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Hypertension. 2018 Sep;72(3):650-657. doi: 10.1161/HYPERTENSIONAHA.118.11465.

Immunohistopathology and Steroid Profiles Associated With Biochemical Outcomes After Adrenalectomy for Unilateral Primary Aldosteronism.

Author information

1
From the Medizinische Klinik und Poliklinik IV, Klinikum der Universität München (L.S.M., X.W., E.S., F.B., M.R., T.A.W.).
2
Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Italy (J.B., P.M., T.A.W.).
3
Department of Electronics and Telecommunications, Polytechnic University of Turin, Italy (A.B.).
4
Division of Pathology, Department of Medical Sciences, University of Torino, Italy (I.C.).
5
Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany (G.E., M.P.).
6
Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany (G.E., J.W.M.L.).
7
Department of Medicine DIMED, University of Padova, Italy (F.F.).
8
Department of Medicine, University of Calgary, Alberta, Canada (G.A.K.).
9
Institute of Pathology (T. Knösel), Ludwig-Maximilians-University of Munich, Germany.
10
Department of Endocrinology, Diabetes, and Metabolic Diseases, University Medical Centre, Ljubljana, Slovenia (T. Kocjan).
11
Department of Medicine, Radboud University Medical Center, Nijmegen, The Netherlands (J.W.M.L.).
12
Department of Endocrinology, Metabolism, and Hypertension, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Japan (M.N.).
13
Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Japan (T.N.).
14
Department of Nephrology, Heinrich-Heine-University, Düsseldorf, Germany (L.C.R.).
15
Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, Universitätsspital Zürich, Switzerland (F.B.).
16
Department of Internal Medicine I, Endocrinology and Diabetes Unit, University Hospital of Würzburg, Germany (S.H.).
17
Division of Endocrinology, Department of Medicine, University of Mississippi Medical Center, Jackson, MS (C.E.G.-S.).
18
Research and Medicine Services, G.V. (Sonny) Montgomery VA Medical Center, Jackson, MS (C.E.G.-S.).

Abstract

Unilateral primary aldosteronism (PA) is the most common surgically curable form of hypertension that must be accurately differentiated from bilateral PA for therapeutic management (surgical versus medical). Adrenalectomy results in biochemical cure (complete biochemical success) in almost all patients diagnosed with unilateral PA; the remaining patients with partial or absent biochemical success comprise those with persisting aldosteronism who were misdiagnosed as unilateral PA preoperatively. To identify determinants of postsurgical biochemical outcomes, we compared the adrenal histopathology and the peripheral venous steroid profiles of patients with partial and absent or complete biochemical success after adrenalectomy for unilateral PA. A large multicenter cohort of adrenals from patients with absent and partial biochemical success (n=43) displayed a higher prevalence of hyperplasia (49% versus 21%; P=0.004) and a lower prevalence of solitary functional adenoma (44% versus 79%; P<0.001) compared with adrenals from age- and sex-matched patients with PA with complete biochemical success (n=52). We measured the peripheral plasma steroid concentrations in a subgroup of these patients (n=43) and in a group of patients with bilateral PA (n=27). Steroid profiling was associated with histopathologic phenotypes (solitary functional adenoma, hyperplasia, and aldosterone-producing cell clusters) and classified patients according to biochemical outcome or diagnosis of bilateral PA. If validated, peripheral venous steroid profiling may be a useful tool to guide the decision to perform surgery based on expectations of biochemical outcome after the procedure.

KEYWORDS:

adrenal glands; adrenalectomy; aldosterone; hyperaldosteronism; immunohistochemistry

PMID:
30012870
PMCID:
PMC6202235
DOI:
10.1161/HYPERTENSIONAHA.118.11465
[Indexed for MEDLINE]
Free PMC Article

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