in hypertensive

> > and/or hypokalemic patients. The 1 mg overnight dexamethasone

> > suppression test is the test recommended for screening of

> > subclinical Cushing's syndrome (SCS) with a threshold at 138 nmol/l

> > for considering this condition. A value of 50 nmol/l virtually

> > excludes SCS with an area of uncertainty between 50 and 138 nmol/l.

> >

> > MANAGEMENT:

> >

> > Surgery is recommended for masses with suspicious radiological

> > aspects and masses causing overt catecholamine or steroid excess.

> > Data are insufficient to make firm recommendations for or against

> > surgery in patients with SCS. However, adrenalectomy may be

> > considered when an adequate medical therapy does not reach the

> > treatment goals of associated diseases potentially linked to

> > hypercortisolism.

> >

> > PMID:

> > 21471169

> > [PubMed - in process]

> > Related citations

> >

> > 49. J Hypertens. 2011 May;29(5):980-90.

> > A double-blind, randomized study comparing the antihypertensive

> > effect of eplerenone and spironolactone in patients with

> > hypertension and evidence of primary aldosteronism.

> >

> > Parthasarathy HK, MÃ©nard J, White WB, Young WF Jr, GH,

> > B, Ruilope LM, McInnes GT, Connell JM, Mac TM.

> > Source

> >

> > Department of Cardiology, Papworth Hospital, Cambridge, UK.

> >

> > Abstract

> >

> > BACKGROUND:

> >

> > Eplerenone is claimed to be a more selective blocker of the

> > mineralocorticoid receptor than spironolactone being associated with

> > fewer antiandrogenic side-effects. We compared the efficacy, safety

> > and tolerability of eplerenone versus spironolactone in patients

> > with hypertension associated with primary aldosteronism.

> >

> > METHODS:

> >

> > The study was multicentre, randomized, double-blind, active-

> > controlled, and parallel group design. Following a single-blind,

> > placebo run-in period, patients were randomized 1: 1 to a 16-week

> > double-blind, treatment period of spironolactone (75-225 mg once

> > daily) or eplerenone (100-300 mg once daily) using a titration-to-

> > effect design. To be randomized, patients had to meet biochemical

> > criteria for primary aldosteronism and have a seated DBP at least 90

> > mmHg and less than 120 mmHg and SBP less than 200 mmHg. The primary

> > efficacy endpoint was the antihypertensive effect of eplerenone

> > versus spironolactone to establish noninferiority of eplerenone in

> > the mean change from baseline in seated DBP.

> >

> > RESULTS:

> >

> > Changes from baseline in DBP were less on eplerenone (-5.6 Â± 1.3 SE

> > mmHg) than spironolactone (-12.5 Â± 1.3 SE mmHg) [difference, -6.9

> > mmHg (-10.6, -3.3); P<0.001]. Although there were no significant

> > differences between eplerenone and spironolactone in the overall

> > incidence of adverse events, more patients randomized to

> > spironolactone developed male gynaecomastia (21.2 versus 4.5%;

> > P=0.033) and female mastodynia (21.1 versus 0.0%; P=0.026).

> >

> > CONCLUSION:

> >

> > The antihypertensive effect of spironolactone was significantly

> > greater than that of eplerenone in hypertension associated with

> > primary aldosteronism.

> >

> > PMID:

> > 21451421

> > [PubMed - in process]

> > Related citations

> >

> > 50. J Renin Angiotensin Aldosterone Syst. 2011 Jun;12(2):113-122.

> > Epub 2011 Mar 24.

> > Relative kidney hyperfiltration in primary aldosteronism: a meta-

> > analysis.

> >

> > Kuo CC, Wu VC, Tsai CW, Wu KD; The Taiwan Primary Aldosteronism

> > Investigation (TAIPAI) Study Group).

> > Source

> >

> > Department of Internal Medicine, National Taiwan University

> > Hospital, Yun-Lin Branch, Yun-Lin, Taiwan.

> >

> > Abstract

> >

> > INTRODUCTION:

> >

> > : Since the phenomenon of hyperfiltration in primary aldosteronism

> > (PA) was first noted in 1996, subsequent clinical studies have

> > produced conflicting results. To determine the development of

> > relative hyperfiltration in PA, we performed a meta-analysis.

> >

> > METHODS:

> >

> > : MEDLINE, EMBASE, and the Cochrane Central Register of Controlled

> > Trials (CENTRAL) were searched through to July 2009. Reference

> > sections of original articles, meta-analyses, and reviews on

> > hyperfiltration in PA were reviewed. Hypertensive patients provided

> > the controlled data for hyperfiltration. Two authors independently

> > extracted the data.

> >

> > RESULTS:

> >

> > : A total of seven studies were included. One study was from the

> > data of the TAIPAI group. Overall, there was strong evidence that

> > relative kidney hyperfiltration existed in PA (fixed-effects model:

> > standardised mean difference (SMD), 0.13; 95% confidence interval

> > (CI), 0.03-0.22, p = 0.007; random-effects model: SMD, 0.35; 95% CI,

> > -0.01-0.71, p = 0.05), though with a significant heterogeneity (p <

> > 0.0001). In the secondary meta-analysis with five top-quality

> > studies, the relative kidney hyperfiltration was more significant.

> > Mean age in each enrolled study was the only factor significantly

> > associated with the existence of heterogeneity among the selected

> > studies in the meta-regression analysis.

> >

> > CONCLUSIONS:

> >

> > : Current evidence suggests that relative kidney hyperfiltration is

> > the hallmark in PA and the phenomenon is beyond the effect of

> > hypertension of PA. Clinicians should be aware of the possibility of

> > occult renal damage in patients with PA.

> >

> > PMID:

> > 21436207

> > [PubMed - as supplied by publisher]

> > Related citations

> >

> > 51. Ann Clin Biochem. 2011 May;48(Pt 3):256-62. Epub 2011 Mar 22.

> > The clinical utility of two renin mass methods to detect primary

> > hyperaldosteronism compared with renin activity.

> >

> > Wedatilake YN, Scanlon MJ, SC.

> > Source

> >

> > Clinical Biochemistry, St 's Hospital, Imperial College

> > Healthcare NHS Trust, Praed Street, London W2 1NY, UK. yehani.wedatilake@...

> >

> > Abstract

> >

> > BACKGROUND:

> >

> > Primary hyperaldosteronism (PHA) is characterized by a raised plasma

> > aldosterone concentration (PAC) with suppressed plasma renin

> > activity (PRA). We evaluated two renin mass methods for PHA

> > detection compared with the PAC:PRA ratio.

> >

> > METHODS:

> >

> > Samples from patients attending a specialist hypertensive clinic

> > were analysed by Liaison automated chemiluminescent immunoassay and

> > Diagnostic Systems Laboratories (DSL) immunoradiometric assay (IRMA)

> > for renin mass; I(-125) radioimmunoassay of angiotensin I generated

> > from endogenous angiotensinogen for PRA; Siemens Coat-a-count

> > radioimmunoassay for PAC. Subjects included those on Î²-blockers

> > which suppress renin, causing an equivalent biochemical picture to

> > PHA. Aldosterone/renin ratios (ARR) were calculated for PRA, DSL and

> > Liaison methods. The first 100 subjects were used to identify cut-

> > off ratios ensuring maximum specificity at 100% sensitivity for PHA

> > detection. This cut-off was retested in a subsequent population (n =

> > 43).

> >

> > RESULTS:

> >

> > A Liaison renin of 5 ng/L separated PRAs of â‰¤0.5 from â‰¥0.6 pmol/

> > mL/h. The DSL method had greater scatter. In population 1 (18 PHA),

> > cut-off ratios of >118 pmol/ng (Liaison) and >60 pmol/ng (DSL) gave

> > specificities of 58.5% and 61%, respectively, with 100% sensitivity.

> > If criteria for PHA included PAC â‰¥350 pmol/L and excluded Î²-

> > blocked subjects, specificity increased to 95.1% and 90% for Liaison

> > and DSL, respectively. In population 2 (6 PHA), specificities for

> > Liaison and DSL ARRs were 86.4% and 78.3%. Using the ratio with PAC

> > and Î²-blocker criteria, specificities for Liaison and DSL were 97.3%

> > and 86.5%, respectively.

> >

> > CONCLUSIONS:

> >

> > The Liaison ARR used with PAC and Î²-blocker criteria provided an

> > automatable alternative to identify the same patients as the PAC:PRA

> > ratio.

> >

> > PMID:

> > 21427267

> > [PubMed - in process]

> > Related citations

> >

> > 52. Rev Endocr Metab Disord. 2011 Mar;12(1):21-5.

> > Primary aldosteronism, diagnosis and treatment in Japan.

> >

> > Takeda Y, Karashima S, Yoneda T.

> > Source

> >

> > Department of Internal Medicine, Division of Endocrinology and

> > Hypertension, Graduate School of Medical Science, Kanazawa

> > University, Kanzawa, Japan. takeday@...

> >

> > Abstract

> >

> > Primary aldosteronism (PA) has been recognized as a common cause of

> > secondary hypertension and accounts for approximately 5-15% of the

> > hypertensive population in Japan. Screening for PA should therefore

> > be carried out in all hypertensive patients as we have shown the

> > estimated prevalence of PA is 13.6% in pre-hypertensive subjects and

> > 9.1% in stage 1 hypertensive patients. The screening test most

> > advocated is the aldosterone-to-renin ratio (ARR), and when the ARR

> > is >20 the following confirmatory tests should be carried out; the

> > captopril challenge test, frusemide-upright test, or saline infusion

> > test. Adrenal CT is not accurate for distinguishing between an

> > aldosterone-producing adenoma (APA) and idiopathic

> > hyperaldosteronism (IHA). Adrenal venous sampling (AVS) is therefore

> > essential for selecting the appropriate therapy in patients a high

> > probability of PA who require surgical treatment. Rapid cortisol

> > assays during AVS to monitor cortisol levels can reduce the failure

> > associated with AVS. We have developed a new rapid cortisol assay

> > using immunochromatography, in which cortisol concentration can be

> > measured within 6 min. Using this technique, the success rate of AVS

> > improved to 93%. IHA underlies about one-half of cases with PA;

> > treatment with eplerenone (100 mg twice a daily), a specific

> > mineralocorticoid receptor antagonist, results in substantial

> > improvement in hypertension, with fewer side effects compared to

> > spironolactone.

> >

> > PMID:

> > 21424323

> > [PubMed - in process]

> > Related citations

> >

> > 53. Int J Hypertens. 2011 Mar 2;2011:236239.

> > Common secondary causes of resistant hypertension and rational for

> > treatment.

> >

> > Faselis C, Doumas M, Papademetriou V.

> > Source

> >

> > Veterans Affairs Medical Center, Washington University, VAMC

> > 50 Irving Street NW, Washington, DC 20422, USA.

> >

> > Abstract

> >

> > Resistant hypertension is defined as uncontrolled blood pressure

> > despite the use of three antihypertensive drugs, including a

> > diuretic, in optimal doses. Treatment resistance can be attributed

> > to poor adherence to antihypertensive drugs, excessive salt intake,

> > physician inertia, inappropriate or inadequate medication, and

> > secondary hypertension. Drug-induced hypertension, obstructive sleep

> > apnoea, primary aldosteronism, and chronic kidney disease represent

> > the most common secondary causes of resistant hypertension. Several

> > drugs can induce or exacerbate pre-existing hypertension, with non-

> > steroidal anti-inflammatory drugs being the most common due to their

> > wide use. Obstructive sleep apnoea and primary aldosteronism are

> > frequently encountered in patients with resistant hypertension and

> > require expert management. Hypertension is commonly found in

> > patients with chronic kidney disease and is frequently resistant to

> > treatment, while the management of renovascular hypertension remains

> > controversial. A step-by-step approach of patients with resistant

> > hypertension is proposed at the end of this review paper.

> >

> > PMCID: PMC3057025

> > Free PMC Article

> > PMID:

> > 21423678

> > [PubMed]

> > Related citations

> >

> > 54. J Endocrinol Invest. 2011 Mar 21. [Epub ahead of print]

> > CARDIOVASCULAR CHANGES IN PATIENTS WITH PRIMARY ALDOSTERONISM AFTER

> > SURGICAL OR MEDICAL TREATMENT.

> >

> > Bernini G, Bacca A, Carli V, Carrara D, Materazzi G, Berti P,

> > Miccoli P, Pisano R, Tantardini V, Bernini M, Taddei S.

> > Source

> >

> > Department of Internal Medicine, University of Pisa, Pisa, Italy.

giampaolo.bernini@...

> > .

> >

> > Abstract

> >

> > Background: Data on the cardiovascular middle-term follow-up of

> > patients with primary aldosteronism (PA) are scanty. Aim: To detect

> > the cardiovascular effects of surgery in patients with

> > aldosteroneproducing adenoma (APA) and of pharmacotherapy in those

> > with bilateral adrenal hyperplasia (BAH), a prospective study

> > involving 60 consecutive patients with PA was performed. Material/

> > Methods: Clinical, biochemical and cardiovascular assessment was

> > obtained before and after (31.5Â±4.4 months) surgery or proper

> > medical treatment (32.1Â±5.0 months) in 19 and 41 patients,

> > respectively. Results: As expected, plasma aldosterone (ALD)

> > normalized in all operated patients, while in the other group it did

> > not change. Systolic and diastolic blood pressure decreased

> > (p<0.001) after both treatments. However, absolute and percentage

> > reduction was significantly more pronounced (p<0.01) in operated

> > than in non-operated patients. Left ventricular mass showed

> > significant reduction after surgery (LV mass g/m2, p<0.0007; LV mass

> > g/m2.7, p<0.01), but no change after medical treatment, so that the

> > differences between absolute and percentage values at follow-up were

> > statistically significant (p<0.01) between groups. Basal LV mass/

> > m2.7 was positively associated with age (p<0.009), BMI (p<0.0008),

> > drug number (p<0.03) and ALD/PRA ratio (p<0.01). Allocating the

> > patients according to plasma ALD and cardiac parameters, patients

> > who presented ALD reduction during the study also had a decrement in

> > cardiac mass (p<0.04). Conclusions: Our data indicate that in

> > patients with PA the removal of ALD excess by surgery in APA is

> > effective in reducing blood pressure and in improving cardiac

> > parameters, while antihypertensive therapy in BAH shows less

> > positive impact on cardiovascular system.

> >

> > PMID:

> > 21422805

> > [PubMed - as supplied by publisher]

> > Related citations

> >

> > 55. Intern Med. 2011;50(6):585-90. Epub 2011 Mar 15.

> > A case of primary aldosteronism caused by multiple adrenocortical

> > macronodules.

> >

> > Hashimoto N, Kawamura Y, Nakamura T, Murawaki A, Nishiumi T, Hirota

> > Y, Sakagushi K, Kurahashi T, Miyake H, Fujisawa M, Sasano H,

> > Takahashi Y.

> > Source

> >

> > Division of Diabetes and Endocrinology, Department of Internal

> > Medicine, Kobe University Graduate School of Medicine, Japan.

> >

> > Abstract

> >

> > A 60-year-old man presented with drug-resistant hypertension with

> > hypokalemia, a high plasma aldosterone concentration (PAC) and

> > suppressed plasma rennin activity (PRA). Imaging examinations showed

> > multiple macronodules in the left adrenal gland. Endocrinological

> > findings demonstrated autonomous aldosterone secretion and (131)I-

> > adosterol scintigraphy demonstrated a left sided uptake.

> > Laparoscopic left adrenalectomy normalized serum potassium levels

> > and PAC, and substantially improved hypertension. Pathological and

> > immunohistochemical analysis demonstrated that these nodules were

> > positive for 3Î²-hydroxysteroid dehydrogenase (HSD3B) but not for

> > CYP17. In addition, zona glomerulosa demonstrated " paradoxical

> > hyperplasia " , in which these cells were negative for HSD3B. All of

> > these data indicated that the nodules in the left adrenal gland were

> > mainly responsible for the autonomous aldosterone secretion. We

> > conclude that the primary aldosteronism in this case was caused by

> > multiple macronodules. This is a very rare case of primary

> > aldosteronism caused by multiple adrenocortical macronodules.

> >

> > Free Article

> > PMID:

> > 21422683

> > [PubMed - in process]

> > Related citations

> >

> > 56. J Urol. 2011 May;185(5):1578-82. Epub 2011 Mar 21.

> > Long-term results of a prospective, randomized trial comparing

> > retroperitoneoscopic partial versus total adrenalectomy for

> > aldosterone producing adenoma.

> >

> > Fu B, Zhang X, Wang GX, Lang B, Ma X, Li HZ, Wang BJ, Shi TP, Ai X,

> > Zhou HX, Zheng T.

> > Source

> >

> > Department of Urology, First Affiliated Hospital of Nanchang

> > University, Nanchang, People's Republic of China.

> >

> > Abstract

> >

> > PURPOSE:

> >

> > The indication for laparoscopic total or partial adrenalectomy in

> > patients with aldosterone producing adrenal adenoma remains

> > controversial. We compared retroperitoneoscopic partial and total

> > adrenalectomy for aldosterone producing adrenal adenoma in a

> > prospective, randomized, multicenter trial.

> >

> > MATERIALS AND METHODS:

> >

> > Patients with aldosterone producing adrenal adenoma were randomized

> > to retroperitoneoscopic partial or total adrenalectomy. Patient

> > characteristics, surgical data, complications and postoperative

> > clinical results were analyzed statistically.

> >

> > RESULTS:

> >

> > From July 2000 to March 2004, 212 patients were enrolled in this

> > study, including 108 and 104 who underwent total and partial

> > adrenalectomy, respectively. The 2 groups were comparable in patient

> > age, gender, body mass index and tumor site. Mean followup was 96

> > months in each group. No conversion to open surgery was needed and

> > no major complications developed. Partial adrenalectomy required a

> > shorter operative time than total adrenalectomy but this did not

> > attain statistical significance. Intraoperative blood loss in the

> > partial adrenalectomy group was significant higher than in the total

> > adrenalectomy group (p <0.05) but no patient needed blood

> > transfusion. All patients in each group showed improvement in

> > hypertension, and in all plasma renin activity and aldosterone

> > returned to normal after surgery. No patient required potassium

> > supplements postoperatively. In the total and partial adrenalectomy

> > groups 32 (29.6%) and 29 patients (27.9%), respectively, were

> > prescribed a decreased dose of or fewer antihypertensive medicines

> > at final followup.

> >

> > CONCLUSIONS:

> >

> > Retroperitoneoscopic partial adrenalectomy is technically safe. It

> > has therapeutic results similar to those of total adrenalectomy in

> > patients with primary aldosteronism due to aldosteronoma.

> >

> > PMID:

> > 21419437

> > [PubMed - indexed for MEDLINE]

> > Related citations

> >

> > 57. J Clin Endocrinol Metab. 2011 Jun;96(6):1797-804. Epub 2011 Mar

> > 16.

> > Effect of contraceptives on aldosterone/renin ratio may vary

> > according to the components of contraceptive, renin assay method,

> > and possibly route of administration.

> >

> > Ahmed AH, Gordon RD, PJ, Ward G, Pimenta E, Stowasser M.

> > Source

> >

> > Endocrine Hypertension Research Centre, University of Queensland

> > School of Medicine, Greenslopes Hospital, Brisbane, Australia.

> >

> > Abstract

> >

> > BACKGROUND:

> >

> > The most popular screening test for primary aldosteronism is plasma

> > aldosterone/renin ratio (ARR). Because both estrogen and

> > progesterone affect aldosterone and renin levels, we studied effects

> > of two contraceptives commonly used in our population, one oral and

> > one subdermal, on ARR, measuring renin as both direct renin

> > concentration (DRC) and plasma renin activity (PRA).

> >

> > METHODS:

> >

> > Normotensive, healthy women underwent measurement (seated,

> > midmorning) of plasma aldosterone, DRC, PRA, electrolytes, and

> > creatinine and urinary aldosterone, cortisol, electrolytes, and

> > creatinine at baseline (menses) and after either 1) 3 wk treatment

> > with oral ethinylestradiol plus drospirenone (n = 17) or 2) 1 wk and

> > 6 wk treatment with subdermal etonogestrel (n = 15), a third-

> > generation progestin.

> >

> > RESULTS:

> >

> > Treatment with oral ethinylestradiol plus drospirenone was

> > associated with significant increases in aldosterone [median (range)

> > at baseline = 131 (85-590) pmol/liter; at 1 wk, 200 (130-784) pmol/

> > liter; and at 3 wk, 412 (199-1010) pmol/liter (P < 0.001, Friedman

> > test)] and PRA [2.1 (1.2-4.7), 3.6 (1.5-7.1), and 4.9 (1.5-10.8) ng/

> > ml Â· h, P < 0.001] but decreases in DRC [22 (11-36), 21 (8.7-41),

> > and 14 (8.5-39) mU/liter, P < 0.01] leading to increases in ARR

> > calculated by DRC [6.6 (3.3-31.3), 10.9 (5.2-58.9), and 29.8

> > (5.1-88.5), P < 0.001]. There were no significant changes in ARR

> > calculated by PRA, plasma electrolytes and creatinine, and all

> > urinary measurements. In contrast, treatment with subdermal

> > etonogestrel was associated with no significant changes in PRA, DRC,

> > aldosterone, or ARR at either 1 or 6 wk.

> >

> > CONCLUSION:

> >

> > The combined oral contraceptive ethinylestradiol plus drospirenone

> > is capable of significantly increasing ARR with risk of false-

> > positive results during screening for primary aldosteronism, but

> > only if DRC is used to calculate the ratio. Subdermal etonogestrel

> > had no effect on ARR after 6 wk.

> >

> > PMID:

> > 21411552

> > [PubMed - in process]

> > Related citations

> >

> > 58. Arch Esp Urol. 2011 Mar;64(2):114-20.

> > Laparoscoscopic synchronous bilateral adrenalectomy.

> >

> > Castillo OA, LÃ³pez-Fontana G, Vitagliano G.

> > Source

> >

> > Departamento de UrologÃa, ClÃnica Indisa, Santiago, Chile.

octavio.castilloindisa (DOT)

> > cl

> >

> > Abstract

> >

> > OBJECTIVES:

> >

> > To report our experience in a series of bilateral synchronous

> > laparoscopic adrenalectomies detailing technique and results.

> >

> > METHODS:

> >

> > A total of 242 laparoscopic adrenalectomies were performed in an 8

> > year period at our institution. Twenty four out of these were

> > bilateral. Of the 24 patients, 22 (92%) were bilateral and

> > synchronous. Mean patient age was 41.4 years (range 17 to 72 years)

> > and male to female ratio was 1:2.1.

> >

> > RESULTS:

> >

> > Mean adrenal size was 5.5 cm (range 2 to 11 cm). In order of

> > frequency, pathological finding was: pheochromocytoma, cushing`s

> > disease, metastatic lesions, hyperaldosteronism, congenital adrenal

> > hyperplasia, myelolipoma and adrenal adenoma. Complete adrenalectomy

> > was performed in 36 cases (82%) while in 8 cases (18%) partial

> > adrenalectomy was preferred. Mean operative time was 78.6 minutes

> > (range 25 to 210 min) being 79.5 min and 77 min for right and left

> > adrenalectomies respectively. Mean operative bleeding was 63 ml

> > (range 0 to 500 ml). Only one patient received blood transfusion.

> > Intraoperative complications occurred in only one patient (2%), a

> > small tear in the renal vein that was successfully controlled by

> > intracorporeal suturing. Mean hospital stay was 3.2 days (range 2 to

> > 5 days).

> >

> > CONCLUSION:

> >

> > We believe that laparoscopic synchronous bilateral adrenalectomy is

> > a feasible, safe and reproducible technique that should be

> > considered of choice for the management of benign bilateral adrenal

> > pathology.

> >

> > PMID:

> > 21399244

> > [PubMed - in process]

> > Related citations

> >

> > 59. J Renin Angiotensin Aldosterone Syst. 2011 Mar 10. [Epub ahead

> > of print]

> > Verification and evaluation of aldosteronism demographics in the

> > Taiwan Primary Aldosteronism Investigation Group (TAIPAI Group).

> >

> > Kuo CC, Wu VC, Huang KH, Wang SM, Chang CC, Lu CC, Yang WS, Tsai CW,

> > Lai CF, Lee TY, Lin WC, Wu MS, Lin YH, Chu TS, Lin CY, Chang HW,

> > Wang WJ, Kao TW, Chueh SC, Wu KD.

> > Source

> >

> > National Taiwan University Hospital, College of Medicine, National

> > Taiwan University and National Taiwan University Hospital Yun-Lin

> > Branch, Taiwan.

> >

> > Abstract

> >

> > OBJECTIVE:

> >

> > Current data on primary aldosteronism (PA) from Asian populations

> > are scarce. This cohort study clarifies the attributes of patients

> > with PA in a typical Chinese population.

> >

> > DESIGN:

> >

> > An observational cohort study.

> >

> > METHODS:

> >

> > The records of patients referred to the Hypertension Clinic from a

> > multi-centre registration in Taiwan from January 1995 to December

> > 2007 were reviewed. All patients with PA were classified into two

> > subtypes: aldosterone-producing adenomas (APA) and idiopathic

> > hyperaldosteronism (IHA); their characteristics were compared.

> >

> > RESULTS:

> >

> > Our cohort consisted of 346 patients with PA, 255 with APA and 91

> > with IHA. The initial hypokalaemia (59% in APA vs. 27.5% in IHA, p <

> > 0.0001) and transtubular potassium gradient (TTKG) (6.30 Â± 2.41 in

> > APA vs. 4.91 Â± 2.03 in IHA, p = 0.01) were higher in the APA group.

> > Baseline plasma aldosterone concentration (PAC) was also

> > significantly different between the two subgroups (49.96 Â± 38.15 ng/

> > dl in APA vs. 34.24 Â± 21.47 in IHA, p < 0.0001).

> >

> > CONCLUSIONS:

> >

> > In typical Chinese PA patients, the APA subgroup had a higher

> > proportion of hypokalaemia with elevated TTKG and higher PAC as

> > compared with the IHA subgroup. This largest Asian database also

> > demonstrated major differences between the Caucasian and Chinese

> > populations including female predilection, frequent hypokalaemia,

> > and common paralytic myopathy.

> >

> > PMID:

> > 21393359

> > [PubMed - as supplied by publisher]

> > Related citations

> >

> > 60. J Clin Endocrinol Metab. 2011 Jun;96(6):E878-83. Epub 2011 Mar 9.

> > Psychological assessment of primary aldosteronism: a controlled study.

> >

> > Sonino N, Tomba E, Genesia ML, Bertello C, Mulatero P, Veglio F,

> > Fava GA, Fallo F.

> > Source

> >

> > Department of Statistical Sciences, University of Padova, 35128

> > Padova, Italy.

> >

> > Abstract

> >

> > OBJECTIVE:

> >

> > Our objective was to investigate psychological correlates in a

> > population with primary aldosteronism (PA) using methods found to be

> > sensitive and reliable in psychosomatic research.

> >

> > METHODS:

> >

> > Twenty-three PA patients (12 male, 11 female; mean age 50 Â± 9 yr)

> > were compared with 23 patients with essential hypertension (EH) (15

> > male, eight female; mean age 47 Â± 8 yr) and 23 matched normotensive

> > subjects. A modified version of the Structural Clinical Interview

> > for DSM-IV, a shortened version of the structured interview for the

> > Diagnostic Criteria for Psychosomatic Research, and two self-rating

> > questionnaires, the Psychosocial Index and the Symptom

> > Questionnaire, were administered.

> >

> > RESULTS:

> >

> > Twelve of 23 patients with PA (52.2%) suffered from an anxiety

> > disorder compared with four of 23 with EH (17.4%) and one control

> > (4.3%) (P < 0.001). Generalized anxiety disorder was more frequent

> > in PA than in EH patients and controls (P < 0.05). As assessed by

> > Diagnostic Criteria for Psychosomatic Research, irritable mood was

> > more frequent in PA and EH compared with controls (P < 0.05) but did

> > not differentiate PA from EH. According to Psychosocial Index

> > results, patients with PA had higher levels of stress (P < 0.01) and

> > psychological distress (P < 0.01) and lower level of well-being (P <

> > 0.05) than controls. Compared with EH patients, PA patients had

> > higher scores in stress subscale (P < 0.05). The Symptom

> > Questionnaire showed higher levels of anxiety (P < 0.01), depression

> > (P < 0.01) and somatization (P < 0.01) and lower physical well-being

> > (P < 0.05) in PA than controls.

> >

> > CONCLUSION:

> >

> > A role of mineralocorticoid regulatory mechanisms in clinical

> > situations concerned with anxiety and stress is suggested.

> >

> > PMID:

> > 21389142

> > [PubMed - in process]

> > Related citations

> >

> > 61. Dtsch Med Wochenschr. 2011 Mar;136(11):537-40. Epub 2011 Mar 8.

> > [Diagnosis of endocrinological hypertension: when to screen, and by

> > which method?].

> >

> > [Article in German]

> > Fischer E, Beuschlein F, Reincke M.

> > Source

> >

> > Medizinische Klinik Ludwig-Maximilians-UniversitÃ¤t MÃ¼nchen, MÃ¼nchen.

martin.reincke@...

> > .de

> >

> > PMID:

> > 21387212

> > [PubMed - indexed for MEDLINE]

> > Related citations

> >

> > 62. Nurse Pract. 2011 Apr;36(4):12-21; quiz 21-2.

> > Diagnosis and management of primary aldosteronism.

> >

> > Thanavaro JL.

> > Source

> >

> > Adult Nurse Practitioner Program at St. Louis University School of

> > Nursing, St. Louis, Missouri, MO, USA.

> >

> > Abstract

> >

> > Primary aldosteronism (PAL) is characterized by excessive production

> > of aldosterone, which leads to hypernatremia, hypertension (HTN),

> > hypokalemia, and alkalosis. Three crucial diagnostic steps include

> > case detection, case confirmation, and subtype classification.

> > Marked improvement or cure of HTN is achieved with appropriate

> > treatment.

> >

> > PMID:

> > 21386738

> > [PubMed - in process]

> > Related citations

> >

> > 63. Masui. 2011 Feb;60(2):244-6.

> > [Case of severe hypokalemia during emergency surgery caused by long-

> > term administration of Shakuyaku-kanzo-to].

> >

> > [Article in Japanese]

> > Yasuda T, Hirasaki Y, Oguchi M, Tajima K.

> > Source

> >

> > Department of Anesthesia, Tsukuba Memorial Hospital, Tsukuba 300-2622.

> >

> > Abstract

> >

> > An 82-year-old female underwent emergency surgery for right femoral

> > incarcerated hernia under general anesthesia. Anesthesia was induced

> > and maintained with remifentanil and propofol. Her laboratory data

> > showed severe hypokalemia (1.83 mEq x l(-1)) and metabolic alkalosis

> > (HCO3 36.9 mmol x l(-1)). We suspected that the causes of such

> > abnormalities were due to an endocrinological abnormality, but we

> > could not ascertain the actual cause. Drip infusion of sodium

> > chloride and saline solution infusion, to avoid supplying lactate or

> > acetate, the source of bicarbonate ions, were chosen for palliative

> > treatment. No adverse event occurred during surgery. After surgery,

> > endocrinological functions were examined. Primary aldosteronism was

> > ruled out because serum aldosterone and rennin activity were within

> > normal ranges. The patient had been taking a Kampo preparation,

> > Shakuyaku-kanzo-to, for two years. Glycyrrhizin, the main component

> > of Shakuyaku-kanzo-to, has been reported to be a cause of

> > pseudoaldosteronism by inhibiting the enzyme converting cortisol to

> > cortisone. With these findings we confirmed that severe hypokalemia

> > was induced by pseudoaldosteronism by long-term administration of

> > Shakuyaku-kanzo-to.

> >

> > PMID:

> > 21384669

> > [PubMed - indexed for MEDLINE]

> > Related citations

> > 64. Hypertension. 2011 May;57(5):990-5. Epub 2011 Mar 7.

> > Adrenal venous sampling: evaluation of the German Conn's registry.

> >

> > Vonend O, Ockenfels N, Gao X, Allolio B, Lang K, Mai K, Quack I,

> > Saleh A, Degenhart C, Seufert J, Seiler L, Beuschlein F, Quinkler M,

> > Podrabsky P, Bidlingmaier M, Lorenz R, Reincke M, Rump LC; German

> > Conn's Registry.

> > Source

> >

> > Department of Nephrology, Medical Faculty, Heinrich-Heine University

> > DÃ¼sseldorf, 40225 DÃ¼sseldorf, Germany.

> >

> > Abstract

> >

> > In patients with primary aldosteronism, adrenal venous sampling is

> > helpful to distinguish between unilateral and bilateral adrenal

> > diseases. However, the procedure is technically challenging, and

> > selective bilateral catheterization often fails. The aim of this

> > analysis was to evaluate success rate in a retrospective analysis

> > and compare data with procedures done prospectively after

> > introduction of measures designed to improve rates of successful

> > cannulation. Patients were derived from a cross-sectional study

> > involving 5 German centers (German Conn's registry). In the

> > retrospective phase, 569 patients with primary aldosteronism were

> > registered between 1990 and 2007, of whom 230 received adrenal

> > venous sampling. In 200 patients there were sufficient data to

> > evaluate the procedure. In 2008 and 2009, primary aldosteronism was

> > diagnosed in 156 patients, and adrenal venous sampling was done in

> > 106 and evaluated prospectively. Retrospective evaluation revealed

> > that 31% were bilaterally selective when a selectivity index

> > (cortisol adrenal vein/cortisol inferior vena cava) of â‰¥2.0 was

> > applied. Centers completing <20 procedures had success rates between

> > 8% and 10%. Overall success rate increased in the prospective phase

> > from 31% to 61%. Retrospective data demonstrated the pitfalls of

> > performing adrenal venous sampling. Even in specialized centers,

> > success rates were poor. Marked improvements could be observed in

> > the prospective phase. Selected centers that implemented specific

> > measures to increase accuracy, such as rapid-cortisol-assay and

> > introduction of standard operating procedures, reached success rates

> > of >70%. These data demonstrate the importance of throughput,

> > expertise, and various potentially beneficial measures to improve

> > adrenal vein sampling.

> >

> > PMID:

> > 21383311

> > [PubMed - indexed for MEDLINE]

> > Related citations

> >

> > 65. Int J Neuropsychopharmacol. 2011 Mar 4:1-19. [Epub ahead of print]

> > Subchronic treatment with aldosterone induces depression-like

> > behaviours and gene expression changes relevant to major depressive

> > disorder.

> >

> > Hlavacova N, Wes PD, Ondrejcakova M, Flynn ME, Poundstone PK, Babic

> > S, Murck H, Jezova D.

> > Source

> >

> > Laboratory of Pharmacological Neuroendocrinology, Institute of

> > Experimental Endocrinology, Slovak Academy of Sciences, Vlarska,

> > Bratislava, Slovakia.

> >

> > Abstract

> >

> > The potential role of aldosterone in the pathophysiology of

> > depression is unclear. The aim of this study was to test the

> > hypothesis that prolonged elevation of circulating aldosterone

> > induces depression-like behaviour accompanied by disease-relevant

> > changes in gene expression in the hippocampus. Subchronic (2-wk)

> > treatment with aldosterone (2 Î¼g/100 g body weight per day) or

> > vehicle via subcutaneous osmotic minipumps was used to induce

> > hyperaldosteronism in male rats. All rats (n=20/treatment group)

> > underwent a modified sucrose preference test. Half of the animals

> > from each treatment group were exposed to the forced swim test

> > (FST), which served both as a tool to assess depression-like

> > behaviour and as a stress stimulus. Affymetrix microarray analysis

> > was used to screen the entire rat genome for gene expression changes

> > in the hippocampus. Aldosterone treatment induced an anhedonic state

> > manifested by decreased sucrose preference. In the FST,

> > depressogenic action of aldosterone was manifested by decreased

> > latency to immobility and increased time spent immobile. Aldosterone

> > treatment resulted in transcriptional changes of genes in the

> > hippocampus involved in inflammation, glutamatergic activity, and

> > synaptic and neuritic remodelling. Furthermore, aldosterone-

> > regulated genes substantially overlapped with genes affected by

> > stress in the FST. This study demonstrates the existence of a causal

> > relationship between the hyperaldosteronism and depressive

> > behaviour. In addition, aldosterone treatment induced changes in

> > gene expression that may be relevant to the aetiology of major

> > depressive disorder. Subchronic treatment with aldosterone

> > represents a new animal model of depression, which may contribute to

> > the development of novel targets for the treatment of depression.

> >

> > PMID:

> > 21375792

> > [PubMed - as supplied by publisher]

> > Related citations

> >

> > 66. Rev Endocr Metab Disord. 2011 Mar;12(1):27-36.

> > Diagnosis and treatment of primary aldosteronism.

> >

> > Rossi GP.

> > Source

> >

> > DMCS Gino Patrassi-Clinica Medica 4, University of Padua, Padua,

> > Italy. gianpaolo.rossi@...

> >

> > Abstract

> >

> > Primary aldosteronism involves more than 11% of hypertensive

> > patients who are referred to specialized centers for the diagnosis

> > and treatment of hypertension. If not diagnosed early it causes an

> > excess damage to the heart, vessels and kidney, which translates

> > into an cardiovascular events. Since these ominous consequences can

> > be corrected with a timely diagnosis and an appropriate therapy,

> > physicians should exercise a high degree of alert concerning the

> > possibility that primary aldosteronism is present in hypertensive

> > patients. The purpose of this review is to provide up-dated

> > information on the strategy for case detection, the subtype

> > differentiation and the management of primary aldosteronism.

> >

> > PMID:

> > 21369868

> > [PubMed - in process]

> > Related citations

> >

> > 67. Iran J Kidney Dis. 2011 Mar;5(2):71-6.

> > Aldosterone, hypertension, and beyond.

> >

> > Samavat S, Ahmadpoor P, Samadian F.

> > Source

> >

> > Department of Nephrology, Shahid Beheshti University of Medical

> > Sciences, Tehran, Iran.

> >

> > Erratum in

> >

> > Iran J Kidney Dis. 2011 Jul;5(3):214. Samadian, Fariba [added].

> > Abstract

> >

> > Aldosterone, a mineralocorticoid hormone, has a well-known function

> > on water balance and blood pressure homeostasis. Recently, its role

> > in metabolic syndrome, insulin resistance, and obesity has come into

> > a spotlight. Aldosterone induces inflammation and oxidative stress

> > that are attenuated by mineralocorticoid receptor blockers such as

> > spironolactone. Aldosterone exerts its effects via the epithelial

> > sodium channel by non-genomic pathways, including serum and

> > glucocorticoid kinase 1, neural precursor cell-expressed

> > developmentally downregulated (gene 4) protein, and K-Ras, and

> > genomic pathways via epigenetic mechanisms. Beyond regulating

> > epithelial sodium channel, aldosterone induces cardiac hypertrophy,

> > endothelial dysfunction, podocyte injury, and fibrosis. This opens

> > new horizons for mineralocorticoid receptor antagonists and novel

> > therapeutic targets such as serum-glucocorticoid regulated kinase 1.

> >

> > Free Article

> > PMID:

> > 21368382

> > [PubMed - indexed for MEDLINE]

> > Related citations

> >

> > 68. J Clin Hypertens (Greenwich). 2011 Mar;13(3):E3-4. doi: 10.1111/

> > j.1751-7176.2010.00413.x. Epub 2011 Jan 10.

> > Trick or treat? Pseudohyperaldosteronism due to episodic licorice

> > consumption.

> >

> > Wynn GJ, GK, Maher B.

> > PMID:

> > 21366843

> > [PubMed - indexed for MEDLINE]

> > Related citations

> >

> > 69. Surg Endosc. 2011 Feb 27. [Epub ahead of print]

> > Outpatient laparoscopic adrenalectomy: a new step ahead.

> >

> > RamÃrez-Plaza CP, Gallego Perales JL, Camero NM, RodrÃguez-CaÃ±ete

> > A, BondÃa-Navarro JA, Santoyo-Santoyo J.

> > Source

> >

> > Department of General and Digestive Surgery and Transplants,

> > Hospital Regional Universitario " Haya " (Malaga), Avenida de

> > Haya s/n, 29010, Malaga, Spain, cprptot@...

> >

> > Abstract

> >

> > BACKGROUND:

> >

> > The feasibility of performing laparoscopic adrenalectomy (LA) as an

> > outpatient procedure in selected patients in the context of a

> > specialized unit has been assessed in this study.

> >

> > METHODS:

> >

> > Retrospective cohort of 22 patients who underwent LA without

> > hospital admission under strict selection criteria within a specific

> > laparoscopic surgery unit of a tertiary hospital center has been

> > reported. Patient demographics, indications for surgery, operative

> > data, outpatient management, morbidity, and immediate follow-up have

> > been analyzed.

> >

> > RESULTS:

> >

> > The mean age of the patients was 50.9 years (median 52.5, range

> > 28-65) and 13 (59.1%) were women. All patients underwent successful

> > LA and none of them required conversion to laparotomy. The mean

> > length of the procedure was 56.6 min (median 60, range 15-120 min)

> > and no patient required transfusion. The most common indications for

> > surgery were adrenal incidentaloma and primary hyperaldosteronism

> > (36.4% each). Three patients accurately complied with the MAS

> > regimen and the other 19 spent the night on a DC basis and were

> > discharged with the hospital stay being less than 23 h. No patient

> > required readmission and relevant events occurred only in three

> > patients. With regard to postoperative pain management, only six

> > patients (27.27%) required more than 1 week of analgesics. In 68.1%

> > of the cases, resuming physical and professional activity took less

> > than 2 weeks and only three patients required more than 1 month

> > before restoring a " normal life. "

> >

> > CONCLUSION:

> >

> > By applying strict protocol and selection criteria, LA can be safely

> > and successfully performed as an outpatient procedure within an

> > experienced laparoscopic unit.

> >

> > PMID:

> > 21359891

> > [PubMed - as supplied by publisher]

> > Related citations

> >

> > 70. Clin Chim Acta. 2011 Jul 15;412(15-16):1319-25. Epub 2011 Feb 21.

> > Kidney impairment in primary aldosteronism.

> >

> > Wu VC, Yang SY, Lin JW, Cheng BW, Kuo CC, Tsai CT, Chu TS, Huang KH,

> > Wang SM, Lin YH, Chiang CK, Chang HW, Lin CY, Lin LY, Chiu JS, Hu

> > FC, Chueh SC, Ho YL, Liu KL, Lin SL, Yen RF, Wu KD; TAIPAI Study

> > Group.

> > Collaborators: Wu VC, Lin YH, Ho YL, Chang HW, Lin LY, Hu FC, Liu

> > KL, Wang SM, Huang KH, Chen YM, Kuo CC, Chang CC, Chueh SC, Lu CC,

> > Liao SC, Yen RF, Wu KD.

> >

> > Source

> >

> > Department of Internal Medicine, National Taiwan University

> > Hospital, Taipei, Taiwan.

> >

> > Abstract

> >

> > BACKGROUND:

> >

> > Kidney impairment is noted in primary aldosteronism (PA), and

> > probably initiated by glomerular hyperfiltration.

> >

> > METHODS:

> >

> > A prospectively defined survey was conducted on 602 patients who

> > were suspected of PA in the multiple-center Taiwan Primary

> > Aldosteronism Investigation (TAIPAI) database. Estimated glomerular

> > filtration rate (eGFR) was calculated and followed up at 1 yr after

> > treatment.

> >

> > RESULTS:

> >

> > The diagnosis of PA was confirmed in 330 patients. Among them 17% of

> > these patients had kidney impairment (eGFR<60 ml/min/1.73 mÂ²).

> > Patients with PA had a higher prevalence of estimated

> > hyperfiltration than those with essential hypertension (EH) (14.5%

> > vs. 7.0%, p=0.005). The eGFR independently predicted PA (OR, 1.017)

> > in the propensity-adjusted multivariate logistic model. In PA,

> > plasma renin activity and lower serum potassium (p=0.018) was

> > correlated with kidney impairment (p=0.001), while this relationship

> > was not significant in patients with EH. Either unilateral

> > adrenalectomy or treatment of spironolactone for PA patients caused

> > a decrease of eGFR (p<0.001). Pre-operative hypokalemia (p=0.013)

> > and the long latency of hypertension (p=0.016) could enhance the

> > significant decrease of eGFR after adrenalectomy.

> >

> > CONCLUSIONS:

> >

> > Patients with aldosteronism had relative estimated hyperfiltration

> > than patients with EH. Calculation of eGFR may increase the

> > specificity in identifying patients with PA. Our findings

> > demonstrate the correlation of serum potassium and renin with

> > estimated hyperfiltration in PA and their relationship to kidney

> > damage. These results provide a high priority for future renal

> > protective strategies and methods for the early diagnosis and prompt

> > treatment of PA.

> >

> > PMID:

> > 21345337

> > [PubMed - in process]

> > Related citations

> >

> > 71. Urology. 2011 Jul;78(1):68-73. Epub 2011 Feb 18.

> > Single-center Outcome of Laparoscopic Unilateral Adrenalectomy for

> > Patients With Primary Aldosteronism: Lateralizing Disease Using

> > Results of Adrenal Venous Sampling.

> >

> > Ishidoya S, Kaiho Y, Ito A, Morimoto R, Satoh F, Ito S, Ishibashi T,

> > Nakamura Y, Sasano H, Arai Y.

> > Source

> >

> > Department of Urology, Tohoku University Graduate School of

> > Medicine, Sendai, Japan.

> >

> > Abstract

> >

> > OBJECTIVES:

> >

> > To assess the clinical effect of the universal use of adrenal venous

> > sampling and to investigate the characteristics of patients with

> > primary aldosteronism undergoing laparoscopic adrenalectomy at a

> > single tertiary care center.

> >

> > METHODS:

> >

> > After the screening examination, confirmatory test, and computed

> > tomography (CT) scans were completed, all patients with

> > biochemically diagnosed hyperaldosteronism underwent adrenal venous

> > sampling to differentiate unilateral disease from bilateral

> > idiopathic hyperaldosteronism. A total of 174 consecutive patients

> > with unilateral aldosterone excess underwent unilateral laparoscopic

> > adrenalectomy.

> >

> > RESULTS:

> >

> > The surgically treated cohort was divided into 3 groups according to

> > the CT findings. A total of 129 patients (74.1%) had findings

> > associated with CT-positive macroadenoma (type 1A) and 42 (24.1%)

> > with CT-negative microadenoma (type 2A). Only 3 patients (1.8%) had

> > adrenocortical hyperplasia (type 3). The aldosterone level was

> > normalized in all but 2 patients (98.9%), and the number of

> > antihypertensive agents was significantly reduced within 1 month

> > after adrenalectomy. Of the 174 patients, 155 (89.1%) showed

> > resolution or improvement of hypertension.

> >

> > CONCLUSIONS:

> >

> > The routine use of adrenal venous sampling could adequately detect

> > lateralization in patients with unilateral aldosterone excess, which

> > led to satisfactory short-term outcomes after surgery. The results

> > of the present study showed that nearly one fourth of patients with

> > the unilateral form had a CT-negative aldosterone-producing

> > microadenoma.

> >

> > PMID:

> > 21334048

> > [PubMed - in process]

> > Related citations

> >

> > 72. Kardiol Pol. 2011;69(2):156-8; discussion 159.

> > [Aortic dissection - a rare complication of primary aldosteronism -

> > a case report].

> >

> > [Article in Polish]

> > PodgÃ³rski M, Derkacz A, PorÄ™ba R, Belowska-BieÅ„ K, Gruber K, Szuba

> > A, Andrzejak R.

> > Source

> >

> > Katedra i Klinika ChorÃ³b WewnÄ™trznych, Zawodowych i NadciÅ›nienia

> > TÄ™tniczego, Akademia Medyczna, WrocÅ‚aw.

> >

> > Abstract

> >

> > Primary aldosteronism is common cause of secondary hypertension. As

> > a result of high blood pressure it can lead to severe complications,

> > including aortic dissection. We would like to present a case of 40

> > year-old patient who had resistant hypertension despite

> > administration of multiple drugs. During diagnosis primary

> > aldosteronism was found, complicated by aortic dissection. After

> > introducing the appropriate treatment we managed to significantly

> > reduce the cardiovascular risk.

> >

> > Free Article

> > PMID:

> > 21332058

> > [PubMed - indexed for MEDLINE]

> > Related citations

> >

> > 73. Rev Endocr Metab Disord. 2011 Mar;12(1):43-8.

> > Commentary on the Endocrine Society Practice Guidelines:

> > Consequences of adjustment of antihypertensive medication in

> > screening of primary aldosteronism.

> >

> > Fischer E, Beuschlein F, Bidlingmaier M, Reincke M.

> > Source

> >

> > Medizinische Klinik, Ludwig-Maximilians-UniversitÃ¤t MÃ¼nchen,

> > MÃ¼nchen, Germany.

> >

> > Abstract

> >

> > The Endocrine Society guidelines suggest to screen patients with

> > primary aldosteronism (PA) free of hypertensive medications or

> > alternatively to switch to drugs known to have minimal influence on

> > the aldosterone to renin ratio (ARR). We retrospectively

> > investigated the impact of such strategy on clinical outcome. 25

> > patients with PA and 25 with essential hypertension (EH) were

> > studied. Initially all subjects were evaluated biochemically and

> > received if possible an adjustment of their medication following the

> > guidlines. Mineralocorticoid antagonists were discontinued in all

> > subjects. Only 26 of 50 patients could be studied under optimal

> > conditions (drug free or on medication with minimal influence on

> > ARR) whereas the remaining 24 subjects had to receive additional

> > drugs (such as ACE inhibitor, angiotensin-2 receptor blocker, or

> > betablockers) because of initial blood pressure or comorbidities.

> > Every fifth patient with a switch of the medication experienced a

> > significant increase in blood pressure. 13 of 25 of PA patients

> > needed potassium supplementation (105+/-25 mEq per day; range 8-320

> > mEq). Nine of these patients remained hypokalemic despite

> > substitution (serum K 2.82+/-0.07 mmol/l), with 7 classified

> > severely hypokalemic (<.3.0). We observed 6 serious adverse events

> > requiring hospitalization including hypertensive crisis (nâ€‰=â€‰3),

> > atrial fibrillation (nâ€‰=â€‰1), heart failure (nâ€‰=â€‰1) and ICD

> > triggered electric shock (nâ€‰=â€‰1). In conclusion, in our

> > experience the adjustment of the antihypertensive treatment during

> > screening for PA is only possible in approximately half of patients

> > and can cause severe side effect. Such recommendation, therefore,

> > must include a note of caution because of possibly deleterious side

> > effects.

> >

> > PMID:

> > 21331645

> > [PubMed - in process]

> > Related citations

> >

> > 74. Int J Hypertens. 2011 Jan 20;2011:837817.

> > Aldosteronism and resistant hypertension.

> >

> > Acelajado MC, Calhoun DA.

> > Source

> >

> > Vascular Biology and Hypertension Program, University of Alabama at

> > Birmingham, CH19, Room 115, 1530 3rd Avenue South, Birmingham, AL

> > 35294-2041, USA.

> >

> > Abstract

> >

> > Resistant hypertension (RHTN) is defined as blood pressure (BP) that

> > remains uncontrolled in spite of intake of â‰¥3 antihypertensive

> > medications, ideally prescribed at optimal doses and one of which is

> > a diuretic. The incidence of primary aldosteronism (PA) in patients

> > with RHTN is estimated in prospective studies to be 14 to 23%, which

> > is higher than in the general hypertensive population. Patients with

> > PA are at an increased cardiovascular risk, as shown by higher rates

> > of stroke, myocardial infarction, and arrhythmias compared to

> > hypertensive individuals without PA. Likewise, RHTN is associated

> > with adverse cardiovascular outcomes, and the contribution of PA to

> > this increased risk is undetermined. Similar to PA, obstructive

> > sleep apnea (OSA) is closely associated with RHTN, and a causal link

> > between PA, OSA, and RHTN remains to be elucidated. The addition of

> > MR antagonists to the antihypertensive regimen in patients with RHTN

> > produces a profound BP-lowering effect, and this effect is seen in

> > patients with or without biochemical evidence of PA, highlighting

> > the role of relative aldosterone excess in driving treatment

> > resistance in this group of patients.

> >

> > PMCID: PMC3034938

> > Free PMC Article

> > PMID:

> > 21331160

> > [PubMed]

> > Related citations

> >

> > 75. Eur J Endocrinol. 2011 Mar;164(3):405-12.

> > A case of primary aldosteronism in pregnancy: do LH and GNRH

> > receptors have a potential role in regulating aldosterone secretion?

> >

> > Albiger NM, Sartorato P, Mariniello B, Iacobone M, Finco I, Fassina

> > A, Mantero F.

> > Source

> >

> > Division of Endocrinology, Department of Medical and Surgical

> > Sciences, University of Padua, Via Ospedale 105, 35128 Padua, Italy.

nora.albiger@...

> >

> > Abstract

> >

> > OBJECTIVE:

> >

> > The mechanisms inducing steroidogenesis in primary aldosteronism

> > (PA) remain poorly defined. It was recently demonstrated that some G-

> > protein-coupled receptors are abnormally expressed in aldosterone-

> > producing adenomas (APA). We evaluated the potential role of LH and

> > GNRH receptors (LHR (or LHCGR) and GNRHR) in regulating aldosterone

> > secretion in a patient with APA arising during pregnancy (index

> > case) and in a subset of other patients with PA.

> >

> > PATIENTS AND METHODS:

> >

> > GNRH test was performed in the index case, 11 other PA, and 5

> > controls. GNRHR and LHR expressions were examined in 23 APA and 6

> > normal tissues.

> >

> > RESULTS:

> >

> > Aldosterone response increased significantly (114%) in the index

> > case after GNRH test was performed preoperatively, while it was

> > blunted after adrenalectomy. Aldosterone also increased after human

> > chorionic gonadotropin and triptorelin stimulation. A partial

> > aldosterone response to GNRH was observed in other 7/11 PA, while a

> > significant response was observed in two patients. Controls did not

> > respond to GNRH test. GNRHR was overexpressed and LHR expression was

> > moderate in the APA tissue from the index case. Moreover, LHR was

> > found in normal adrenals and overexpressed in 6/22 APA. GNRHR was

> > overexpressed in 6/22 APA, 2 of them with a 95- and 109-fold higher

> > expression than normal. A correlation between the clinical and

> > molecular findings was observed in five out of seven patients.

> >

> > CONCLUSION:

> >

> > We describe a case of PA diagnosed during pregnancy, which appeared

> > to correlate with aberrant LHR and GNRHR expression. Our findings

> > suggest that a subset of patients with PA has aberrant LHR and GNRHR

> > expression, which could modulate aldosterone secretion.

> >

> > PMID:

> > 21330483

> > [PubMed - indexed for MEDLINE]

> > Related citations

> >

> > 76. J Clin Endocrinol Metab. 2011 May;96(5):E825-9. Epub 2011 Feb 16.

> > Chromogranin a measurement for assessing the selectivity of adrenal

> > venous sampling in primary aldosteronism.

> >

> > Seccia TM, Miotto D, De Toni R, Maniero C, Vincenzi M, Motta R,

> > Pessina AC, Rossi GP.

> > Source

> >

> > Clinical and Experimental Medicine (DMCS) Gino Patrassi-Internal

> > Medicine 4, University of Padua, 35126 Padova, Italy.

> >

> > Abstract

> >

> > CONTEXT:

> >

> > The assessment of selectivity of blood sampling is a fundamental

> > step for a proper interpretation of the results of adrenal vein

> > sampling (AVS), which is a " must " for identifying the surgically

> > curable subtypes of primary aldosteronism. However, uncertainties

> > remain on how to best achieve this goal.

> >

> > OBJECTIVE:

> >

> > The aim of the study was to investigate whether chromogranin A (ChA)

> > is tonically released in adrenal vein blood and might be used to

> > assess the selectivity of AVS.

> >

> > DESIGN AND METHODS:

> >

> > In consecutive patients undergoing AVS, we compared the plasma

> > cortisol and ChA levels in the adrenal veins and infrarenal inferior

> > vena cava blood. We then calculated and compared the selectivity

> > index based on cortisol with that based on ChA.

> >

> > RESULTS:

> >

> > Thirteen patients had cortisol and ChA levels assessed

> > simultaneously. Besides the expected step-up of cortisol, they

> > showed a step-up of ChA levels between the inferior vena cava and

> > blood from either adrenal vein. The selectivity index determined

> > with ChA was weakly correlated with that calculated with cortisol;

> > the former was much smaller (3- and 4- fold on the right and left

> > side, respectively) than the latter. This translated into a

> > proportional error at Bland-Altman plot between selectivity indexes.

> > Accordingly, only 53% of AVS were bilaterally selective using the

> > selectivity index determined with ChA, as compared to 84% with

> > selectivity index determined with cortisol (P = 0.0001).

> >

> > CONCLUSIONS:

> >

> > These findings indicate that ChA is tonically released by the

> > adrenal gland but do not support the usefulness of using ChA instead

> > of cortisol for assessing the selectivity of blood sampling during

> > AVS, perhaps with the exception of aldosterone-producing tumors that

> > cosecrete cortisol.

> >

> > PMID:

> > 21325453

> > [PubMed - indexed for MEDLINE]

> > Related citations

> >

> > 77. Rev Endocr Metab Disord. 2011 Mar;12(1):49-52.

> > Primary aldosteronism: A contrarian view.

> >

> > Kaplan NM.

> > Source

> >

> > University of Texas Southwestern Medical School, Dallas, TX 75390,

> > USA. Norman.Kaplan@...

> >

> > Abstract

> >

> > This paper provides evidence that primary aldosteronism is likely

> > much less common than is believed by the other authors of this

> > collection. The basis for this contrarian view is simple: there is

> > no way to know the true prevalence of PA because of the uncertain

> > validity of all of the diagnostic procedures used to find and

> > characterize this disease. Moreover, even if these uncertainties are

> > overcome, the eventual treatment of most who have PA can be provided

> > without the need for extensive testing and expensive treatment.

> >

> > PMID:

> > 21311980

> > [PubMed - in process]

> > Related citations

> >

> > 78. Science. 2011 Feb 11;331(6018):768-72.

> > K+ channel mutations in adrenal aldosterone-producing adenomas and

> > hereditary hypertension.

> >

> > Choi M, Scholl UI, Yue P, BjÃ¶rklund P, Zhao B, - C, Ji

> > W, Cho Y, Patel A, Men CJ, Lolis E, Wisgerhof MV, Geller DS, Mane S,

> > Hellman P, Westin G, Ã…kerstrÃ¶m G, Wang W, Carling T, Lifton RP.

> > Source

> >

> > Department of Genetics, Medical Institute, Yale

> > University School of Medicine, New Haven, CT 06510, USA.

> >

> > Comment in

> >

> > Science. 2011 Feb 11;331(6018):685-6.

> > Abstract

> >

> > Endocrine tumors such as aldosterone-producing adrenal adenomas

> > (APAs), a cause of severe hypertension, feature constitutive hormone

> > production and unrestrained cell proliferation; the mechanisms

> > linking these events are unknown. We identify two recurrent somatic

> > mutations in and near the selectivity filter of the potassium (K(+))

> > channel KCNJ5 that are present in 8 of 22 human APAs studied. Both

> > produce increased sodium (Na(+)) conductance and cell

> > depolarization, which in adrenal glomerulosa cells produces calcium

> > (Ca(2+)) entry, the signal for aldosterone production and cell

> > proliferation. Similarly, we identify an inherited KCNJ5 mutation

> > that produces increased Na(+) conductance in a Mendelian form of

> > severe aldosteronism and massive bilateral adrenal hyperplasia.

> > These findings explain pathogenesis in a subset of patients with

> > severe hypertension and implicate loss of K(+) channel selectivity

> > in constitutive cell proliferation and hormone production.

> >

> > PMID:

> > 21311022

> > [PubMed - indexed for MEDLINE]

> > Related citations

> >

> > 79. Science. 2011 Feb 11;331(6018):685-6.

> > Medicine. The genetics of primary aldosteronism.

> >

> > Funder JW.

> > Source

> >

> > Prince Henry's Institute of Medical Research, Monash Medical Centre,

> > Clayton, 3168, Australia. john.funder@...

> >

> > Comment on

> >

> > Science. 2011 Feb 11;331(6018):768-72.

> > PMID:

> > 21310991

> > [PubMed - indexed for MEDLINE]

> > Related citations

> >

> > 80. Rev Endocr Metab Disord. 2011 Mar;12(1):15-20.

> > Treatment of primary aldosteronism: Where are we now?

> >

> > Karagiannis A.

> > Source

> >

> > Second Propedeutic Department of Internal Medicine, Medical School,

> > Aristotle University of Thessaloniki, Hippokration Hospital, 44,

> > Tsimiski str., Thessaloniki, 54623, Greece. astkar@...

> >

> > Abstract

> >

> > Primary aldosteronism (PA) is an important cause of secondary

> > hypertension, is being increasingly diagnosed and may account for

> > more than 10% of hypertensive patients, both in primary care and in

> > referral centers. Aldosterone excess is associated with adverse

> > cardiovascular, renal and metabolic effects that are in part

> > hypertension-independent. Laparoscopic adrenalectomy remains the

> > mainstay of treatment for unilateral forms of PA, whereas medical

> > treatment is recommended for bilateral forms of PA. However, a

> > favourable surgical outcome depends on several factors and many

> > patients are not suitable for this treatment. On the other hand,

> > surgery in patients considered to have bilateral PA may contribute

> > to better blood pressure control. In this review, established and

> > novel strategies for the management of different types of PA are

> > discussed.

> >

> > PMID:

> > 21305359

> > [PubMed - in process]

> > Related citations

> >

> > 81. Intern Med. 2011;50(3):227-32. Epub 2011 Feb 1.

> > A rare case of ACTH-independent macronodular adrenal hyperplasia

> > associated with aldosterone-producing adenoma.

> >

> > Hayakawa E, Yoshimoto T, Hiraishi K, Kato M, Izumiyama H, Sasano H,

> > Hirata Y.

> > Source

> >

> > Department of Clinical and Molecular Endocrinology, Tokyo Medical

> > and Dental University Graduate School, Tokyo, Japan.

> >

> > Abstract

> >

> > A 52-year-old man was evaluated for incidentally discovered

> > bilateral adrenal masses. He had drug-resistant hypertension but

> > lacked Cushingoid features. Endocrinological tests revealed

> > autonomous secretion of cortisol and aldosterone with suppressed

> > plasma ACTH and renin activity. A selective adrenal venous sampling

> > demonstrated aldosterone hypersecretion from the left adrenal vein.

> > The clinical diagnosis of subclinical Cushing's syndrome due to ACTH-

> > independent macronodular adrenal hyperplasia (AIMAH) associated with

> > primary aldosteronism was made, and he underwent left adrenalectomy;

> > the resected adrenal lesion was consistent with the pathological

> > diagnosis of AIMAH coexistent with aldosterone-producing adenoma

> > (APA). This is a very rare case of AIMAH with concomitant unilateral

> > APA, whose hypertension improved after surgery.

> >

> > Free Article

> > PMID:

> > 21297325

> > [PubMed - indexed for MEDLINE]

> > Related citations

> >

> > 82. Actas Urol Esp. 2011 Feb;35(2):119-22. Epub 2011 Feb 2.

> > [Partial laparoscopic adrenalectomy in primary hyperaldosteronism].

> >

> > [Article in Spanish]

> > Castillo OA, DÃaz M, Arellano L.

> > Source

> >

> > Departamento de UrologÃa, ClÃnica Indisa, Santiago, Chile.

octavio.castilloindisa (DOT)

> > cl

> >

> > Abstract

> >

> > INTRODUCTION:

> >

> > primary hyperaldosteronism is one of the few potentially curable

> > causes of secondary arterial hypertension. One of the most important

> > variants is the adenoma of the adrenal cortex that produces

> > aldosterona (Conn's Syndrome). The treatment of choice in this

> > subgroup of patients was the removal of the lesion. An initial

> > series of patients with aldosteronoma subjected to partial

> > laparoscopic adrenalectomy is presented.

> >

> > MATERIALS AND METHOD:

> >

> > We examined the case selection and methods applied to hypertensive

> > patients subjected to partial laparoscopic adrenalectomy between

> > November 2001 and March 2004 due to primary hyperaldosteronism. They

> > all presented an imaging study (CT scan) compatible with a tumour of

> > the adrenal cortex and, in two patients the lesion was bilateral.

> > One patient had a history of incidental adrenalectomy during and

> > open colecistectomy performed some years previously.

> >

> > RESULTS:

> >

> > we operated on 16 patients, 13 of them women and 3 men, with a mean

> > age of 55.4 years. We performed 18 laparoscopic adrenalectomies: 17

> > conservative operations and one total adrenalectomy of a 4.3 cm

> > tumour in a patient with bilateral lesion. The mean duration of the

> > operations was 70.9 minutes, with a mean bleeding rate of 30 ml.

> > There were no complications or the need to resort to open surgery.

> > Postoperative hospital stay was 2.8 days. In all the cases, the

> > hypertension improved totally or partially.

> >

> > CONCLUSION:

> >

> > although small, the series confirmed that partial laparoscopic

> > suprarenalectomy can be performed with good results and with the

> > advantages of minimally invasive surgery.

> >

> > reserved.

> >

> > Free Article

> > PMID:

> > 21292350

> > [PubMed - in process]

> > Related citations

> >

> > 83. J Clin Endocrinol Metab. 2011 Apr;96(4):1039-45. Epub 2011 Feb 2.

> > Effects of two selective serotonin reuptake inhibitor

> > antidepressants, sertraline and escitalopram, on aldosterone/renin

> > ratio in normotensive depressed male patients.

> >

> > Ahmed AH, Calvird M, Gordon RD, PJ, Ward G, Pimenta E, Young

> > R, Stowasser M.

> > Source

> >

> > Endocrine Hypertension Research Centre, University of Queensland

> > School of Medicine, Princess andra Hospital, Ipswich Road,

> > Woolloongabba, Brisbane 4102, Australia.

> >

> > Abstract

> >

> > BACKGROUND:

> >

> > Plasma aldosterone to renin ratio (ARR) is the most popular

> > screening test for primary aldosteronism (PAL). Certain medications

> > are known to cause false-negative or -positive ARRs by affecting

> > renin and aldosterone levels. There are no previously published data

> > on the effects of antidepressants on ARR.

> >

> > METHODS:

> >

> > Normotensive, depressed male patients (n = 26) underwent measurement

> > (seated, midmorning) of plasma aldosterone, direct renin

> > concentration (DRC), renin activity (PRA), electrolytes and

> > creatinine and urinary aldosterone, cortisol, electrolytes, and

> > creatinine at baseline and after 2 and 6 wk treatment with

> > sertraline (n = 14) or escitalopram (n = 12).

> >

> > RESULTS:

> >

> > For both antidepressants, treatment was associated with rises in

> > aldosterone [sertraline: baseline, mean Â± sd, 243 Â± 34; 2 wk, 256

> > Â± 33; 6 wk, 267 Â± 34 pmol/liter (P < 0.01 by ANOVA); escitalopram,

> > 261 Â± 36, 269 Â± 38, 282 Â± 40 pmol/liter (P < 0.05)], DRC [19.5 Â±

> > 2.2, 33.5 Â± 2.0, 39.0 Â± 2.4 mU/liter (P < 0.001); 24.5 Â± 2.4, 34.0

> > Â± 2.7, 42.8 Â± 2.4 mU/liter (P < 0.001)], and PRA [2.24 Â± 0.21,

> > 2.58 Â± 0.26, 4.68 Â± 0.42 ng/ml Â· h (P < 0.001); 4.31 Â± 0.22, 5.57

> > Â± 0.36, 6.42 Â± 0.53 ng/ml Â· h (P < 0.001)]. ARR fell significantly

> > whether calculated using DRC [sertraline, 13.7 Â± 2.2, 7.5 Â± 0.7,

> > 6.8 Â± 0.7 (P < 0.001); escitalopram, 11.5 Â± 1.9, 8.0 Â± 1.1, 6.6 Â±

> > 1.0 (P < 0.001)], or PRA [116.6 Â± 15.8, 108.4 Â± 15.6, 60.4 Â± 6.2

> > (P < 0.001); 61.2 Â± 8.1, 50.0 Â± 7.7, 45.6 Â± 6.0 (P < 0.01)].

> >

> > CONCLUSION:

> >

> > Selective serotonin reuptake inhibitor antidepressants can

> > significantly reduce ARR and therefore potentially increase the risk

> > of false-negative results when screening for PAL. Further studies in

> > hypertensive patients, including patients with confirmed PAL, are

> > required.

> >

> > PMID:

> > 21289246

> > [PubMed - indexed for MEDLINE]

> > Related citations

> >

> > 84. Rev Endocr Metab Disord. 2011 Mar;12(1):37-42.

> > Primary aldosteronism and a Texas two-step.

> >

> > Auchus RJ.

> > Source

> >

> > Division of Endocrinology and Metabolism, UT Southwestern Medical

> > Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8857, USA.

richard.auchus@...

> >

> > Abstract

> >

> > Primary aldosteronism is unquestionably the most common secondary

> > cause of hypertension, and effective approaches to diagnosis and

> > targeted treatments exist. Even the most conservative estimates of

> > the prevalence of primary aldosteronism, however, indicate that the

> > condition is grossly underdiagnosed. Part of the reason why

> > diagnosis and treatment lag far behind is the lack of expertise,

> > even among endocrinologists and hypertension specialists, in the

> > approach to the patient with possible primary aldosteronism. We will

> > never make an impression on this important problem unless general

> > internists and primary care physicians actively participate in the

> > screening and referral process. A healthcare delivery team need not

> > fear an overwhelming and fruitless battle with an intractable

> > conundrum if a practical and staged approach to workup and treatment

> > is taken. This review discusses the approach we have taken in

> > Dallas, a strategy of targeted screening, referral for positive

> > screens, and individualized management.

> >

> > PMID:

> > 21286821

> > [PubMed - in process]

> > Related citations

> >

> > 85. Rev Endocr Metab Disord. 2011 Mar;12(1):3-9.

> > Diagnosis and treatment of primary aldosteronism.

> >

> > Mulatero P, Monticone S, Veglio F.

> > Source

> >

> > Division of Internal Medicine and Hypertension, Department of

> > Medicine and Experimental Oncology, University of Torino, 10126,

> > Torino, Italy. paolo.mulatero@...

> >

> > Abstract

> >

> > Primary aldosteronism is the most common form of secondary

> > hypertension. The detection of primary aldosteronism is of

> > particular importance, not only because it provides an opportunity

> > for a targeted treatment (surgical for APA and medical with

> > mineralocorticoid receptor antagonists for BAH), but also because it

> > has been extensively demonstrated that patients affected by PA are

> > more prone to cardiovascular events and target organ damage than

> > essential hypertensives. According to the Endocrine Society

> > Guidelines diagnosis of PA is made following a rigorous flow-chart

> > comprising screening, confirmation/exclusion testing and subtype

> > diagnosis. In the present review we describe briefly the published

> > diagnostic strategies of the Guidelines, highlighting new evidence

> > that has become recently available and discuss issues that still

> > need to be addressed by future research.

> >

> > PMID:

> > 21279548

> > [PubMed - in process]

> > Related citations

> >

> > 86. J Renin Angiotensin Aldosterone Syst. 2011 Jan 27. [Epub ahead

> > of print]

> > Captopril suppression: Limitations for confirmation of primary

> > aldosteronism.

> >

> > Westerdahl C, Bergenfelz A, Isaksson A, Valdemarsson S.

> > Source

> >

> > Department of General Practice, Lund University, Sweden.

> >

> > Abstract

> >

> > INTRODUCTION:

> >

> > : The aldosterone/renin ratio (ARR) is the first line screening test

> > for primary aldosteronism (PA). However, in hypertensive patients

> > with an increased ARR, PA needs to be confirmed by other means.

> >

> > METHODS:

> >

> > : A 25 mg oral captopril test was performed in 16 healthy subjects

> > to obtain reference values for aldosterone and ARR at 120 minutes

> > after the test. Subsequently these data were applied to 46

> > hypertensive patients screened for PA with an increased ARR.

> >

> > RESULTS:

> >

> > : At 120 minutes after the captopril test ARR decreased in healthy

> > subjects within a narrow range, but remained high in patients with

> > PA and in patients with primary hypertension, especially for those

> > with low renin characteristics. At 120 minutes after captopril, the

> > range of ARR in primary hypertensive patients overlapped in 88% of

> > the cases with the range of the ARR in the PA patients. Sensitivity

> > and specificity of basal ARR and ARR after the captopril test to

> > diagnose PA, calculated as receiver operator characteristics, showed

> > an area under the curve of 0.595 for basal ARR and 0.664 for ARR at

> > 120 minutes after the test.

> >

> > CONCLUSION:

> >

> > : The ARR at 120 minutes after the captopril test is only marginally

> > better than basal ARR in diagnosing PA in hypertensive patients

> > screened with an increased ARR. Owing to an overall limited capacity

> > to clearly discriminate PA from primary hypertension, the test could

> > not therefore be recommended for the confirmatory diagnosis of PA.

> >

> > PMID:

> > 21273222

> > [PubMed - as supplied by publisher]

> > Related citations

> >

> > 87. Eur J Endocrinol. 2011 Apr;164(4):447-55. Epub 2011 Jan 26.

> > Aldosterone- and cortisol-co-secreting adrenal tumors: the lost

> > subtype of primary aldosteronism.

> >

> > SpÃ¤th M, Korovkin S, Antke C, Anlauf M, Willenberg HS.

> > Source

> >

> > Department of Endocrinology, Diabetes and Rheumatology Clinic of

> > Nuclear Medicine Institute of Pathology, University Hospital

> > Duesseldorf, nstrasse 5, D-40225 Duesseldorf, Germany.

> >

> > Abstract

> >

> > Current guidelines suggest proving angiotensin-independent

> > aldosterone secretion in patients with primary aldosteronism (PA).

> > It is further recommended to demonstrate unilateral disease because

> > of its consequence for therapy. A general screening for excess

> > secretion of other hormones is not recommended. However, clinically

> > relevant autonomous aldosterone production rarely originates in

> > adrenal tumors, compromised of zona glomerulosa cells only. This

> > article reviews published data on aldosterone- and cortisol-co-

> > secreting tumors and shows that pre-operative diagnosis of such a

> > lesion is beneficial for patients. Overt or subclinical

> > glucocorticoid hypersecretion may interfere with diagnostic studies,

> > e.g. adrenal venous sampling, screening of familial forms of PA on

> > the basis of serum 18-hydroxy-cortisol (18-OH-F) determination, and

> > provoke glucocorticoid deficiency after surgical removal of the

> > tumor. In addition, knowledge from histological and molecular

> > studies in patients with aldosterone- and cortisol-co-secreting

> > tumors challenges some concepts of the development of adrenal

> > autonomy. The presence of an aldosterone- and cortisol-co-secreting

> > adrenocortical tumor should be considered if a patient has i) PA and

> > an adenoma that is larger than 2.5â€Šcm, ii) cortisol that is non-

> > suppressible with overnight low-dose dexamethasone, or iii) grossly

> > elevated serum levels of hybrid steroids, such as 18-OH-F.

> >

> > Free Article

> > PMID:

> > 21270113

> > [PubMed - indexed for MEDLINE]

> > Related citations

> >

> > 88. Obstet Gynecol. 2011 Feb;117(2 Pt 2):512-6.

> > Pregnancy in inherited hypokalemic salt-losing renal tubular disorder.

> >

> > Nordio F, Bianchetti MG.

> > Source

> >

> > Division of Pediatrics, Mandic Hospital, Merate, Italy.

> >

> > Abstract

> >

> > BACKGROUND:

> >

> > The management of inherited hypokalemia has improved and the issue

> > of pregnancy has become important.

> >

> > CASES:

> >

> > Between 1992 and 2010, five Italian women with the clinical

> > diagnosis of Gitelman syndrome gave birth to a total of six

> > newborns. Pregnancy was uneventful in four women but was complicated

> > by tiredness and tetanic seizures in the fifth woman. Drug

> > management included potassium chloride in four cases and magnesium

> > and amiloride in one case each. The six neonates were born at term

> > (n=4) or near term (n=2), with a body weight that was appropriate

> > for gestational age. The children, aged between 6 weeks and 18

> > years, were healthy and neurodevelopmentally and somatically normal

> > at the last follow-up.

> >

> > CONCLUSION:

> >

> > Women with hypokalemia can become pregnant and the disorder may be

> > managed without negative effect on the fetus.

> >

> > PMID:

> > 21252808

> > [PubMed - indexed for MEDLINE]

> > Related citations

> > 89. Eur J Clin Invest. 2011 Jul;41(7):743-750. doi: 10.1111/j.

> > 1365-2362.2010.02462.x. Epub 2011 Jan 21.

> > The association of serum potassium level with left ventricular mass

> > in patients with primary aldosteronism.

> >

> > Lin YH, Wang SM, Wu VC, Lee JK, Kuo CC, Yen RF, Liu KL, Huang KH,

> > Chueh SC, Wang WJ, Lin LY, Chien KL, Ho YL, Chen MF, Wu KD; the

> > TAIPAI study group.

> > Source

> >

> > Departments of Internal Medicine Urology Laboratory Medicine,

> > National Taiwan University Hospital and National Taiwan University

> > College of Medicine, Taipei, Taiwan Department of Internal Medicine,

> > National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin,

> > TaiwanDepartments of Nuclear Medicine Radiology, National Taiwan

> > University Hospital and National Taiwan University College of

> > Medicine, Taipei, Taiwan Department of Urology, Cleveland Clinic,

> > Cleveland, OH, USA Department of Internal Medicine, Tao-Yuan General

> > Hospital, Tao-Yaun, Taiwan Institute of Epidemiology and Preventive

> > Medicine, National Taiwan University, Taipei, Taiwan.

> >

> > Abstract

> >

> > Eur J Clin Invest 2011; 41 (7): 743-750 ABSTRACT: Backgroundâ€‚

> > Primary aldosteronism (PA) is associated a worse cardiovascular

> > outcome than essential hypertension. Hypokalemia, which is one major

> > characteristic of PA, can affect both cardiac structure and

> > function. The goal of this study is to evaluate the influence of

> > serum potassium level on left ventricular (LV) mass and function in

> > PA patients. Materials and methodsâ€‚ We prospectively analysed 85 PA

> > patients from October 2006 to September 2008 and 27 essential

> > hypertension patients as the control group (group 1). Thirty-two

> > patients with serum potassium <â€ƒ3Â·5â€ƒmmolâ€ƒL(-1) were defined as

> > hypokalemia (group 2), and 53 patients with serum potassium â‰¥â€ƒ

> > 3Â·5â€ƒmmolâ€ƒL(-1) were defined as normokalemia (group 3).

> > Echocardiography including tissue Doppler image (TDI) recordings was

> > performed in all patients. Resultsâ€‚ Group 2 patients had

> > significant higher systolic and diastolic blood pressure (DBP), log-

> > transformed plasma aldosterone concentration, log-transformed

> > aldosterone-to-renin ratio and lower serum potassium level than

> > groups 1 and 3. In echocardiographic measurement, group 2 patients

> > had higher LV mass index (LVMI) than groups 1 and 3. In multivariate

> > analysis for factors affecting LVMI in PA patients, only serum

> > potassium level (Pâ€ƒ=â€ƒ0Â·001), use of spironolactone (Pâ€ƒ=â€ƒ

> > 0Â·004) and DBP (Pâ€ƒ=â€ƒ0Â·005) were independent factors. In the TDI

> > study, both groups 2 and 3 had lower e' and E/e' values than group

> > 1. Conclusionsâ€‚ Serum potassium level is significantly associated

> > with LVMI in PA patients. Compared with essential hypertensive

> > patients, PA patients had a greater impairment of cardiac diastolic

> > function.

> >

> > 2011 Stichting European Society for Clinical Investigation Journal

> > Foundation.

> >

> > PMID:

> > 21250985

> > [PubMed - as supplied by publisher]

> > Related citations

> >

> > 90. Eur J Endocrinol. 2011 Apr;164(4):613-9. Epub 2011 Jan 19.

> > Gene expression profiles in aldosterone-producing adenomas and

> > adjacent adrenal glands.

> >

> > Wang T, Satoh F, Morimoto R, Nakamura Y, Sasano H, Auchus RJ,

> > MA, Rainey WE.

> > Source

> >

> > Department of Physiology, Medical College of Georgia, 1120 15th

> > Street, Augusta, Georgia 30912, USA.

> >

> > Abstract

> >

> > BACKGROUND:

> >

> > Primary aldosteronism (PA) is the most common form of endocrine

> > hypertension affecting âˆ¼8-10% of hypertensive subjects. Aldosterone

> > production in PA occurs under low-renin conditions, and the

> > mechanisms that maintain the production of aldosterone in PA remain

> > unknown. Objective This study was designed to compare the transcript

> > profiles between aldosterone-producing adenoma (APA) and their

> > adjacent adrenal gland (AAG) from the same adrenal.

> >

> > METHODS:

> >

> > Total RNA was extracted from ten APA and ten AAG; and subsequently

> > analyzed by microarray and real-time quantitative RT-PCR (qPCR). The

> > microarray data were paired for each APA-AAG, and analyzed by

> > GeneSpring GX 11 with paired t-test and fold change calculations for

> > each transcript. Changes identified by microarray analysis were

> > confirmed by qPCR.

> >

> > RESULTS:

> >

> > Microarray analysis indicated that 14 genes had significantly up-

> > regulated expression in APA compared to AAG. Among the elevated

> > genes were aldosterone synthase (CYP11B2) as well as novel

> > transcription factors, calmodulin-binding proteins, and other genes

> > that have not been previously studied in APA. Selective analysis of

> > 11 steroidogenic enzymes using microarray demonstrated that only

> > CYP11B2 showed a significantly higher transcript level in APA

> > compared to AAG (P<0.001). In contrast, AKR1C3 (17Î²-hydroxysteroid

> > dehydrogenase type 5), CYP17 (17Î±-hydroxylase/17,20 lyase), and CYB5

> > (cytochrome b5) showed significantly lower transcript level in APA

> > (P<0.05).

> >

> > CONCLUSION:

> >

> > The transcriptome analysis of APA compared with AAG showed several

> > novel genes that are associated with APA phenotype. This gene list

> > provides new candidates for the elucidation of the molecular

> > mechanisms leading to PA.

> >

> > PMID:

> > 21248073

> > [PubMed - indexed for MEDLINE]

> > Related citations

> >

> > 91. Surgery. 2011 Jun;149(6):852. doi: 10.1016/j.surg.2010.02.010.

> > Epub 2011 Jan 5.

> > Adrenal venous sampling but not computed tomography is essential

> > before undertaking adrenalectomy for primary aldosteronism.

> >

> > Rossitto G, Toniato A, Rossi GP.

> > Comment on

> >

> > Surgery. 2010 Jul;148(1):129-34.

> > PMID:

> > 21208633

> > [PubMed - in process]

> > Related citations

> >

> > 92. Kidney Int. 2011 Jan;79(2):260.

> > Reninoma.

> >

> > Chao CT, Chang FC, Wu VC, Chen JC; Taiwan Primary Aldosteronism

> > Investigation Study Group.

> > Source

> >

> > Division of Nephrology, Department of Internal Medicine, National

> > Taiwan University Hospital, College of Medicine, National Taiwan

> > University, Taipei, Taiwan.

> >

> > PMID:

> > 21191395

> > [PubMed - indexed for MEDLINE]

> > Related citations

> >

> > 93. Zhonghua Xin Xue Guan Bing Za Zhi. 2010 Oct;38(10):939-42.

> > [Etiology analysis for hospitalized hypertensive patients: 10 years

> > report from the department of hypertension (1999 - 2008)].

> >

> > [Article in Chinese]

> > Li NF, Lin L, Wang L, Wang XL, Zu FY, Zhang DL, Chang GJ, Zhang YM,

> > Zhou KM, Guli N, Li T, Hu JL, Kong JQ, Wang MH, Luo Q.

> > Source

> >

> > Department of Hypertension, Hypertension Institute of Xinjiang Uygur

> > Autonomous Region, Urumuqi 830001, China. lnanfang2009@...

> >

> > Abstract

> >

> > OBJECTIVE:

> >

> > To analyze etiology of hospitalized hypertensive patients in the

> > department of hypertension from 1999 to 2008.

> >

> > METHODS:

> >

> > This retrospective study was performed to analyze the etiology of

> > hospitalized hypertensive patients in department of hypertension and

> > to show the distribution change of hypertension from 1999 to 2008.

> >

> > RESULTS:

> >

> > (1) There were 5867 (75.1%) patients with essential hypertension and

> > 1942 (24.9%) patients with secondary hypertension (SH). (2) The

> > prevalence rate of SH increased significantly during the 10 years

> > (Ï‡(2) = 387.621, P < 0.001) and was higher in 2008 than in 1999

> > (39.3% vs. 9.5%, P < 0.05). The prevalence of obstructive sleep

> > apnea syndrome (OSAS) and primary aldosteronism (PA) in 2008

> > increased 38.3 and 1.8 times respectively than in 1999 (Ï‡(2) =

> > 304.025, P < 0.001; Ï‡(2) = 42.845, P < 0.001) and other SH remained

> > unchanged. (3) The prevalence of PA complicated with OSAS increased

> > significantly in recent five years (Ï‡(2) = 26.376, P < 0.001).

> > Incidence of OSAS was 23.9% in PA patients and incidence of PA was

> > 6.7% in OSAS patients.

> >

> > CONCLUSIONS:

> >

> > With the insights gained on hypertension mechanism and the

> > development of new diagnostic technology, percent of diagnosed SH

> > increased remarkably in recent years in hospitalized hypertensive

> > patients in our department of hypertension. OSAS and PA are the

> > leading causes of SH.

> >

> > PMID:

> > 21176641

> > [PubMed - in process]

> > Related citations

> > 94. Diabetol Metab Syndr. 2010 Dec 20;2:71.

> > Prevalence of adrenal masses in Japanese patients with type 2

> > diabetes mellitus.

> >

> > Hiroi N, Sue M, Yoshihara A, Ichijo T, Yoshida-Hiroi M, Higa M,

> > Yoshino G.

> > Source

> >

> > Division of Diabetes, Metabolism and Endocrinology, Department of

> > Internal Medicine (Omori), Toho University School of Medicine,

> > Tokyo, Japan. n-hiroi@...

> >

> > Abstract

> >

> > ABSTRACT:

> >

> > INTRODUCTION:

> >

> > To date, there have been no reports on the prevalence of adrenal

> > masses in type 2 diabetic patients. The present study aimed to

> > evaluate the prevalence of adrenal incidentaloma in type 2 diabetic

> > patients in Japan.

> >

> > SUBJECTS:

> >

> > We retrospectively evaluated the presence of adrenal masses using

> > abdominal CT scans in 304 type 2 diabetic patients. In those with

> > adrenal masses, we examined the hormone production capacity of the

> > adrenal mass.

> >

> > RESULTS:

> >

> > Fourteen patients (4.6%) had an adrenal mass. Hormonal analysis

> > identified one case as having subclinical Cushing's syndrome, two

> > with primary aldosteronism. Eleven cases had non-functioning masses.

> >

> > DISCUSSION:

> >

> > The reported prevalence of adrenal incidentaloma in normal subjects

> > is 0.6-4.0% in abdominal CT scan series. Our results show a

> > relatively high prevalence of adrenal tumors in diabetic patients.

> > On the other hand, the frequency of functional adenoma in diabetic

> > patients is 21.4%, which is similar to that of normal subjects.

> >

> > CONCLUSION:

> >

> > Although further studies are needed to evaluate the prevalence of

> > adrenal tumors in diabetic patients, our data suggest that

> > evaluation of the presence of adrenal masses may be needed in

> > patients with type 2 diabetes mellitus.

> >

> > PMCID: PMC3018421

> > Free PMC Article

> > PMID:

> > 21171971

> > [PubMed]

> > Related citations

> >

> > 95. Am Fam Physician. 2010 Dec 15;82(12):1471-8.

> > Diagnosis of secondary hypertension: an age-based approach.

> >

> > Viera AJ, Neutze DM.

> > Source

> >

> > Department of Family, University of North Carolina at Chapel Hill

> > School of Medicine, Chapel Hill, NC 27599, USA. anthony_viera@...

> >

> > Abstract

> >

> > Secondary hypertension is a type of hypertension with an underlying,

> > potentially correctable cause. A secondary etiology may be suggested

> > by symptoms (e.g., flushing and sweating suggestive of

> > pheochromocytoma), examina- tion findings (e.g., a renal bruit

> > suggestive of renal artery stenosis), or laboratory abnormalities

> > (e.g., hypokalemia suggestive of aldosteronism). Secondary

> > hypertension also should be considered in patients with resistant

> > hyper- tension, and early or late onset of hypertension. The

> > prevalence of secondary hypertension and the most common etiologies

> > vary by age group. Approximately 5 to 10 percent of adults with

> > hypertension have a secondary cause. In young adults, particu- larly

> > women, renal artery stenosis caused by fibromuscular dyspla- sia is

> > one of the most common secondary etiologies. Fibromuscular dysplasia

> > can be detected by abdominal magnetic resonance imag- ing or

> > computed tomography. These same imaging modalities can be used to

> > detect atherosclerotic renal artery stenosis, a major cause of

> > secondary hypertension in older adults. In middle-aged adults,

> > aldosteronism is the most common secondary cause of hyperten- sion,

> > and the recommended initial diagnostic test is an aldosterone/ renin

> > ratio. Up to 85 percent of children with hypertension have an

> > identifiable cause, most often renal parenchymal disease. Therefore,

> > all children with confirmed hypertension should have an evaluation

> > for an underlying etiology that includes renal ultrasonography.

> >

> > PMID:

> > 21166367

> > [PubMed - indexed for MEDLINE]

> > Related citations

> >

> > 96. Am J Emerg Med. 2010 Dec 13. [Epub ahead of print]

> > Torsade de pointes-a rare presentation of primary hyperaldosteronism.

> >

> > Kornelius E, Chen KS, Yang YS, Huang CN.

> > PMID:

> > 21159461

> > [PubMed - as supplied by publisher]

> > Related citations

> >

> > 97. Surgery. 2010 Dec;148(6):1178-85; discussion 1185.

> > The management of aldosterone-producing adrenal adenomas--does

> > adrenalectomy increase costs?

> >

> > Reimel B, Zanocco K, Russo MJ, Zarnegar R, OH, dorf JD,

> > Chabot JA, Duh QY, Lee JA, Sturgeon C.

> > Source

> >

> > Department of Surgery, Columbia University Medical Center, New York,

> > NY, USA.

> >

> > Abstract

> >

> > BACKGROUND:

> >

> > Most experts agree that primary hyperaldosteronism (PHA) caused by

> > an aldosterone-producing adenoma (APA) is best treated by

> > adrenalectomy. From a public health standpoint, the cost of

> > treatment must be considered. We sought to compare the current

> > guideline-based (surgical) strategy with universal pharmacologic

> > management to determine the optimal strategy from a cost perspective.

> >

> > METHODS:

> >

> > A decision analysis was performed using a Markov state transition

> > model comparing the strategies for PHA treatment. Pharmacologic

> > management for all patients with PHA was compared with a strategy of

> > screening for and resecting an aldosterone-producing adenoma.

> > Success rates were determined for treatment outcomes based on a

> > literature review. Medicare reimbursement rates were calculated to

> > estimate costs from a third-party payer perspective.

> >

> > RESULTS:

> >

> > Screening for and resecting APAs was the least costly strategy in

> > this model. For a reference patient with 41 remaining years of life,

> > the discounted expected cost of the surgical strategy was $27,821.

> > The discounted expected cost of the medical strategy was $34,691.

> > The cost of adrenalectomy would have to increase by 156% to $22,525

> > from $8,784 for universal pharmacologic therapy to be less costly.

> > Screening for APA is more costly if fewer than 9.6% of PHA patients

> > have resectable APA.

> >

> > CONCLUSION:

> >

> > Resection of APAs was the least costly treatment strategy in this

> > decision analysis model.

> >

> > PMID:

> > 21134549

> > [PubMed - indexed for MEDLINE]

> > Related citations

> >

> > 98. QJM. 2010 Dec 2. [Epub ahead of print]

> > Sweet root, bitter pill: liquorice-induced hyperaldosteronism.

> >

> > Imtiaz KE.

> > Source

> >

> > From the Department of Endocrinology, Lancashire Teaching Hospital

> > NHS Foundation Trust, Chorley Hospital, Preston Road, Chorley

> > PR71PP, UK.

> >

> > PMID:

> > 21131288

> > [PubMed - as supplied by publisher]

> > Related citations

> >

> > 99. Rev Med Liege. 2010 Oct;65(10):583-7.

> > [Current opinion on primary aldosteronism].

> >

> > [Article in French]

> > Vroonen L, Krzezinski JM, Hamoir E, Maweja S, Beckers A.

> > Source

> >

> > Service d'Endocrinologie, CHU LiÃ¨ge, Belgique.

> >

> > Abstract

> >

> > In recent years, a greater interest has been focused on primary

> > aldosteronism (PA), which shows a higher prevalence rate than

> > previously thought. The consequences of PA are life threatening such

> > as a refractory hypertension with serious cardiovascular damages.The

> > evaluation of a suspected PA should follow a step-by-step approach

> > (screening test, then confirmatory test and, in some cases, adrenal

> > venous sampling). This protocol may seem tedious, but it allows an

> > accurate etiologic diagnosis that leads to an appropriate therapy

> > with better blood pressure control,improvement of quality of life,

> > and, in some cases even,cure of hypertension.

> >

> > PMID:

> > 21128365

> > [PubMed - indexed for MEDLINE]

> > Related citations

> > 100. Hypertens Res. 2011 Mar;34(3):361-6. Epub 2010 Dec 2.

> > Aldosterone-to-renin ratio and home blood pressure in subjects with

> > higher and lower sodium intake: the Ohasama study.

> >

> > Satoh M, Kikuya M, Hara A, Ohkubo T, Mori T, Metoki H, Utsugi MT,

> > Hirose T, Obara T, Inoue R, Asayama K, Totsune K, Hoshi H, Satoh H,

> > Imai Y.

> > Source

> >

> > Department of Planning for Drug Development and Clinical Evaluation,

> > Tohoku University Graduate School of Pharmaceutical Sciences,

> > Sendai, Japan.

> >

> > Abstract

> >

> > Aldosterone-to-renin ratio (ARR) is used to screen primary

> > hyperaldosteronism. We investigated the association between ARR and

> > the prevalence of hypertension using home blood pressure (HBP)

> > measurements in community residents stratified for long-term

> > habitual dietary sodium intake. We obtained HBP and conventional

> > blood pressure (CBP) data for 514 participants aged â‰¥35 years not

> > receiving antihypertensive treatment in the general population of

> > Ohasama (mean age: 59.7Â±10.8 years; 71.2% women). A standardized

> > method was used to calculate habitual sodium intake from a food-

> > frequency questionnaire. The prevalence of HBP hypertension

> > (â‰¥135/85 mmHg) and CBP hypertension (â‰¥140/90 mmHg) were 12.6 and

> > 20.2%, respectively. The median plasma renin activity (PRA), plasma

> > aldosterone concentration (PAC) and ARR were 1.1 ngml(-1)h(-1), 6.4

> > ng per 100 ml and 5.5 ng per 100 ml per ngml(-1)h(-1), respectively.

> > After adjustment for possible confounding factors, each 1 s.d.

> > increase in logARR was associated with the prevalence of HBP

> > hypertension (odds ratio 1.37; P=0.04), but not with the prevalence

> > of CBP hypertension (P=0.2). The association of ARR with HBP

> > hypertension was strengthened for subjects with high sodium intake

> > (greater than or equal to the median of 4822 mgday(-1)), whereas it

> > became nonsignificant for those with low sodium intake (interaction

> > P=0.03). Among subjects with high sodium intake, HBP hypertensives

> > had significantly lower PRA than normotensives, despite no

> > differences in PAC. In conclusion, relative aldosterone excess or

> > low-renin hypertension may have an important role in HBP

> > hypertension in the general population with high sodium intake.

> >

> > PMID:

> > 21124331

> > [PubMed - in process]

> > Related citations

> >

> > 101. Clin Med. 2010 Oct;10(5):518.

> > 'With a pinch of salt' revisited.

> >

> > Cappuccio FP.

> > Comment on

> >

> > Clin Med. 2010 Feb;10(1):86-7.

> > PMID:

> > 21117393

> > [PubMed - indexed for MEDLINE]

> > Related citations

> >

> > 102. Best Pract Res Clin Endocrinol Metab. 2010 Dec;24(6):923-32.

> > Treatment of primary aldosteronism.

> >

> > Quinkler M, PM.

> > Source

> >

marcus.quinkler@...

> > e

> >

> > Abstract

> >

> > The prevalence of primary hyperaldosteronism approaches 10% of all

> > hypertensive patients, and besides efficient diagnostic procedures,

> > effective treatment is of increasing importance to reverse increased

> > morbidity and mortality. Aldosterone-producing adenoma and

> > unilateral adrenal hyperplasia are amenable to cure by endoscopic

> > adrenalectomy. Bilateral adrenal hyperplasia (micro- or

> > macronodular), which comprises two-thirds of primary

> > hyperaldosteronism, is treated primarily by mineralocorticoid

> > receptor antagonists (starting dose 12.5-25mg/day spironolactone

> > with titration up to 100mg/day, alternatively 50-100mg/day

> > eplerenone). If blood pressure is not normalised by this first-line

> > treatment, additional treatment with potassium-sparing diuretics

> > (amiloride or triamterene) or calcium channel antagonists is

> > necessary. The start of medication should be closely monitored by

> > serum electrolyte and creatinine controls.

> >

> > PMID:

> > 21115161

> > [PubMed - indexed for MEDLINE]

> > Related citations

> >

> > 103. Best Pract Res Clin Endocrinol Metab. 2010 Dec;24(6):915-21.

> > Primary aldosteronism: what consensus for the diagnosis.

> >

> > Cicala MV, Mantero F.

> > Source

> >

> > Division of Endocrinology, Department of Medical and Surgical

> > Sciences, University of Padua, Via Ospedale 105, 35128 Padova,

> > Italy. mariaverena.cicala@...

> >

> > Abstract

> >

> > Primary Aldosteronism (PA) is characterized by inappropriate

> > aldosterone production partially autonomous of the renin-angiotensin

> > system. Since the ARR ratio was introduced a much higher prevalence

> > of this disease is recognized. PA could be the most common

> > identifiable, specifically treatable and potentially curable form of

> > hypertension so the need of a clinical practice guideline on primary

> > aldosteronism becomes mandatory. Recently the Endocrine Society USA

> > published clinical practice guidelines for the diagnosis and

> > treatment of patients with primary hyperaldosteronism. Systematic

> > reviews of available evidence were used to formulate the key

> > treatment and prevention recommendations. Actually the Endocrine

> > Society consensus is the most used guidelines in diagnosis and

> > treatment of hyperaldosteronism. However, there remains a few

> > unresolved issues, which unfortunately require more of a detour

> > guide and cannot be easily addressed by a straight forward guideline.

> >

> > PMID:

> > 21115160

> > [PubMed - indexed for MEDLINE]

> > Related citations

> >

> > 104. Ann Surg. 2010 Dec;252(6):1058-64.

> > Radiofrequency ablation for benign aldosterone-producing adenoma: a

> > scarless technique to an old disease.

> >

> > Liu SY, Ng EK, Lee PS, Wong SK, Chiu PW, Mui WL, So WY, Chow FC.

> > Source

> >

> > Department of Surgery, Prince of Wales Hospital, The Chinese

> > University of Hong Kong, Hong Kong.

> >

> > Abstract

> >

> > OBJECTIVE:

> >

> > To evaluate the safety and efficacy of radiofrequency ablation (RFA)

> > in treating primary aldosteronism (PA) due to aldosterone-producing

> > adenoma (APA).

> >

> > BACKGROUND:

> >

> > Radiofrequency ablation is an established technique for treating

> > malignant solid organ neoplasm. Its application on benign functional

> > adrenal adenoma has never been prospectively described.

> >

> > METHODS:

> >

> > We prospectively evaluated a patient cohort with computed tomography

> > (CT)-guided percutaneous RFA performed on functional APA of size 4

> > cm or less. Treatment success was defined as complete tumor ablation

> > on follow-up CT scan plus normalization of serum aldosterone-to-

> > renin ratio (ARR) at 3 to 6 months after RFA. Salvage laparoscopic

> > adrenalectomy was offered to patients who had failed RFA and

> > remained hypertensive.

> >

> > RESULTS:

> >

> > Between August 2004 and August 2008, 28 patients were referred for

> > the procedure. Radiofrequency ablation was not performed on 4 APA

> > because of their close proximity to major vascular structures.

> > Twenty-four patients (11 men and 13 women) with a median age of 51.5

> > (range = 34-63) years underwent RFA for 11 right and 13 left APA.

> > The median tumor diameter was 16.0 (range = 4.0-25.0) mm. There was

> > no periprocedure hypertensive crisis or major morbidity or

> > mortality. Minor complications occurred in 4 patients (16.7%),

> > including 1 small pneumothorax and 3 retroperitoneal hematomas (< 3

> > cm), which all resolved on conservative treatment. At 3 to 6 months

> > of follow-up, CT scan showed complete tumor ablation in all patients

> > (100%). Primary aldosteronism was biochemically resolved in 23

> > patients (95.8%). Salvage adrenalectomy was not performed in the

> > single failed patient, as she remained normotensive on repeated

> > follow-up. The overall success rate of RFA was 95.8%.

> >

> > CONCLUSIONS:

> >

> > Computed tomography-guided percutaneous RFA is a safe and

> > efficacious alternative to laparoscopic adrenalectomy in treating

> > patients with PA due to small APA.

> >

> > PMID:

> > 21107117

> > [PubMed - indexed for MEDLINE]

> > Related citations

> >

> > 105. Nat Rev Nephrol. 2011 Jan;7(1):55-60. Epub 2010 Nov 23.

> > A case of primary aldosteronism revealed after renal transplantation.

> >

> > Hoorn EJ, Hesselink DA, Kho MM, Roodnat JI, Weimar W, van Saase JL,

> > van den Meiracker AH, Zietse R.

> > Source

> >

> > Department of Internal Medicine, Erasmus Medical Center,

> > Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.

> >

> > Abstract

> >

> > BACKGROUND:

> >

> > A 57-year-old woman was referred to a nephrology clinic because of

> > chronic hypokalemia. She had a history of polycystic kidney disease,

> > resistant hypertension, atrial fibrillation, type 2 diabetes,

> > stroke, and end-stage renal disease, and had received a kidney

> > transplant from a deceased donor at the age of 48 years. At

> > presentation, the patient described symptoms of chronic fatigue and

> > muscle aches, but she did not report pareses. Her medications

> > included four antihypertensive agents, glucose-lowering drugs,

> > immunosuppressants, digoxin, a coumarin derivative, and potassium

> > chloride.

> >

> > INVESTIGATIONS:

> >

> > Full history, physical examination, laboratory testing of blood and

> > urine, including aldosterone-torenin ratio, and a saline infusion

> > test.

> >

> > DIAGNOSIS:

> >

> > Primary aldosteronism.

> >

> > MANAGEMENT:

> >

> > Treatment with spironolactone resulted in prompt control of

> > hypertension and hypokalemia, allowing discontinuation of potassium

> > chloride and reduction in antihypertensive medication.

> >

> > PMID:

> > 21102541

> > [PubMed - indexed for MEDLINE]

> > Related citations

> >

> > 106. BMC Urol. 2010 Nov 23;10:19.

> > Initial experience of transumbilical laparoendoscopic single-site

> > surgery of partial adrenalectomy in patient with aldosterone-

> > producing adenoma.

> >

> > Yuge K, Miyajima A, Hasegawa M, Miyazaki Y, Maeda T, Takeda T,

> > Takeda A, Miyashita K, Kurihara I, Shibata H, Kikuchi E, Oya M.

> > Source

> >

> > Department of Urology, Keio University School of Medicine, Tokyo,

> > Japan.

> >

> > Abstract

> >

> > BACKGROUND:

> >

> > Laparoscopic single-site surgery has recently emerged in the field

> > of urology and this minimally-invasive surgery has resulted in a

> > further reduction in morbidity compared with traditional

> > laparoscopy. We present our initial experience with laparoendoscopic

> > single-site surgery of partial adrenalectomy (LESS-PA) to treat

> > aldosterone-producing adenomas.

> >

> > CASE PRESENTATION:

> >

> > A 60-year-old woman was diagnosed with aldosterone-producing

> > macroadenomas in the left adrenal and aldosterone-producing

> > microadenomas in the right adrenal. A two-step operation was

> > planned. The first step involved transumbilical LESS-PA for the left

> > adrenal tumors. A multichannel port was inserted through the center

> > of the umbilicus and the left adrenal gland was approached using

> > bent instruments according to standard traditional laparoscopic

> > procedures. The tumors were resected using an ultrasonic scalpel,

> > and the resected site was coagulated using a vessel sealing

> > instrument and then sealed with fibrin glue. Operative time was 123

> > minutes and blood loss was minimal. The patient was discharged from

> > hospital within 72 hours. Her right adrenal microadenomas will be

> > treated in the next several months.

> >

> > CONCLUSIONS:

> >

> > Although our experience is limited, LESS-PA appears to be safe and

> > feasible for treating aldosterone-producing adenomas. More cases and

> > comparisons with the multiport technique are needed before drawing

> > any definite conclusions concerning the technique.

> >

> > PMCID: PMC3000378

> > Free PMC Article

> > PMID:

> > 21092240

> > [PubMed - indexed for MEDLINE]

> > Related citations

> >

>

July 23, 2011

What you need to document DASH adherence or to interpret renin Aldo numbers is urine Sodium and K and creatinine. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

Dr. Grim, The numbers for NA that I have been reporting are listed under "Chemistry (Plasma)" in my lab results. Is this the right one? I haven't noticed any other NA in the reports but have a lot of pages to review! Thanks.

- 64 yo morb. ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank & testicle pain. I have decided against an adrenalectomy at this time since Meds. are working so well. Current BP: 130/77

Other Issues/Opportunities: COPD w/ft Oxygen, OSA w Bi-Pap settings 13/19, DM2. and PTSD

Meds: Duloxetine hcl 80 MG, Mirtazapine 15 MG, Metoprolol Tartrate 200 MG, Metformin 2000MG and Spironolactone 75 MG.

> >> > > > > > > > >

> >> > > > > > > > > Perhaps someone, ? ?, can summarize the ones on

> >> > > surgery and

> >> > > > > > > > > someone on the Dx issues.

> >> > > > > > > > >

> >> > > > > > > > > I would do an excel set up

> >> > > > > > > > >

> >> > > > > > > > > Paste abstract in first cell then summarize in columns

> >> > > next to it.

> >> > > > > > > > > Number of subjects etc. and conclusions. Also upload all

> >> > > to our

> >> > > > > > > > > references on PA.

> >> > > > > > > > >

> >> > > > > > > > > CE Grim MD

> >> > > > > > > > >

> >> > > > > > > > > Begin forwarded message:

> >> > > > > > > > >

> >> > > > > > > > > > From: Sent by NCBI <nobody@>

> >> > > > > > > > > > Date: July 20, 2011 9:55:01 AM PDT

> >> > > > > > > > > > To: lowerbp2@

> >> > > > > > > > > > Subject: PubMed Search Results

> >> > > > > > > > > >

> >> > > > > > > > > > This message contains search results from the National

> >> > > Center for

> >> > > > > > > > > > Biotechnology Information (NCBI) at the U.S. National

> >> > > Library of

> >> > > > > > > > > > Medicine (NLM). Do not reply directly to this message

> >> > > > > > > > > >

> >> > > > > > > > > > Sender's message: PA refs to July 11

> >> > > > > > > > > >

> >> > > > > > > > > > Sent on: Wed Jul 20 12:52:12 2011

> >> > > > > > > > > > 106 selected items

> >> > > > > > > > > >

> >> > > > > > > > > > pubmed Results

> >> > > > > > > > > > Items 1 -106 of 106

> >> > > > > > > > > >

> >> > > > > > > > > > 1. Clin Endocrinol (Oxf). 2011 Jul 18. doi: 10.1111/j.

> >> > > > > > > > > > 1365-2265.2011.04177.x. [Epub ahead of print]

> >> > > > > > > > > > 100 cases of primary aldosteronism. Careful choice of

> >> > > patients for

> >> > > > > > > > > > surgery using adrenal venous sampling and CT imaging

> >> > > results in

> >> > > > > > > > > > excellent blood pressure and potassium outcomes.

> >> > > > > > > > > >

> >> > > > > > > > > > Graham U, Ellis P, Hunter S, H, Mullan K, Atkinson A.

> >> > > > > > > > > > Source

> >> > > > > > > > > >

> >> > > > > > > > > > Regional Centre for Endocrinology and Diabetes, Royal

> >> > >

> >> > > > > > > > > > Hospital, Belfast Imaging Centre, Royal

> >> > > Hospital, Belfast

> >> > > > > > > > > > Regional Endocrine Laboratory, Royal Hospital,

> >> > > Belfast.

> >> > > > > > > > > >

> >> > > > > > > > > > Abstract

> >> > > > > > > > > >

> >> > > > > > > > > > Objective:ÃƒÆ’fÃƒâ€šÃ‚Â¢ÃƒÆ’Ã‚Â¢ÃƒÂ¢EURs(Ãƒâ€šÃ‚Â¬ÃƒÆ’Ã‚Â¢ÃƒÂ¢,Ã‚Â¬Ãƒâ€¦Ã‚Â¡ Patients with primary

> >> > > aldosteronism (PA) who are

> >> > > > > > > > > > suitable for surgery should undergo adrenal computerised

> >> > > tomography

> >> > > > > > > > > > (CT) and adrenal venous sampling (AVS). A retrospective

> >> > > study was

> >> > > > > > > > > > performed of 100 patients with PA. We determined the

> >> > > optimal AVS

> >> > > > > > > > > > lateralisation ratio for unilateral disease and reviewed

> >> > > > > > > > > > adrenalectomy outcomes evaluating which characteristics

> >> > > predicted

> >> > > > > > > > > > hypertension cure. Methods:ÃƒÆ’fÃƒâ€šÃ‚Â¢ÃƒÆ’Ã‚Â¢ÃƒÂ¢EURs(Ãƒâ€šÃ‚Â¬ÃƒÆ’Ã‚Â¢ÃƒÂ¢,Ã‚Â¬Ãƒâ€¦Ã‚Â¡ AVS was

> >> > > performed in 93 patients.

> >> > > > > > > > > > Lateralisation criteria were assessed using ROC curve

> >> > > analysis. The

> >> > > > > > > > > > outcome of adrenalectomy was reviewed in 39 patients and

> >> > > predictive

> >> > > > > > > > > > factors for cure determined using univariate and

> >> > > multivariate

> >> > > > > > > > > > analysis. Results:ÃƒÆ’fÃƒâ€šÃ‚Â¢ÃƒÆ’Ã‚Â¢ÃƒÂ¢EURs(Ãƒâ€šÃ‚Â¬ÃƒÆ’Ã‚Â¢ÃƒÂ¢,Ã‚Â¬Ãƒâ€¦Ã‚Â¡ Of previously

> >> > > published criteria, ROC curve

> >> > > > > > > > > > analysis found a cortisol corrected aldosterone affected to

> >> > > > > > > > > > unaffected (Aldo/Cort A:U) cut-off of 2.0 was the best

> >> > > predictor of

> >> > > > > > > > > > adenoma identifying 80.4% of patients. A novel ratio

> >> > > calculated by

> >> > > > > > > > > > dividing the affected to unaffected ratio by the

> >> > > unaffected to

> >> > > > > > > > > > peripheral ratio (Aldo/Cort A:U ÃƒÆ’fÃƒâ€ 'ÃƒÆ’,Ãƒâ€šÃ‚Â· Aldo/Cort

> >> > > U:IVC) was successful in

> >> > > > > > > > > > identifying 87.0% of patients. Cure rate for blood

> >> > > pressure after

> >> > > > > > > > > > adrenalectomy was 38.5% with improvement in 59.0%. On

> >> > > univariate

> >> > > > > > > > > > analysis, predictors of post-operative hypertension were

> >> > > increased

> >> > > > > > > > > > weight, raised creatinine, left ventricular hypertrophy

> >> > > (LVH) and

> >> > > > > > > > > > male sex. On multivariate analysis, male sex and higher

> >> > > pre-

> >> > > > > > > > > > operative systolic blood pressure were predictive.

> >> > > Conclusions:ÃƒÆ’fÃƒâ€šÃ‚Â¢ÃƒÆ’Ã‚Â¢ÃƒÂ¢EURs(Ãƒâ€šÃ‚Â¬ÃƒÆ’Ã‚Â¢ÃƒÂ¢,Ã‚Â¬Ãƒâ€¦Ã‚Â¡

> >> > > > > > > > > > Patients with PA should have CT scanning and AVS.

> >> > > Aldo/Cort A:U >2.0

> >> > > > > > > > > > is the most accurate of previously published ratios in

> >> > > predicting

> >> > > > > > > > > > unilateral disease. When patients were carefully

> >> > > selected for

> >> > > > > > > > > > surgery, 97% had cure or improvement in blood pressure

> >> > > control.

> >> > > > > > > > > > Further confirmatory work is required on a novel ratio

> >> > > which was

> >> > > > > > > > > > even more predictive in our series.

> >> > > > > > > > > >

> >> > > > > > > > > > PMID:

> >> > > > > > > > > > 21767289

> >> > > > > > > > > > [PubMed - as supplied by publisher]

> >> > > > > > > > > > Related citations

> >> > > > > > > > > > 2. J Clin Hypertens (Greenwich). 2011 Jul;13(7):487-91.

> >> > > doi: 10.1111/

> >> > > > > > > > > > j.1751-7176.2011.00443.x. Epub 2011 Mar 28.

> >> > > > > > > > > > Resistant hypertension and undiagnosed primary

> >> > > hyperaldosteronism

> >> > > > > > > > > > detected by use of a computerized database.

> >> > > > > > > > > >

> >> > > > > > > > > > EA, JR, Meier JL, Swislocki AL, Siegel D.

> >> > > > > > > > > > Source

> >> > > > > > > > > >

> >> > > > > > > > > > From the VA Northern California Health Care System,

> >> > > Mather Field,

> >> > > > > > > > > > CA;the School of Medicine, University of California,

> >> > > , CA.

> >> > > > > > > > > >

> >> > > > > > > > > > Abstract

> >> > > > > > > > > >

> >> > > > > > > > > > J Clin Hypertens (Greenwich).

> >> > > > > > > > > > Periodicals, Inc. A pharmacy database was used to

> >> > > identify patients

> >> > > > > > > > > > with resistant hypertension who could then be tested for

> >> > > the

> >> > > > > > > > > > presence of primary hyperaldosteronism. Inclusion

> >> > > criteria were: (1)

> >> > > > > > > > > > resistant hypertension defined as uncontrolled

> >> > > hypertension and use

> >> > > > > > > > > > of 3 antihypertensive medication classes or

> >> > > ÃƒÆ’fÃƒâ€šÃ‚Â¢ÃƒÆ’Ã‚Â¢ÃƒÂ¢,Ã‚Â¬Ãƒâ€šÃ‚Â°ÃƒÆ’,Ãƒâ€šÃ‚Â¥4 antihypertensive

> >> > > > > > > > > > classes regardless of blood pressure; (2) low or normal

> >> > > potassium

> >> > > > > > > > > > levels (ÃƒÆ’fÃƒâ€šÃ‚Â¢ÃƒÆ’Ã‚Â¢ÃƒÂ¢,Ã‚Â¬Ãƒâ€šÃ‚Â°ÃƒÆ’,Ãƒâ€šÃ‚Â¤4.9ÃƒÆ’fÃƒâ€šÃ‚Â¢ÃƒÆ’Ã‚Â¢ÃƒÂ¢EURs(Ãƒâ€šÃ‚Â¬ÃƒÆ’+'mEq/L); and

> >> > > (3) continuous health care from October

> >> > > > > > > > > > 1, 2008, to February 28, 2009. Exclusion criteria were:

> >> > > (1) past or

> >> > > > > > > > > > current use of an aldosterone antagonist, or (2) a

> >> > > medication

> >> > > > > > > > > > possession ratio (adherence) <80% for any

> >> > > antihypertensive drug.

> >> > > > > > > > > > Hyperaldosteronism was classified as an

> >> > > aldosterone/renin ratio

> >> > > > > > > > > > (ARR) ÃƒÆ’fÃƒâ€šÃ‚Â¢ÃƒÆ’Ã‚Â¢ÃƒÂ¢,Ã‚Â¬Ãƒâ€šÃ‚Â°ÃƒÆ’,Ãƒâ€šÃ‚Â¥30. Using the computer, 746

> >> > > patients were identified who met

> >> > > > > > > > > > criteria. After manual chart review to verify inclusion and

> >> > > > > > > > > > exclusion criteria, 333 patients remained. Of 184

> >> > > individuals in

> >> > > > > > > > > > whom an ARR was obtained, 39 (21.2%) had a ratio of

> >> > > ÃƒÆ’fÃƒâ€šÃ‚Â¢ÃƒÆ’Ã‚Â¢ÃƒÂ¢,Ã‚Â¬Ãƒâ€šÃ‚Â°ÃƒÆ’,Ãƒâ€šÃ‚Â¥30. A computer

> >> > > > > > > > > > database is useful to identify patients with resistant

> >> > > hypertension

> >> > > > > > > > > > and those who may have primary aldosteronism.

> >> > > > > > > > > >

> >> > > > > > > > > > PMID:

> >> > > > > > > > > > 21762361

> >> > > > > > > > > > [PubMed - in process]

> >> > > > > > > > > > Related citations

> >> > > > > > > > > >

> >> > > > > > > > > > 3. Eur J Endocrinol. 2011 Jul 13. [Epub ahead of print]

> >> > > > > > > > > > PHENOTYPE-GENOTYPE CORRELATION AND FOLLOW-UP IN ADULT

> >> > > PATIENTS WITH

> >> > > > > > > > > > HYPOKALAEMIA OF RENAL ORIGIN SUGGESTING GITELMAN SYNDROME.

> >> > > > > > > > > >

> >> > > > > > > > > > Balavoine AS, Bataille P, Vanhille P, Azar R,

> >> > > NoÃƒÆ’fÃƒâ€ 'ÃƒÆ’,Ãƒâ€šÃ‚Â«l C, Asseman P,

> >> > > > > > > > > > Soudan B, Wemeau JL, Vantyghem MC.

> >> > > > > > > > > > Source

> >> > > > > > > > > >

> >> > > > > > > > > > A Balavoine, Service Endocrinologie et Maladies

> >> > > > > > > > > > Clinique Endocrinologique Marc Linquette, Lille, 59037

> >> > > cedex, France.

> >> > > > > > > > > >

> >> > > > > > > > > > Abstract

> >> > > > > > > > > >

> >> > > > > > > > > > Gitelman syndrome is a tubulopathy caused by SLC12A3

> >> > > gene mutations,

> >> > > > > > > > > > which lead to hypokalaemic alkalosis, secondary

> >> > > hyperaldosteronism,

> >> > > > > > > > > > hypomagnesaemia and hypocalciuria. The aim of this study

> >> > > was to

> >> > > > > > > > > > assess the prevalence of SLC12A3 gene mutations in adult

> >> > > > > > > > > > hypokalaemic patients; to compare the phenotype of

> >> > > homozygous,

> >> > > > > > > > > > heterozygous and non-mutated patients; and to determine the

> >> > > > > > > > > > efficiency of treatment. Methods: Clinical, biological

> >> > > and genetic

> >> > > > > > > > > > data were recorded in 26 patients. Results: Screening

> >> > > for the

> >> > > > > > > > > > SLC12A3 gene detected 2 mutations in 15 patients (6

> >> > > homozygous and 9

> >> > > > > > > > > > compound heterozygous), one mutation in 6, and no

> >> > > mutation in 5

> >> > > > > > > > > > patients. There was no statistical difference in

> >> > > clinical symptoms

> >> > > > > > > > > > at diagnosis between the 3 groups. Systolic blood

> >> > > pressure tended to

> >> > > > > > > > > > be lower in patients with 2 mutations (p=0.16).

> >> > > Hypertension was

> >> > > > > > > > > > unexpectedly detected in 4 patients. Five patients with

> >> > > 2 mutated

> >> > > > > > > > > > alleles and 2 with heterozygosity had severe

> >> > > manifestations of GS.

> >> > > > > > > > > > Significant differences were observed between the 3

> >> > > groups in blood

> >> > > > > > > > > > potassium, chloride, magnesium, supine aldosterone,

> >> > > 24-hr urine

> >> > > > > > > > > > chloride and magnesium levels, and in MDRD. Mean blood

> >> > > potassium

> >> > > > > > > > > > levels increased from 2.8ÃƒÆ’fÃƒÂ¢EURs(ÃƒÆ’,Ãƒâ€šÃ‚Â±0.3,

> >> > > 3.5ÃƒÆ’fÃƒÂ¢EURs(ÃƒÆ’,Ãƒâ€šÃ‚Â±0.5, and 3.2ÃƒÆ’fÃƒÂ¢EURs(ÃƒÆ’,Ãƒâ€šÃ‚Â±0.3 before

> >> > > > > > > > > > treatment to 3.2ÃƒÆ’fÃƒÂ¢EURs(ÃƒÆ’,Ãƒâ€šÃ‚Â±0.5, 3.7ÃƒÆ’fÃƒÂ¢EURs(ÃƒÆ’,Ãƒâ€šÃ‚Â±0.6 and

> >> > > 3.7ÃƒÆ’fÃƒÂ¢EURs(ÃƒÆ’,Ãƒâ€šÃ‚Â±0.3 mmol/l with treatment in

> >> > > > > > > > > > groups with 2 (p=0.003), 1 and no mutated alleles,

> >> > > respectively.

> >> > > > > > > > > > Conclusion: In adult patients referred for renal

> >> > > hypokalaemia, we

> >> > > > > > > > > > confirmed the presence of mutations of the SLC12A3 gene

> >> > > in 80% of

> >> > > > > > > > > > cases. GS was more severe in patients with 2 than with 1

> >> > > or no

> >> > > > > > > > > > mutated alleles. High blood pressure should not rule out

> >> > > the

> >> > > > > > > > > > diagnosis, especially in older patients.

> >> > > > > > > > > >

> >> > > > > > > > > > PMID:

> >> > > > > > > > > > 21753071

> >> > > > > > > > > > [PubMed - as supplied by publisher]

> >> > > > > > > > > > Related citations

> >> > > > > > > > > >

> >> > > > > > > > > > 4. J Clin Endocrinol Metab. 2011 Jul 13. [Epub ahead of

> >> > > print]

> >> > > > > > > > > > Significance of Adrenocorticotropin Stimulation Test in the

> >> > > > > > > > > > Diagnosis of an Aldosterone-Producing Adenoma.

> >> > > > > > > > > >

> >> > > > > > > > > > Sonoyama T, Sone M, Miyashita K, Tamura N, Yamahara K,

> >> > > Park K,

> >> > > > > > > > > > Oyamada N, Taura D, Inuzuka M, Kojima K, Honda K,

> >> > > Fukunaga Y,

> >> > > > > > > > > > Kanamoto N, Miura M, Yasoda A, Arai H, Itoh H, Nakao K.

> >> > > > > > > > > > Source

> >> > > > > > > > > >

> >> > > > > > > > > > Department of Medicine and Clinical Science, Kyoto

> >> > > University

> >> > > > > > > > > > Graduate School of Medicine, Sakyo-ku, Kyoto 606-8507,

> >> > > Japan.

> >> > > > > > > > > >

> >> > > > > > > > > > Abstract

> >> > > > > > > > > >

> >> > > > > > > > > > Context: Adrenal venous sampling is the "gold standard"

> >> > > test in the

> >> > > > > > > > > > diagnosis of an aldosterone-producing adenoma (APA)

> >> > > among patients

> >> > > > > > > > > > with primary aldosteronism (PA) but is available only in

> >> > > specialized

> >> > > > > > > > > > medical centers. Meanwhile, an APA is reported to be

> >> > > generally more

> >> > > > > > > > > > sensitive to ACTH than idiopathic hyperaldosteronism.

> >> > > Objective: The

> >> > > > >

> >> > > >

> >> > >

> >> >

> >>

> >

>

July 23, 2011

No one ever said Medicine was easy. Tiped sad Send form miiPhone ;-)May your pressure be low!CE Grim MDSpecializing in DifficultHypertension

Thanks for the articles AND discussion it will take long to read all that...

>

> Perhaps someone, ? ?, can summarize the ones on surgery and

> someone on the Dx issues.

>

> I would do an excel set up

>

> Paste abstract in first cell then summarize in columns next to it.

> Number of subjects etc. and conclusions. Also upload all to our

> references on PA.

>

> CE Grim MD

>

> Begin forwarded message:

>

> >

> > Date: July 20, 2011 9:55:01 AM PDT

> > To: lowerbp2@...

> > Subject: PubMed Search Results

> >

> > This message contains search results from the National Center for

> > Biotechnology Information (NCBI) at the U.S. National Library of

> > Medicine (NLM). Do not reply directly to this message

> >

> > Sender's message: PA refs to July 11

> >

> > Sent on: Wed Jul 20 12:52:12 2011

> > 106 selected items

> >

> > pubmed Results

> > Items 1 -106 of 106

> >

> > 1. Clin Endocrinol (Oxf). 2011 Jul 18. doi: 10.1111/j.

> > 1365-2265.2011.04177.x. [Epub ahead of print]

> > 100 cases of primary aldosteronism. Careful choice of patients for

> > surgery using adrenal venous sampling and CT imaging results in

> > excellent blood pressure and potassium outcomes.

> >

> > Graham U, Ellis P, Hunter S, H, Mullan K, Atkinson A.

> > Source

> >

> > Regional Centre for Endocrinology and Diabetes, Royal

> > Hospital, Belfast Imaging Centre, Royal Hospital, Belfast

> > Regional Endocrine Laboratory, Royal Hospital, Belfast.

> >

> > Abstract

> >

> > Objective:Ã¢â‚¬â€š Patients with primary aldosteronism (PA) who are

> > suitable for surgery should undergo adrenal computerised tomography

> > (CT) and adrenal venous sampling (AVS). A retrospective study was

> > performed of 100 patients with PA. We determined the optimal AVS

> > lateralisation ratio for unilateral disease and reviewed

> > adrenalectomy outcomes evaluating which characteristics predicted

> > hypertension cure. Methods:Ã¢â‚¬â€š AVS was performed in 93 patients.

> > Lateralisation criteria were assessed using ROC curve analysis. The

> > outcome of adrenalectomy was reviewed in 39 patients and predictive

> > factors for cure determined using univariate and multivariate

> > analysis. Results:Ã¢â‚¬â€š Of previously published criteria, ROC curve

> > analysis found a cortisol corrected aldosterone affected to

> > unaffected (Aldo/Cort A:U) cut-off of 2.0 was the best predictor of

> > adenoma identifying 80.4% of patients. A novel ratio calculated by

> > dividing the affected to unaffected ratio by the unaffected to

> > peripheral ratio (Aldo/Cort A:U ÃƒÂ· Aldo/Cort U:IVC) was successful in

> > identifying 87.0% of patients. Cure rate for blood pressure after

> > adrenalectomy was 38.5% with improvement in 59.0%. On univariate

> > analysis, predictors of post-operative hypertension were increased

> > weight, raised creatinine, left ventricular hypertrophy (LVH) and

> > male sex. On multivariate analysis, male sex and higher pre-

> > operative systolic blood pressure were predictive. Conclusions:Ã¢â‚¬â€š

> > Patients with PA should have CT scanning and AVS. Aldo/Cort A:U >2.0

> > is the most accurate of previously published ratios in predicting

> > unilateral disease. When patients were carefully selected for

> > surgery, 97% had cure or improvement in blood pressure control.

> > Further confirmatory work is required on a novel ratio which was

> > even more predictive in our series.

> >

> > PMID:

> > 21767289

> > [PubMed - as supplied by publisher]

> > Related citations

> > 2. J Clin Hypertens (Greenwich). 2011 Jul;13(7):487-91. doi: 10.1111/

> > j.1751-7176.2011.00443.x. Epub 2011 Mar 28.

> > Resistant hypertension and undiagnosed primary hyperaldosteronism

> > detected by use of a computerized database.

> >

> > EA, JR, Meier JL, Swislocki AL, Siegel D.

> > Source

> >

> > From the VA Northern California Health Care System, Mather Field,

> > CA;the School of Medicine, University of California, , CA.

> >

> > Abstract

> >

> > Periodicals, Inc. A pharmacy database was used to identify patients

> > with resistant hypertension who could then be tested for the

> > presence of primary hyperaldosteronism. Inclusion criteria were: (1)

> > resistant hypertension defined as uncontrolled hypertension and use

> > of 3 antihypertensive medication classes or Ã¢â€°Â¥4 antihypertensive

> > classes regardless of blood pressure; (2) low or normal potassium

> > levels (Ã¢â€°Â¤4.9Ã¢â‚¬Æ’mEq/L); and (3) continuous health care from October

> > 1, 2008, to February 28, 2009. Exclusion criteria were: (1) past or

> > current use of an aldosterone antagonist, or (2) a medication

> > possession ratio (adherence) <80% for any antihypertensive drug.

> > Hyperaldosteronism was classified as an aldosterone/renin ratio

> > (ARR) Ã¢â€°Â¥30. Using the computer, 746 patients were identified who met

> > criteria. After manual chart review to verify inclusion and

> > exclusion criteria, 333 patients remained. Of 184 individuals in

> > whom an ARR was obtained, 39 (21.2%) had a ratio of Ã¢â€°Â¥30. A computer

> > database is useful to identify patients with resistant hypertension

> > and those who may have primary aldosteronism.

> >

> > PMID:

> > 21762361

> > [PubMed - in process]

> > Related citations

> >

> > 3. Eur J Endocrinol. 2011 Jul 13. [Epub ahead of print]

> > PHENOTYPE-GENOTYPE CORRELATION AND FOLLOW-UP IN ADULT PATIENTS WITH

> > HYPOKALAEMIA OF RENAL ORIGIN SUGGESTING GITELMAN SYNDROME.

> >

> > Balavoine AS, Bataille P, Vanhille P, Azar R, NoÃƒÂ«l C, Asseman P,