Primary aldosteronism (PA), the most common cause of
|
|
- Timothy Emery Townsend
- 5 years ago
- Views:
Transcription
1 Primary Aldosteronism Androstenedione and 17-α-Hydroxyprogesterone Are Better Indicators of Adrenal Vein Sampling Selectivity Than Cortisol Giulio Ceolotto, Giorgia Antonelli, Giuseppe Maiolino, Maurizio Cesari, Giacomo Rossitto, Valeria Bisogni, Mario Plebani, Gian Paolo Rossi Abstract For identification of potentially surgically curable primary aldosteronism, guidelines recommend use of adrenal vein sampling (AVS) that requires selective catheterization of both adrenal veins as verified by using the cortisolderived selectivity index. Unfortunately, bilaterally selective studies are not obtained under unstimulated conditions in a proportion of the cases ranging between 15% and 50% depending on the cutoff used. We therefore investigated whether 17-α-hydroxyprogesterone and androstenedione, which showed a higher step-up between adrenal vein and inferior vena cava blood than cortisol, can ascertain selectivity when cortisol failed to do so. We prospectively recruited 32 hypertensive patients with confirmed primary aldosteronism, who underwent bilaterally simultaneous sampling without cosyntropin stimulation and with the same predefined AVS protocol. All were consecutively selected because of a cortisol-based selectivity index <2.00 in at least one of the paired adrenal vein blood samples collected as per protocol. Results showed that the values of the selectivity index based on 17-α-hydroxyprogesterone and androstenedione were higher (P<0.01) on average by 1.6- and 12-fold, respectively, than those based on cortisol. With use of these steroids, we rescued 43% and 73% of the AVS, respectively, from being judged nonselective. Thus, in challenging patients with primary aldosteronism submitted to AVS use of 17-α-hydroxyprogesterone, and even more so of androstenedione, for ascertaining selectivity allows demonstration of correct catheter placement in a proportion of AVS studies better than cortisol. Thus, replacing cortisol measurement with these steroids, and particularly androstenedione, can improve the diagnostic yield of AVS. (Hypertension. 2017;70: DOI: /HYPERTENSIONAHA ) Key Words: androstenedione catheterization cosyntropin diagnosis steroids Primary aldosteronism (PA), the most common cause of endocrine arterial hypertension, can be cured at long term if lateralized aldosterone excess is demonstrated. To establish lateralization, all current guidelines consider adrenal vein sampling (AVS) as the gold standard to be offered to all patients with PA seeking surgical cure. 1 3 The diagnostic use of AVS is, however, possible only when bilaterally selective catheterization is achieved. Because the adrenal cortex is the only appreciable site of cortisol production, in clinical practice, detection of a step-up of the level of this hormone between the adrenal vein and a peripheral vein blood or the inferior vena cava blood upstream the adrenal venous drainage is used to ascertain selectivity, which implies calculation of the selectivity index (SI). Bilateral selectivity is considered to be the case when the SI value exceeds a cutoff in both adrenal veins, which is set at 2.00 or 4.00, under unstimulated or cosyntropin-stimulated conditions, respectively. 4 Unfortunately, it is common experience that with these popular cutoffs to define selectivity, a relatively large proportion of AVS studies, ranging between 15% and 50% depending on the cutoff used, is judged to be nonselective under unstimulated conditions. 5 Luckily, recent studies with use of liquid chromatography tandem mass spectometry led to be discovery that the step-up cortisol is smaller than that of several other steroids, 6 including 17-α-hydroxyprogesterone (17α-hydroxypregn-4- ene-3,20-dione, 17α-OHP) and androstenedione (4-androstene-3,17-dione). Hence, it is conceivable that use of these steroids can rescue diagnosis in a proportion of the AVS studies held to be nonselective based on the cortisol-derived SI. This within-patient pairwise comparison study was therefore set up to test this hypothesis in a cohort of patients with PA, who posed special challenges at AVS in that they were judged nonselective on their cortisol-based SI value. Materials and Methods The study used a cohort of referred hypertensive patients with documented PA, who were prospectively recruited for the AVS study following the Endocrine Society guidelines. 1 All patients underwent imaging with computed tomography according to current guidelines. 1 For this protocol, we selected the Received March 21, 2017; first decision April 7, 2017; revision accepted May 5, From the Clinica dell Ipertensione Arteriosa (G.C., G.M., M.C., G.R., V.B., G.P.R.) and Laboratory Medicine (G.A., M.P.), Department of Medicine, DIMED-University of Padua, Italy. Correspondence to Gian Paolo Rossi, Clinica dell Ipertensione Arteriosa DIMED, University Hospital, via Giustiniani, Padova, Italy. gianpaolo.rossi@unipd.it 2017 American Heart Association, Inc. Hypertension is available at DOI: /HYPERTENSIONAHA
2 Ceolotto et al Aldosterone Renin Ratio and APA Diagnosis 343 AVS studies that showed a cortisol-based SI <2.00 in at least 1 sample of the paired adrenal vein samples systematically collected at our center. This cutoff value is the most commonly used for unstimulated AVS studies 7 and is recommended by an Expert Consensus Statement. 4 All patients provided informed written consent and underwent AVS with the bilaterally simultaneous catheterization twice under unstimulated conditions at time 15 minutes and again at time 0 as described. 8 The Ethics Committee of the University of Padua approved the protocol; all procedures followed the Helsinki Declaration Principles. The assay used to measure cortisol was previously reported. 9 Plasma 17α-OHP and androstenedione levels were measured by commercial kits: an enzyme immunoassay (DRG Instruments GmbH, Germany) and a competitive chemi-luminescence enzyme immunoassay (Immulite 2000; Siemens), respectively. For plasma 17α-OHP, the imprecision monitored with 3 internal quality controls in our routine practice showed a coefficient of variation of 4.7% at 1.45 nmol/l, 6.8% at 7.08 nmol/l, and 5.5% at nmol/l. For plasma androstenedione, a similar analysis demonstrated a coefficient of variation of 7.9%, 6.7%, and 4.8% at 2.59, 9.33, and nmol/l, respectively. All these coefficient of variations are lower than those declared by the manufacturers. Definitions The SI was calculated as ratio between the value of each steroid (cortisol, 17α-OHP, or androstenedione) in each adrenal vein and in the infrarenal inferior vena cava. 10 A cutoff of 2.00 was used to establish selectivity, as recommended in an Expert Consensus Statement 4 and by the Endocrine Society guidelines. 1 Statistical Analysis Nonparametric Wilcoxon test was used for within-patient and between-group comparison of quantitative variables because no transformation of skewed variables was used. The distribution of categorical variables was compared by χ 2 analysis. Significance was set at P<0.05. For statistical analysis, we used the SPSS (version 24 for Mac, IBM, Italy) and the GraphPad Prism (version 6.00 for Mac, GraphPad Software, La Jolla, CA) softwares. Results Baseline Characteristics of the Patients The AVS samples that fulfilled these selection criteria pertained to 32 of 160 consecutive patients studied with the same AVS protocol, corresponding to 16% (77 of 480) blood samples. Table 1 shows the baseline characteristics of the patients recruited in this study. In brief, besides high blood pressure, the patients had all of the biochemical features expected for a cohort of patients with PA, including low serum K + and plasma renin activity and high plasma aldosterone concentration and aldosterone renin ratio. As expected by inclusion criterion, no bilateral selectivity was found in at least one of the paired cortisol-based SI values. Therefore, the patients who did not meet the criteria for clinical use of AVS were not submitted to surgery. Those with bilaterally selective results in at least 1 pair of the samples and lateralization of aldosterone excess underwent unilateral adrenalectomy. Accordingly, 2 groups of patients were generated: one comprising 14 patients, who underwent adrenalectomy and received a conclusive diagnosis of aldosterone-producing adenoma (APA), as determined by the demonstration of adenoma at pathology and by cure of PA at post-adrenalectomy follow-up, and one of 18 patients Table 1. Demographic and Clinical Features of the Patients Baseline Age, y 51.8±12.1 Gender, % (F) 50% BMI, kg/m ±3.4 Systolic BP, mm Hg 171±32 Diastolic BP, mm Hg 98±15 Serum creatinine, mmol/l 73 (55 90) Serum K +, mmol/l 3.37±0.14 PRA, ng/ml per hour 0.80 ( ) PAC, ng/dl 18.9±2.2 ARR, (ng/dl)/(ng/ml per hour) 41.6±6.5 For ARR calculation, PRA the minimum value was set at Data presented as mean±sd or median (interquartile range), as appropriate. ARR indicates aldosterone renin ratio; BMI, body mass index; BP, blood pressure; F, female; PAC, plasma aldosterone concentration; and PRA, plasma renin activity. defined as non-apa, because a conclusive subtype diagnosis could not be determined as adrenalectomy was not performed. Comparison of the overall features of the APA and non-apa patients (Table 2) shows that there were no clearcut differences between these groups with the exception of lower serum K + in APA versus non-apa patients. Comparison of SI Based on Cortisol, 17α-OHP, and Androstenedione The pairwise within-patient comparison showed that the SI based on 17α-OHP was higher than that based on cortisol both on the right and the left sides, and that the SI based on Table 2. Demographic and Clinical Features at Baseline of the Patients With and Without a Conclusive Diagnosis of APA APA (n=14) Non-APA (n=18) P Value Age, y 48.4± ±11.8 NS Gender, % (F) 43% 55% NS BMI, kg/m ± ±3.0 NS Systolic BP, mm Hg 163±18 181±43 NS Diastolic BP, mm Hg 94±15 101±16 NS Serum creatinine, mmol/l 78 (55 89) 71 (54 90) NS Serum K +, mmol/l 2.89± ± Urinary albumin excretion, mg/g creatinine 15.3 (8.9 21) 12.7 (6.7 28) NS PRA, ng/ml per hour 0.55 ( ) 0.80 ( ) NS PAC, ng/dl 25.0± ±1.6 NS ARR (ng/dl)/(ng/ml per hour) 53.0± ±7.1 NS Lateralization index 14.2± ± For ARR calculation, PRA the minimum value was set at Data presented as mean±sd or median and interquartile range, as appropriate. APA indicates aldosterone producing adenoma; and NS, nonsignificant. Other abbreviations are as in Table 1.
3 344 Hypertension August 2017 Table 3. Comparison of Selectivity Index (SI) Values Based on Cortisol (F), 17-α-Hydroxyprogesterone (17α-OHP), and Androstenedione (A) in the All Cohort F P Value F vs 17α-OHP 17α-OHP P Value 17α- OHP vs A A P Value A vs F Right side 1.12 ( ) ( ) ( ) Left side 1.79 ( ) ( ) ( ) Data presented as median and 95% confidence interval. androstenedione was even higher on both sides (Table 3). A bar graph of the SI values based on cortisol, 17α-OHP, and androstenedione on the right and the left sides, and bilaterally, is shown in Figure 1. On average, the SI values was higher on the right than on the left side, probably because of anatomic differences, as discussed below. Figure 2 shows a scatter plot of the within-patient relationship SI values based on the different steroids, with a direct linear relationship between cortisol based, 17α- OHP based, and androstenedione based. For both steroids, the slope was significantly different from zero (for 17α-OHP, F=4.83, P=0.03; for androstenedione, F=14.38, P= ). The slope of the androstenedione-based versus the cortisol-based SI values was significantly higher (F=11.72, P=0.0009) than that of the 17α-OHP based SI values because the androstenedione-based SI values were systematically higher than the 17α-OHP based SI values. A Bland Altman plot of the difference between 17α-OHP and cortisol- (Figure 3A) or androstenedione- and cortisolbased SI (Figure 3B) shows a proportional bias for both 17α-OHP and androstenedione; moreover, it unambiguously demonstrated that on average the SI difference of each steroid versus cortisol was much greater for androstenedione than for 17α-OHP. Rate of Selective Studies By inclusion criteria, all AVS studies were nonbilaterally selective when selectivity was assessed by cortisol-based SI value of In contrast, 43% and 73% such AVS studies were shown to be selective with 17α-OHP and androstenedione, respectively, with the same cutoff. Of further note, even with androstenedione, the steroid providing the highest SI values of the hormones tested, 27% of the samples were nonselective, suggesting that unfavorable anatomy, as discussed below, cannot be overcome even with use of a steroid released in greater amounts from the adrenal cortex. 11 Discussion This study selected the most challenging patients with PA consecutively submitted to AVS in that they failed to reach a SI cutoff >2.00 under unstimulated conditions. 5,7 It is possible that in this cohort, selective catheterization was not achieved because of unfavorable anatomy, for example, the common drainage of the right adrenal vein with an accessory hepatic vein, which, by diluting adrenal vein blood with that from the liver, decreases the SI value, because the liver clearance of androstenedione is reported to be between 82% and 92% in humans. 12,13 Therefore, from the practical standpoint, it was of interest to verify whether in this cohort of patients, use of adrenocortical steroids other than cortisol could provide a more sensitive assessment of selectivity than cortisol. In fact, the SI based on androstenedione and 17α-OHP was 12- and 1.6-fold higher than that based on cortisol, respectively (Figure 2), a finding that agrees with the larger gradient of these steroids between the inferior vena cava and the adrenal vein blood found in 2 studies that used liquid chromatography tandem mass spectrometry. 6,14 By measuring 17α-OHP and androstenedione in a large data set of PA cases judged nonselective based on cortisol, 43% of and 73%, respectively, of the studies were judged to be selective. Thus, the demonstration that both 17α-OHP and androstenedione allowed assessment of selectivity in such challenging cases, where cortisol failed, is an important novel finding with several clinical implications. The measurement of both 17α-OHP and androstenedione is widely available at most certified laboratories, in contrast with other biomarkers that have been proposed to assess selectivity (eg, plasma metanephrine). Needless to say that use of these steroids can also be exploited at centers where liquid chromatography-tandem mass spectrometry is available. 6 Figure 1. The bar graph shows the value of the selectivity index (SI) on the right and left sides and overall in the patients with SI <2.00 when assessed using cortisol (empty bars). The dashed horizontal line indicates the cutoff value of the SI most commonly used to define selectivity. By definition, the cortisol-based SI was <2.00 in this cohort of patients. Use of 17-α-hydroxyprogesterone (17α- OHP, black bars) and, even more so, androstenedione (A, dashed bars) resulted not only in significantly higher values but also in rescuing many adrenal vein sampling studies from being classified as nonselective.
4 Ceolotto et al Aldosterone Renin Ratio and APA Diagnosis 345 referral centers and, therefore, is not as widely available as the steroids herein investigated. Conclusions This study extends to clinical use in a challenging PA population the recent knowledge generated with mass spectrometry, 6 that the adrenal plasma levels of several steroids, particularly androstenedione, relative to peripheral vein blood concentrations are higher than those of cortisol. Accordingly, use of androstenedione as biomarker can be advantageous over that of cortisol in those AVS studies judged nonselective with only SI based on cortisol. Currently, these AVS studies are discarded for diagnostic purposes, thus limiting the clinical usefulness of AVS. Of the 2 steroids tested in this study, androstenedione is clearly preferable. Figure 2. The scatter plot of within-patient selectivity index (SI) values shows a direct linear relationship between cortisol and both 17-α-hydroxyprogesterone (17α-OHP) and androstenedione (A). For the purpose of visual clarity, the y axis is on a log 2 scale. The slope was significantly nonzero for both 17α-OHP (F=4.834, P=0.03) and A (F=14.38, P= ). The slope of the A-based vs the cortisol-based SI values was significantly higher (F=11.72, P=0.0009) than that of 17α-OHP based vs the cortisol-based SI values because the A-based SI values were systematically higher than the 17α-OHP based SI values. Some limitations are to be acknowledged in this study. First, because it entailed a single referral center that evaluates mostly white patients, its results need to be replicated in other centers and ethnic groups, who might have a different rate of either 17α-OHP and androstenedione production or unfavorable anatomy, or both. Second, our study was not powered to investigate the question whether there are differences between genders in the adrenal step-up of these steroids. Third, it refers to unstimulated AVS data; therefore, its conclusions cannot be extended to cosyntropin-stimulated AVS studies. Finally, we did not compare the diagnostic performance of these steroids with that of plasma metanephrine, which has also been reported to have a higher SI than cortisol. 15 This was because routine assay of free plasma metanephrine is done only at few Perspectives There is an urgent need to improve the diagnostic accuracy of AVS to open the way for unilateral adrenalectomy in many patients with PA who still do not receive long-term cure because of inconclusive AVS results. The improvement of assessment of selectivity by use of biomarkers better than those currently used can be an important step in the right direction. The wider availability of liquid chromatography coupled to tandem mass spectrometry can further advance this practice by providing more accurate measurement of the steroids, such as androstenedione, that have high within-run coefficient of variation with currently available commercial kits. Sources of Funding This study was supported by the COST BM1301 Aldosterone and Mineralocorticoid Receptor (ADMIRE) EU program (to G.P. Rossi) and by FORICA (The Foundation for advanced Research In hypertension and Cardiovascular disease). None. Disclosures References 1. Funder JW, Carey RM, Mantero F, Murad MH, Reincke M, Shibata H, Stowasser M, Young WF Jr. The management of primary aldosteronism: case detection, diagnosis, and treatment: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016;101: doi: /jc Onozawa S, Murata S, Tajima H, Yamaguchi H, Mine T, Ishizaki A, Sugihara H, Oikawa S, Kumita S. Evaluation of right adrenal vein cannulation by computed tomography angiography in 140 consecutive patients Figure 3. The Bland Altman plot of the within-patient differences between the selectivity index (SI) based on 17-αhydroxyprogesterone (17α-OHP) and on cortisol (A) and between the SI based on androstenedione (A) and on cortisol (B). Both plots show a proportional bias in the measurement of the SI because 17α-OHP and androstenedione provided greater SI values than cortisol. Please note that for visualization purposes the x-axis scale was set to be 5-fold larger in the latter than in the former, indicating that the difference between SI values was much larger when determined with androstenedione than with 17α-OHP.
5 346 Hypertension August 2017 undergoing adrenal venous sampling. Eur J Endocrinol. 2014;170: doi: /EJE Maiolino G, Mareso S, Bisogni V, Rossitto G, Azzolini M, Cesari M, Seccia TM, Calò L, Rossi GP. Assessment of the quantitative value usefulness of the aldosterone-renin ratio (ARR) for primary aldosteronism (AQUARR) study. High Blood Press Cardiovasc Prev. 2016;23: doi: /s Rossi GP, Auchus RJ, Brown M, Lenders JW, Naruse M, Plouin PF, Satoh F, Young WF Jr. An expert consensus statement on use of adrenal vein sampling for the subtyping of primary aldosteronism. Hypertension. 2014;63: doi: /HYPERTENSIONAHA Rossi GP, Ganzaroli C, Miotto D, De Toni R, Palumbo G, Feltrin GP, Mantero F, Pessina AC. Dynamic testing with high-dose adrenocorticotrophic hormone does not improve lateralization of aldosterone oversecretion in primary aldosteronism patients. J Hypertens. 2006;24: doi: /01.hjh Eisenhofer G, Dekkers T, Peitzsch M, Dietz AS, Bidlingmaier M, Treitl M, Williams TA, Bornstein SR, Haase M, Rump LC, Willenberg HS, Beuschlein F, Deinum J, Lenders JW, Reincke M. Mass spectrometrybased adrenal and peripheral venous steroid profiling for subtyping primary aldosteronism. Clin Chem. 2016;62: doi: / clinchem Rossi GP, Barisa M, Allolio B, et al. The Adrenal Vein Sampling International Study (AVIS) for identifying the major subtypes of primary aldosteronism. J Clin Endocrinol Metab. 2012;97: doi: /jc Seccia TM, Miotto D, Battistel M, Motta R, Barisa M, Maniero C, Pessina AC, Rossi GP. A stress reaction affects assessment of selectivity of adrenal venous sampling and of lateralization of aldosterone excess in primary aldosteronism. Eur J Endocrinol. 2012;166: doi: /EJE Seccia TM, Miotto D, De Toni R, Pitter G, Mantero F, Pessina AC, Rossi GP. Adrenocorticotropic hormone stimulation during adrenal vein sampling for identifying surgically curable subtypes of primary aldosteronism: comparison of 3 different protocols. Hypertension. 2009;53: doi: /HYPERTENSIONAHA Rossitto G, Miotto D, Battistel M, Barbiero G, Maiolino G, Bisogni V, Sanga V, Rossi GP. Metoclopramide unmasks potentially misleading contralateral suppression in patients undergoing adrenal vein sampling for primary aldosteronism. J Hypertens. 2016;34: doi: / HJH Miotto D, De Toni R, Pitter G, Seccia TM, Motta R, Vincenzi M, Feltrin G, Rossi GP. Impact of accessory hepatic veins on adrenal vein sampling for identification of surgically curable primary aldosteronism. Hypertension. 2009;54: doi: /HYPERTENSIONAHA Rivarola MA, Singleton RT, Migeon CJ. Splanchnic extraction and interconversion of testosterone and androstenedione in man. J Clin Invest. 1967;46: doi: /JCI Horton R, Tait JF. Androstenedione production and interconversion rates measured in peripheral blood and studies on the possible site of its conversion to testosterone. J Clin Invest. 1966;45: doi: / JCI Nilubol N, Soldin SJ, Patel D, Rwenji M, Gu J, Masika LS, Chang R, Stratakis CA, Kebebew E. 11-Deoxycortisol may be superior to cortisol in confirming a successful adrenal vein catheterization without cosyntropin: a pilot study. Int J Endo Oncol. 2017;4: Dekkers T, Deinum J, Schultzekool LJ, Blondin D, Vonend O, Hermus AR, Peitzsch M, Rump LC, Antoch G, Sweep FC, Bornstein SR, Lenders JW, Willenberg HS, Eisenhofer G. Plasma metanephrine for assessing the selectivity of adrenal venous sampling. Hypertension. 2013;62: doi: /HYPERTENSIONAHA Novelty and Significance What Is New? The achievement of surgical cure of primary aldosteronism depends on identification of unilateral causes by adrenal vein sampling (AVS). To this aim, guidelines recommend use of AVS, which is based on the achievement of selective catheterization of both adrenal veins, as commonly verified by using the cortisol-derived selectivity index. With a within-patient study design of challenging AVS studies judged to be nonselective using cortisol as a biomarker of selectivity, we discovered that androstenedione and 17-α-hydroxyprogesterone can allow to ascertain selectivity when cortisol failed to do so. What Is Relevant? Use of androstenedione as a biomarker of selectivity can allow rescue for diagnostic purposes up to 73% of AVS studies that would be discarded with use of cortisol. Summary This study demonstrates that the rate of bilaterally selective AVS studies can be markedly increased by using androstenedione as a biomarker of selectivity, over the most widely used cortisol in the most challenging cases. Exploiting this strategy in the subtyping of primary aldosteronism can allow reach a diagnosis in far more cases than by using cortisol as a biomarker for selectivity.
Primary aldosteronism (PA), the most common endocrine
Mineralocorticoids Impact of Accessory Hepatic Veins on Adrenal Vein Sampling for Identification of Surgically Curable Primary Aldosteronism Diego Miotto, Renzo De Toni, Gisella Pitter, Teresa Maria Seccia,
More informationAdrenal vein sampling (AVS) is considered the gold
Adrenocorticotropic Hormone Stimulation During Adrenal Vein Sampling for Identifying Surgically Curable Subtypes of Primary Aldosteronism Comparison of 3 Different Protocols Teresa M. Seccia, Diego Miotto,
More informationAdrenal hypertension caused by primary aldosteronism
Plasma Metanephrine and Adrenal Venous Sampling Plasma Metanephrine for Assessing the Selectivity of Adrenal Venous Sampling Tanja Dekkers, Jaap Deinum, Leo J. Schultzekool, Dirk Blondin, Oliver Vonend,
More informationHyperaldosteronism, caused by an aldosterone-producing
CONTROVERSIES IN HYPERTENSION Adrenal Vein Sampling Is the Preferred Method to Select Patients With Primary Aldosteronism for Adrenalectomy Pro Side of the Argument Gian Paolo Rossi, John W. Funder Hyperaldosteronism,
More informationAdrenal Vein Sampling: A Critical Tool for Subtyping Primary Aldosteronism
Adrenal Vein Sampling: A Critical Tool for Subtyping Primary Aldosteronism Disclosures No conflicts of interest relevant to this presentation Jason W. Pinchot, M.D. Assistant Professor, Vascular and Interventional
More informationPrimary Aldosteronism
Primary Aldosteronism Odelia Cooper, MD Assistant Professor of Medicine Division of Endocrinology, Diabetes, and Metabolism Cedars-Sinai Medical Center HYPERTENSION CENTER Barriers to diagnosing primary
More informationADRENAL VEIN SAMPLING: AN INTEGRAL PART OF MANAGING COMPLICATED ADRENAL HYPERTENSION- SAFE? WORTH IT?
ADRENAL VEIN SAMPLING: AN INTEGRAL PART OF MANAGING COMPLICATED ADRENAL HYPERTENSION- SAFE? WORTH IT? Chaitanya Ahuja, M.D. Assistant Professor, Vascular and Interventional Radiology Director of Interventional
More informationGALECTIN-3 PREDICTS LONG TERM CARDIOVASCULAR DEATH IN HIGH-RISK CORONARY ARTERY DISEASE PATIENTS
GALECTIN-3 PREDICTS LONG TERM CARDIOVASCULAR DEATH IN HIGH-RISK CORONARY ARTERY DISEASE PATIENTS Table of Contents List of authors pag 2 Supplemental figure I pag 3 Supplemental figure II pag 4 Supplemental
More informationAVS and IPSS: The Basics and the Pearls William F. Young, Jr., MD, MSc Professor of Medicine Mayo Clinic College of Medicine Rochester, MN, USA
AVS and IPSS: The Basics and the Pearls William F. Young, Jr., MD, MSc Professor of Medicine Mayo Clinic College of Medicine Rochester, MN, USA 2016 Mayo Foundation for Medical Education and Research.
More information--Manuscript Draft-- Primary Aldosteronism; adrenal vein sampling; aldosterone producing adenoma. Brisbane, Queensland, AUSTRALIA
Journal of Hypertension Repeating adrenal vein sampling when neither aldosterone/cortisol ratio exceeds peripheral yields a high incidence of aldosterone-producing adenoma --Manuscript Draft-- Manuscript
More informationAVS and IPSS: The Basics and the Pearls
AVS and IPSS: The Basics and the Pearls William F. Young, Jr., MD, MSc Professor of Medicine Mayo Clinic College of Medicine Rochester, MN, USA 2018 Mayo Foundation for Medical Education and Research.
More informationDiagnosis of primary aldosteronism (PA), the most frequent
Effect of Adrenocorticotropic Hormone Stimulation During Adrenal Vein Sampling in Primary Aldosteronism Silvia Monticone, Fumitoshi Satoh, Gilberta Giacchetti, Andrea Viola, Ryo Morimoto, Masataka Kudo,
More informationUpon completion, participants should be able to:
Learning Objectives Upon completion, participants should be able to: Describe the causes of secondary hypertension and the prevalence of primary aldosteronism Discuss the diagnostic approach to primary
More informationThe recent Lancet Commission on Arterial Hypertension
ORIGINAL RESEARCH Quantitative Value of Aldosterone-Renin Ratio for Detection of Aldosterone-Producing Adenoma: The Aldosterone-Renin Ratio for Primary Aldosteronism (AQUARR) Study Giuseppe Maiolino, MD;
More informationPrimary Aldosteronism: screening, diagnosis and therapy
Primary Aldosteronism: screening, diagnosis and therapy Jacques W.M. Lenders, internist DEPT. OF INTERNAL MEDICINE, RADBOUD UNIVERSITY NIJMEGEN MEDICAL CENTER, NIJMEGEN,THE NETHERLANDS DEPT. OF INTERNAL
More informationSubtyping of Patients with Primary Aldosteronism: An Update
Lenders JacquesW M et al. Subtyping of Patients with Horm Metab Res 2017; 00: 00 00 Subtyping of Patients with Primary Aldosteronism: An Update Authors Jacques W. M. Lenders 1, 2, Graeme Eisenhofer 3,
More informationClinical Pathological Conference
Clinical Pathological Conference Case of Primary Aldosteronism With Discordant Hormonal and Computed Tomographic Findings Laurence Amar, Yehonatan Sharabi, Gian Paolo Rossi, Emmanuelle Vidal-Petiot, Anna
More informationPrimary aldosteronism (PA) is a syndrome caused by
ORIGINAL Endocrine ARTICLE Care The Adrenal Vein Sampling International Study (AVIS) for Identifying the Major Subtypes of Primary Aldosteronism Gian Paolo Rossi, Marlena Barisa, Bruno Allolio, Richard
More informationA clinical prediction score for diagnosing unilateral primary Aldosteronism may not be generalizable
Venos et al. BMC Endocrine Disorders 2014, 14:94 RESEARCH ARTICLE Open Access A clinical prediction score for diagnosing unilateral primary Aldosteronism may not be generalizable Erik S Venos 1, Benny
More informationPrimary aldosteronism clinical practice guidelines: a re-appraisal The Management of Primary Aldosteronism
Primary aldosteronism clinical practice guidelines: a re-appraisal The Management of Primary Aldosteronism Prof. FRANCO MANTERO Division of Endocrinology University of Padua Italy Case Detection, Diagnosis
More informationDiagnosis of primary aldosteronism (PA), the most frequent
Effect of Adrenocorticotropic Hormone Stimulation During Adrenal Vein Sampling in Primary Aldosteronism Silvia Monticone, Fumitoshi Satoh, Gilberta Giacchetti, Andrea Viola, Ryo Morimoto, Masataka Kudo,
More informationEndocrine Hypertension
Endocrine Hypertension 1 No Disclosures Endocrine Hypertension Objectives: 1. Understand Endocrine disorders causing hypertension 2. Understand clinical presentation of Pheochromocytoma and Hyperaldosteronism
More informationIn patients with primary aldosteronism (PA), the discrimination
Primary Aldosteronism Hyperparathyroidism Can Be Useful in the Identification of Primary Aldosteronism Due To Aldosterone-Producing Adenoma Gian Paolo Rossi, Fabio Ragazzo, Teresa Maria Seccia, Carmela
More informationPrimary aldosteronism (PA) is currently believed to be
Aldosterone Impact of Different Diagnostic Criteria During Adrenal Vein Sampling on Reproducibility of Subtype Diagnosis in Patients With Primary Aldosteronism Paolo Mulatero, Chiara Bertello, Norlela
More informationArlt W et al.: Steroid Metabolome analysis reveals prevalent glucocorticoid excess in
Figure S1: Comparison of 24-h urinary steroid metabolite excretion in 162 healthy controls and 174 patients with. Panel A, tetrahydroaldosterone; Panel B, cortisol; Panel C, total glucocorticoid metabolites.
More informationPrimary Aldosteronism. Adrenal Venous Sampling in Patients With Positive Screening but Negative Confirmatory Testing for Primary Aldosteronism
Primary Aldosteronism Adrenal Venous Sampling in Patients With Positive Screening but Negative Confirmatory Testing for Primary Aldosteronism Hironobu Umakoshi, Mitsuhide Naruse, Norio Wada, Takamasa Ichijo,
More informationMineralocorticoids. Vascular Remodeling and Duration of Hypertension Predict Outcome of Adrenalectomy in Primary Aldosteronism Patients
Mineralocorticoids Vascular Remodeling and Duration of Hypertension Predict Outcome of Adrenalectomy in Primary Aldosteronism Patients Gian Paolo Rossi, Massimo Bolognesi, Damiano Rizzoni, Teresa M. Seccia,
More informationAdrenal Venous Sampling Evaluation of the German Conn s Registry
Adrenal Venous Sampling Evaluation of the German Conn s Registry Oliver Vonend, Nora Ockenfels, Xing Gao, Bruno Allolio, Katharina Lang, Knut Mai, Ivo Quack, Andreas Saleh, Christoph Degenhart, Jochen
More informationClarification of hypertension Diagnosis of primary hyperaldosteronism
Nr. 1/2010 Clarification of hypertension Diagnosis of primary hyperaldosteronism Marc Beineke The significance of the /renin ratio (ARR) in the diagnosis of normoalaemic and hypokalaemic primary hyperaldosteronism,
More informationYear 2004 Paper two: Questions supplied by Megan 1
Year 2004 Paper two: Questions supplied by Megan 1 QUESTION 96 A 32yo woman if found to have high blood pressure (180/105mmHg) at an insurance medical examination. She is asymptomatic. Clinical examination
More informationAdrenal incidentaloma guideline for Northern Endocrine Network
Adrenal incidentaloma guideline for Northern Endocrine Network Definition of adrenal incidentaloma Adrenal mass detected on an imaging study done for indications that are not related to an adrenal problem
More informationA 64 year old man referred for evaluation of suspected hyperaldosteronism
A 64 year old man referred for evaluation of suspected hyperaldosteronism Dr. Dickens does not have any relevant financial relationships with any commercial interests. ENDORAMA: 64 year old man referred
More informationTreatment of Unilateral PA by Adrenalectomy: Potential Reasons for Incomplete Biochemical Cure
Yang Yuhong et al. Treatment of Unilateral PA Exp Clin Endocrinol Diabetes 2018; 00: 00 00 Treatment of Unilateral PA by Adrenalectomy: Potential Reasons for Incomplete Biochemical Cure Authors Yuhong
More informationSpectrum of Hypertension & Hypokalemia
Spectrum of Hypertension & Hypokalemia Farheen K. Dojki, PGY-6 Hypertension Fellow, ASH Hypertension Center Dr. Dojki does not have any relevant financial relationships with any commercial interests. OBJECTIVES:
More information27 F with new onset hypertension and weight gain. Rajesh Jain Endorama 10/01/2015
27 F with new onset hypertension and weight gain Rajesh Jain Endorama 10/01/2015 HPI 27 F with hypertension x 1 year BP 130-140/90 while on amlodipine 5 mg daily She also reports weight gain, 7 LB, mainly
More informationACTH stimulation test and computed tomography are useful for differentiating the subtype of primary aldosteronism
2017, 64 (1), 65-73 Original ACTH stimulation test and computed tomography are useful for differentiating the subtype of primary aldosteronism Ayako Moriya 1), Masaaki Yamamoto 1), Shunsuke Kobayashi 1),
More informationDiagnostic Role of Captopril Challenge Test in Korean Subjects with High Aldosterone-to-Renin Ratios
Original Article Endocrinol Metab 2016;31:277-283 http://dx.doi.org/10.3803/enm.2016.31.2.277 pissn 2093-596X eissn 2093-5978 Diagnostic Role of Captopril Challenge Test in Korean Subjects with High Aldosterone-to-Renin
More informationChanges in the clinical manifestations of primary aldosteronism
ORIGINAL ARTICLE Korean J Intern Med 2014;29:217-225 Changes in the clinical manifestations of primary aldosteronism Sun Hwa Kim, Jae Hee Ahn, Ho Cheol Hong, Hae Yoon Choi, Yoon Jung Kim, Nam Hoon Kim,
More informationEndocrine Sep 1. doi: /s y. [Epub ahead of print] Clin Endocrinol (Oxf) Sep;87(3):312. doi: /cen
1. Endocrine. 2017 Sep 1. doi: 10.1007/s12020-017-1398-y. [Epub ahead of print] The impact of peri-operative dexamethasone administration on the normal hypothalamic pituitary adrenal response to major
More informationIs Adrenal Venous Sampling Necessary in All Patients with Hyperaldosteronism before Adrenalectomy?
Is Adrenal Venous Sampling Necessary in All Patients with Hyperaldosteronism before Adrenalectomy? Rasa Zarnegar, MD, Alan I. Bloom, MD, James Lee, MD, Robert K. Kerlan, Jr, MD, Mark W. Wilson, MD, Jeanne
More informationUpdates in primary hyperaldosteronism and the rule
Updates in primary hyperaldosteronism and the 20-50 rule I. David Weiner, M.D. Professor of Medicine and Physiology and Functional Genomics University of Florida College of Medicine and NF/SGVHS The 20-50
More informationSubclinical Cushing s Syndrome
Subclinical Cushing s Syndrome AACE 26th Annual Scientific & Clinical Congress Associate Clinical Professor of Medicine and Clinical Chief University of Miami Miller Scholl of Medicine Miami, Florida aayala2@miami.edu
More informationDiagnostic Accuracy of Adrenal Venous Sampling in Comparison with Other Parameters in Primary Aldosteronism
Endocrine Journal 2008, 55 (5), 839 846 Diagnostic Accuracy of Adrenal Venous Sampling in Comparison with Other Parameters in Primary Aldosteronism ISAO MINAMI, TAKANOBU YOSHIMOTO, YUKI HIRONO, HAJIME
More informationRoles of Clinical Criteria, Computed Tomography Scan, and Adrenal Vein Sampling in Differential Diagnosis of Primary Aldosteronism Subtypes
ORIGINAL Endocrine ARTICLE Care Roles of Clinical Criteria, Computed Tomography Scan, and Adrenal Vein Sampling in Differential Diagnosis of Primary Aldosteronism Subtypes Paolo Mulatero, Chiara Bertello,
More informationResistant hypertension is defined as blood. Primary Hyperaldosteronism Decoded: A Case of Curable Resistant Hypertension.
Case Review Primary Hyperaldosteronism Decoded: A Case of Curable Resistant Hypertension Timothy R. Larsen, DO, Wadie David, Susan Steigerwalt, MD, Shukri David, MD Department of Internal Medicine, Section
More informationA Prospective Study of the Prevalence of Primary Aldosteronism in 1,125 Hypertensive Patients
Journal of the American College of Cardiology Vol. 48, No. 11, 2006 2006 by the American College of Cardiology Foundation ISSN 0735-1097/06/$32.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2006.07.059
More information41 th Meeting of the International Aldosterone Conference The Revere Hotel Boston Common March 30 31, 2016
41 th Meeting of the International Aldosterone Conference The Revere Hotel Boston Common March 30 31, 2016 Wednesday, March 30, 2016 1:00-1:10PM Welcome Session I: Molecular Mechanisms 1:10-1:50PM Senior
More informationEvaluation of Endocrine Tests B: screening for hypercortisolism
O R I G I N A L A R T I C L E Evaluation of Endocrine Tests B: screening for hypercortisolism F. Holleman 1*, E. Endert 2, M.F. Prummel 1, M. van Vessem-Timmermans 1, W.M. Wiersinga 1, E. Fliers 1 1 Department
More informationPrimary aldosteronism (PA) is a common curable cause
Heart Long-Term Control of Arterial Hypertension and Regression of Left Ventricular Hypertrophy With Treatment of Primary Aldosteronism Gian Paolo Rossi, Maurizio Cesari, Cesare Cuspidi, Giuseppe Maiolino,
More informationIntegration of steroids analysis in serum using LC-MS/MS with full-automated sample preparation
PO-CON69E Integration of steroids analysis in serum using LC-MS/MS with full-automated sample preparation MSACL 6 EU Stéphane Moreau, Daisuke Kawakami, Toshikazu Minohata Shimadzu Europe GmbH, Duisburg,
More informationPrimary Aldosteronism & Implications for Primary Hypertension
& Implications for Primary Hypertension Richard J. Auchus, MD, PhD, FACE Professor and Fellowship Program Director Depts of Internal Medicine/MEND & Pharmacology University of Michigan Disclosures Contracted
More informationULTIMATE BEAUTY OF BIOCHEMISTRY. Dr. Veena Bhaskar S Gowda Dept of Biochemistry 30 th Nov 2017
ULTIMATE BEAUTY OF BIOCHEMISTRY Dr. Veena Bhaskar S Gowda Dept of Biochemistry 30 th Nov 2017 SUSPECTED CASE OF CUSHING S SYNDROME Clinical features Moon face Obesity Hypertension Hunch back Abdominal
More informationPrimary Aldosteronism
Primary Aldosteronism Elevation of Angiotensin-II Type-1-Receptor Autoantibodies Titer in Primary Aldosteronism as a Result of Aldosterone-Producing Adenoma Giacomo Rossitto,* Giuseppe Regolisti,* Ermanno
More informationPrevalence of Hyperaldosteronism in Primary Care Patients with Resistant Hypertension
ORIGINAL RESEARCH Prevalence of Hyperaldosteronism in Primary Care Patients with Resistant Hypertension Guido Schmiemann, MD, MPH, Klaus Gebhardt, MD, Eva Hummers-Pradier, MD and Günther Egidi, MD Introduction:
More informationEndocrine hypertensionmolecules. Marie Freel Caledonian Endocrine Society Meeting 29 th November 2015
Endocrine hypertensionmolecules and genes Marie Freel Caledonian Endocrine Society Meeting 29 th November 2015 Plan Mineralocorticoid hypertension Myths surrounding Primary Aldosteronism (PA) New developments
More informationAdrenocorticotropic Hormone-Independent Cushing Syndrome with Bilateral Cortisol-Secreting Adenomas
Case Report Endocrinol Metab 2013;28:133-137 http://dx.doi.org/10.3803/enm.2013.28.2.133 pissn 2093-596X eissn 2093-5978 Adrenocorticotropic Hormone-Independent Cushing Syndrome with Bilateral Cortisol-Secreting
More informationLONG-TERM EFFECTS OF SURGICAL MENAGEMENT OF PRIMARY ALDOSTERONISM ON THE CARDIOVASCULAR SISTEM
LONG-TERM EFFECTS OF SURGICAL MENAGEMENT OF PRIMARY ALDOSTERONISM ON THE CARDIOVASCULAR SISTEM Riccardo Marsili, Pietro Iacconi, Massimo Chiarugi, Giampaolo Bernini*, Alessandra Bacca*, Paolo Miccoli Department
More informationPrimary aldosteronism (PA) is a common curable cause
Heart Long-Term Control of Arterial Hypertension and Regression of Left Ventricular Hypertrophy With Treatment of Primary Aldosteronism Gian Paolo Rossi, Maurizio Cesari, Cesare Cuspidi, Giuseppe Maiolino,
More informationPatients with primary aldosteronism (PA) are at a higher
ORIGINAL ARTICLE Endocrine Care Predictors of Decreasing Glomerular Filtration Rate and Prevalence of Chronic Kidney Disease After Treatment of Primary Aldosteronism: Renal Outcome of 213 Cases Yoshitsugu
More informationImpact of aldosterone-producing cell clusters on diagnostic discrepancies in primary aldosteronism
, 2018, Vol. 9, (No. 40), pp: 26007-26018 Impact of aldosterone-producing cell clusters on diagnostic discrepancies in primary aldosteronism Mitsuhiro Kometani 1, Takashi Yoneda 1,2, Daisuke Aono 1, Shigehiro
More informationPrognosis of primary aldosteronism in Japan: results from a nationwide epidemiological study
Endocrine Journal 2013 Or i g i n a l Advance Publication doi: 10.1507/endocrj. EJ13-0353 Prognosis of primary aldosteronism in Japan: results from a nationwide epidemiological study Yoshihiro Miyake 1),
More informationUpdates in primary hyperaldosteronism and the rule
Updates in primary hyperaldosteronism and the 20-50 rule I. David Weiner, M.D. C. Craig and Audrae Tisher Chair in Nephrology Professor of Medicine and Physiology and Functional Genomics University of
More informationWilliam F. Young, Jr., MD, MSc Professor of Medicine, Mayo Clinic, Rochester, MN USA
The Year in Adrenal William F. Young, Jr., MD, MSc Professor of Medicine, Mayo Clinic, Rochester, MN USA Division of ENDOCRINOLOGY, DIABETES, METABOLISM & NUTRITION 2018 Mayo Foundation for Medical Education
More informationAnalysis of Testosterone, Androstenedione, and Dehydroepiandrosterone Sulfate in Serum for Clinical Research
Analysis of Testosterone, Androstenedione, and Dehydroepiandrosterone Sulfate in Serum for Clinical Research Dominic Foley, Michelle Wills, and Lisa Calton Waters Corporation, Wilmslow, UK APPLICATION
More informationAbstract. Introduction
THIEME Original Article 71 Combined Efficacy of Adrenal Vein Sampling and Imaging Findings in Predicting Clinical Outcomes Following Unilateral Adrenalectomy for Primary Aldosteronism Rajiv N. Srinivasa
More informationDIAGNOSIS OF CANINE HYPERADRENOCORTICISM: A CASE-BASED APPROACH Ellen N. Behrend, VMD, PhD, DACVIM
DIAGNOSIS OF CANINE HYPERADRENOCORTICISM: A CASE-BASED APPROACH Ellen N. Behrend, VMD, PhD, DACVIM Case 1: Signalment: 10 yr old, CM, Miniature poodle; History: Presented for teeth cleaning; PE: Severe
More informationThe body mass index (BMI) is reported to be directly related
ORIGINAL ARTICLE Endocrine Care Body Mass Index Predicts Plasma Aldosterone Concentrations in Overweight-Obese Primary Hypertensive Patients Gian Paolo Rossi, Anna Belfiore, Giampaolo Bernini, Bruno Fabris,
More informationEndocrine. Endocrine as it relates to the kidney. Sarah Elfering, MD University of Minnesota
Endocrine Sarah Elfering, MD University of Minnesota Endocrine as it relates to the kidney Parathyroid gland Vitamin D Endocrine causes of HTN Adrenal adenoma PTH Bone Kidney Intestine 1, 25 OH Vitamin
More informationI farmaci ad azione surrenalica: METIRAPONE ed OSILODROSTAT
I farmaci ad azione surrenalica: METIRAPONE ed OSILODROSTAT Maria Cristina De Martino Dipartimento di Medicina Clinica e Chirurgia Sezione di Endocrinologia, Università Federico II di Napoli, Italy 1 Treatment
More informationInternational Journal of Health Sciences and Research ISSN:
International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571 Original Research Article Congenital Adrenal Hyperplasia in Saudi Arabia: The Biochemical Characteristics Nasir A. M.
More informationTestosterone Therapy in Men An update
Testosterone Therapy in Men An update SANDEEP DHINDSA Associate Professor of Medicine Director, Division of Endocrinology and Metabolism, Saint Louis University, St. Louis, MO Presenter Disclosure None
More informationA Rare Case of Subclinical Primary Aldosteronism and Subclinical Cushing s Syndrome without Cardiovascular Complications
Tokai J Exp Clin Med., Vol. 41, No. 1, pp. 35-41, 216 A Rare Case of Subclinical Primary Aldosteronism and Subclinical Cushing s Syndrome without Cardiovascular Complications Natsumi KITAJIMA *1, Toshiro
More informationPREOPERATIVE DIAGNOSIS AND LOCALIZATION OF ALDOSTERONE-PRODUCING ADENOMA BY ADRENAL VENOUS SAMPLING AFTER ADMINISTRATION OF METOCLOPRAMIDE
K.D. Wu, T.S. Liao, Y.M. Chen, et al PREOPERATIVE DIAGNOSIS AND LOCALIZATION OF ALDOSTERONE-PRODUCING ADENOMA BY ADRENAL VENOUS SAMPLING AFTER ADMINISTRATION OF METOCLOPRAMIDE Kwan-Dun Wu, Tsou-Song Liao,
More informationSupplemental Data. Supplement to: Abiraterone Acetate to Lower Androgens in Classic 21-Hydroxylase Deficiency
Supplemental Data Supplement to: Abiraterone Acetate to Lower Androgens in Classic 21-Hydroxylase Deficiency Richard J. Auchus, Elizabeth O. Buschur, Alice Y. Chang, Gary D. Hammer, Carole Ramm, David
More informationIncidental Adrenal Nodules Differential Diagnosis
Adrenal Stuff Richard J. Auchus, MD, PhD, FACE Division of Metabolism, Endocrinology & Diabetes Departments of Internal Medicine & Pharmacology University of Michigan/VA Ann Arbor Incidental Adrenal Nodules
More informationThe Work-up and Treatment of Adrenal Nodules
The Work-up and Treatment of Adrenal Nodules Lawrence Andrew Drew Shirley, MD, MS, FACS Assistant Professor of Surgical-Clinical Department of Surgery Division of Surgical Oncology The Ohio State University
More informationDiagnostic methods 2: receiver operating characteristic (ROC) curves
abc of epidemiology http://www.kidney-international.org & 29 International Society of Nephrology Diagnostic methods 2: receiver operating characteristic (ROC) curves Giovanni Tripepi 1, Kitty J. Jager
More informationThe Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline
SPECIAL FEATURE Clinical Practice Guideline The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline John W. Funder, Robert M.
More informationHow to Recognize Adrenal Disease
How to Recognize Adrenal Disease CME Away India & Sri Lanka March 23 - April 7, 2018 Richard A. Bebb MD, ABIM, FRCPC Consultant Endocrinologist Medical Subspecialty Institute Cleveland Clinic Abu Dhabi
More informationStudies both in vivo and in vitro have demonstrated that
Primary Aldosteronism Clinical Management and Outcomes of Adrenal Hemorrhage Following Adrenal Vein Sampling in Primary Aldosteronism Silvia Monticone,* Fumitoshi Satoh,* Anna S. Dietz, Remi Goupil, Katharina
More informationMeasurement of Renin Activity using Tandem Mass Spectrometry Ravinder J Singh, PhD, DABCC Mayo Clinic, Rochester, MN
Measurement of Renin Activity using Tandem Mass Spectrometry Ravinder J Singh, PhD, DABCC Mayo Clinic, Rochester, MN Renin Angiotension System Weber, et al. NEJM 2001; 345:1690. Renin Angiotension System
More informationAlthough debate on the true prevalence of primary aldosteronism
Annals of Internal Medicine Review Systematic Review: Diagnostic Procedures to Differentiate Unilateral From Bilateral Adrenal Abnormality in Primary Aldosteronism Marlies J.E. Kempers, MD, PhD; Jacques
More informationAdrenal venous sampling as used in a patient with primary pigmented nodular adrenocortical disease
Original Article on Translational Imaging in Cancer Patient Care Adrenal venous sampling as used in a patient with primary pigmented nodular adrenocortical disease Xiaoxin Peng 1, Yintao Yu 1, Yi Ding
More informationA Rare Case of ACTH-independent Macronodular Adrenal Hyperplasia Associated with Aldosterone-producing Adenoma
CASE REPORT A Rare Case of ACTHindependent Macronodular Adrenal Hyperplasia Associated with Aldosteroneproducing Adenoma Eri Hayakawa 1, Takanobu Yoshimoto 1, Kiichiro Hiraishi 1, Masako Kato 1, Hajime
More informationAdrenal Mass. Cynthia Kwong SUNY Downstate Medical Center Grand Rounds October 13, 2016
Adrenal Mass Cynthia Kwong SUNY Downstate Medical Center Grand Rounds October 13, 2016 Case Presentation 65F found to have a 4cm left adrenal mass in 2012 now presents with 6.7cm left adrenal mass PMHx:
More informationLong-Term Cardio- and Cerebrovascular Events in Patients With Primary Aldosteronism
ORIGINAL Endocrine ARTICLE Care Long-Term Cardio- and Cerebrovascular Events in atients With rimary Aldosteronism aolo Mulatero,* Silvia Monticone,* Chiara Bertello,* Andrea Viola, Davide Tizzani, Andrea
More informationAbout 20% of the Canadian population
Mineralocorticoid Hypertension: Common and Treatable Hypertension is the most common chronic disease treated by the primary-care physician. It is now evident that mineralocorticoid hypertension, which
More informationFemale androgen profiles by MS for PCOS patients. CS Ho APCCMS 2010, Hong Kong 14 January 2010
Female androgen profiles by MS for PCOS patients CS Ho APCCMS 2010, Hong Kong 14 January 2010 873 women with increased serum androgens Androgen-secreting neoplasms 0.2% Classical CAH 0.6% Non-classical
More informationPrevalence and characterization of somatic mutations in Chinese aldosterone-producing adenoma. patients. Supplemental data. First author: Baojun Wang
Prevalence and characterization of somatic mutations in Chinese aldosterone-producing adenoma patients Supplemental data First author: Baojun Wang Patients and tumor samples A total of 87 patients with
More informationSUPPLEMENTARY APPENDIX. COU-AA-301 enrolled men with pathologically confirmed mcrpc who had received previous
SUPPLEMENTARY APPENDIX Methods Subjects COUAA30 enrolled men with pathologically confirmed mcrpc who had received previous treatment with docetaxel chemotherapy and had documented PSA progression according
More informationVenous sampling technique in Endocrinology: a renewed technique
Venous sampling technique in Endocrinology: a renewed technique Poster No.: C-0682 Congress: ECR 2014 Type: Educational Exhibit Authors: M. E. Rodriguez Cabillas 1, J. Garcia Villanego 2, I. Olea Comas
More informationHuman adrenal glands secrete vitamin C in response to adrenocorticotrophic hormone 1 5
Human adrenal glands secrete vitamin C in response to adrenocorticotrophic hormone 1 5 Sebastian J Padayatty, John L Doppman, Richard Chang, Yaohui Wang, John Gill, Dimitris A Papanicolaou, and Mark Levine
More informationORIGINAL ARTICLE Endocrinology, Nutrition & Metabolism INTRODUCTION
ORIGINAL ARTICLE Endocrinology, Nutrition & Metabolism http://dx.doi.org/10.3346/jkms.2011.26.11.1454 J Korean Med Sci 2011; 26: 1454-1460 Relationships of Basal Level of Serum 17-Hydroxyprogesterone with
More informationPlasma Steroid Metabolome for Diagnosis and Subtyping Patients with Cushing Syndrome
Zurich Open Repository and Archive University of Zurich Main Library Strickhofstrasse 39 CH-8057 Zurich www.zora.uzh.ch Year: 2018 Plasma Steroid Metabolome for Diagnosis and Subtyping Patients with Cushing
More informationDimitrios Linos, M.D., Ph.D. Professor of Surgery National & Kapodistrian University of Athens
Dimitrios Linos, M.D., Ph.D. Professor of Surgery National & Kapodistrian University of Athens What is an adrenal incidentaloma? An adrenal incidentaloma is defined as an adrenal tumor initially diagnosed
More informationA 5-Year Prospective Follow-Up Study of Lipid-Rich Adrenal Incidentalomas: No Tumor Growth or Development of Hormonal Hypersecretion
Original Article Endocrinol Metab 2015;30:481-487 http://dx.doi.org/10.3803/enm.2015.30.4.481 pissn 2093-596X eissn 2093-5978 A 5-Year Prospective Follow-Up Study of Lipid-Rich Adrenal Incidentalomas:
More informationDIFFERENTE RELAZIONE TRA VALORI PRESSORI E MASSA VENTRICOLARE SX NEI DUE SESSI IN PAZIENTI IPERTESI.
DIFFERENTE RELAZIONE TRA VALORI PRESSORI E MASSA VENTRICOLARE SX NEI DUE SESSI IN PAZIENTI IPERTESI. Franco Cipollini, Carlo Porta, Enrica Arcangeli, Carla Breschi, & Giuseppe Seghieri Azienda USL 3, Ambulatorio
More informationSUPPLEMENTAL MATERIAL
SUPPLEMENTAL MATERIAL Clinical perspective It was recently discovered that small RNAs, called micrornas, circulate freely and stably in human plasma. This finding has sparked interest in the potential
More informationIs there a role for Nuclear Medicine in diagnosis and management of patients with primary aldosteronism?
Is there a role for Nuclear Medicine in diagnosis and management of patients with primary aldosteronism? Abstract Primary aldosteronism (PA) is the most common cause of secondary hypertension. The diagnosis
More information