Download PDF
Horm Metab Res 2010; 42(6): 374-381
DOI: 10.1055/s-0029-1243619
Review

© Georg Thieme Verlag KG Stuttgart · New York

Progress in Primary Aldosteronism: Present Challenges and Perspectives

C. E. Gomez-Sanchez1 , G. P. Rossi2 , F. Fallo3 , M. Mannelli4
  • 1Division of Endocrinology, G. V. (Sonny) Montgomery VA Medical Center and University of Mississippi Medical Center, Jackson, USA
  • 2DMCS-Internal Medicine 4, University Hospital, Padova, Padova, Italy
  • 3Department of Medical and Surgical Sciences, University of Padova, Padova, Italy
  • 4Department of Clinical Pathophysiology, University of Florence, Florence, Italy
Further Information

Publication History

received 30.10.2009

accepted 01.12.2009

Publication Date:
20 January 2010 (online)

Also available at
    Permissions and Reprints

Abstract

Primary Aldosteronism (PA) is a disorder of the adrenal zona glomerulosa (ZG) in which aldosterone secretion is increased and is relatively autonomous of normal regulatory mechanisms. A recent conference in Munich organized by Prof. Reincke addressed advances and challenges related to the screening, diagnosis, and identification of uni- and bilateral involvement of the diseased adrenal of PA. Some infrequently addressed issues are described herein. We postulate that most cases of PA are due to the activation by unknown mechanisms of subset of cells resulting in the formation of a multiple foci or nodules of hyperactive zona glomerulosa cells. This implies that one or several yet unidentified stimuli can drive aldosterone overproduction, as well as the proliferation of aldosterone-producing cells. Current diagnostic procedures allow to determine whether inappropriate aldosterone production is driven by one or both adrenal glands and thus to establish optimal treatment.

Key words

adrenal adenoma - adrenal cortex - aldosterone - mineralocorticoid - adrenal tumor - steroidogenesis

References

  • 1 Conn JW. Primary aldosteronism, a new clinical syndrome.  J Lab Clin Med. 1955;  45 3-7
    Search in Google Scholar
  • 2 Conn JW, Knopf RF, Nesbit RM. Clinical characteristics of primary aldosteronism from an analysis of 145 cases.  Am J Surg. 1964;  107 159-172
    Search in Google Scholar
  • 3 Conn JW, Cohen EL, Rovner DR, Nesbit RM. Normokalemic primary aldosteronism. A detectable cause of curable “essential” hypertension.  JAMA. 1965;  193 200-206
    Search in Google Scholar
  • 4 Andersen GS, Toftdahl DB, Lund JO, Strandgaard S, Nielsen PE. The incidence rate of phaeochromocytoma and Conns syndrome in Denmark, 1977–1981.  J Hum Hypertens. 1988;  2 187-189
    Search in Google Scholar
  • 5 Kaplan NM. Hypokalemia in the hypertensive patient, with observations on the incidence of primary aldosteronism.  Ann Int Med. 1967;  66 1079-1090
    Search in Google Scholar
  • 6 Holland O, Brown H, Kuhnert L, Fairchild C, Risk M, Gomez-Sanchez CE. Further evaluation of saline infusion for the diagnosis of primary aldosteronism.  Hypertension. 1984;  6 717-723
    Search in Google Scholar
  • 7 Gordon RD, Stowasser M, Tunny TJ, Klemm SA, Rutherford JC. High incidence of primary aldosteronism in 199 patients referred with hypertension.  Clin Expt Pharmacol Physiol. 1994;  21 315-318
    Search in Google Scholar
  • 8 Anderson  Jr  GH, Blakeman N, Streeten DH. The effect of age on prevalence of secondary forms of hypertension in 4429 consecutively referred patients.  J Hypertension. 1994;  12 609-615
    Search in Google Scholar
  • 9 Loh KC, Koay ES, Khaw MC, Emmanuel SC, Young WF. Prevalence of primary aldosteronism among Asian hypertensive patients in Singapore.  J Clin Endocrinol Metab. 2000;  85 2854-2859
    Search in Google Scholar
  • 10 Fardella CE, Mosso L, Gomez-Sanchez CE, Soto J, Montero J, Gomez L, Pinto M, Oestreicher E, Cortés P. Primary hyperaldosteronism in essential hypertensives: Prevalence, biochemical profile and molecular biology.  J Clin Endocrinol Metab. 2000;  85 1863-1867
    Search in Google Scholar
  • 11 Calhoun DA, Nishizaka MK, Zaman MA, Thakkar RB, Weissmann P. Hyperaldosteronism among black and white subjects with resistant hypertension.  Hypertension. 2002;  40 892-896
    Search in Google Scholar
  • 12 Plouin PF, Amar L, Chatellier G, Gosse P, Tabarin A, Reznik Y, Baguet JP, Chabre O, Prost A, Wemeau JL, Berthezene F, Fauvel JP, Milon H, Vincent M, Conte-Devolx B, Bertagna X, Mouradian D, Herpin D, Croisier-Lukas C, Lefebvre H, Imbs JL, Chamontin B. Trends in the prevalence of primary aldosteronism, aldosterone-producing adenomas, and surgically correctable aldosterone-dependent hypertension.  Nephrol Dial Transpl. 2004;  19 774-777
    Search in Google Scholar
  • 13 Mulatero P, Stowasser M, Loh KC, Fardella CE, Gordon RD, Mosso L, Gomez-Sanchez CE, Veglio F, Young  Jr  WF. Increased diagnosis of primary aldosteronism, including surgically correctable forms, in centers from five continents.  J Clin Endocrinol Metab. 2004;  89 1045-1050
    Search in Google Scholar
  • 14 Rossi GP, Bernini G, Caliumi C, Desideri G, Fabris B, Ferri C, Ganzaroli C, Giacchetti G, Letizia C, Maccario M, Mallamaci F, Mannelli M, Mattarello MJ, Moretti A, Palumbo G, Parenti G, Porteri E, Semplicini A, Rizzoni D, Rossi E, Boscaro M, Pessina AC, Mantero F. A prospective study of the prevalence of primary aldosteronism in 1 125 hypertensive patients.  J Am Coll Cardiol. 2006;  48 2293-2300
    Search in Google Scholar
  • 15 Funder JW, Carey RM, Fardella C, Gomez-Sanchez CE, Mantero F, Stowasser M, Young  Jr  WF, Montori VM. Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline.  J Clin Endocrinol Metab. 2008;  93 3266-3281
    Search in Google Scholar
  • 16 Abdelhamid S, Blomer R, Hommel G, Haack D, Lewicka S, Fiegel P, Krumme B. Urinary tetrahydroaldosterone as a screening method for primary aldosteronism: a comparative study.  Am J Hypertens. 2003;  16 522-530
    Search in Google Scholar
  • 17 Weinberger MH, Grim CE, Hollifield JW, Kem DC, Ganguly A, Kramer NJ, Yune HY, Wellman H, Donohue JP. Primary aldosteronism: diagnosis, localization, and treatment.  Ann Intern Med. 1979;  90 386-395
    Search in Google Scholar
  • 18 Rodriguez JA, Lopez JM, Biglieri EG. DOCA test for aldosteronism: its usefulness and implications.  Hypertension. 1981;  3 II-102
    Search in Google Scholar
  • 19 Anderson GH, Blakeman N, Streeten DHP. The effect of age on prevalence of secondary forms of hypertension in 4429 consecutively referred patients.  J Hypertension. 1994;  12 609-615
    Search in Google Scholar
  • 20 Flood C, Layne DS, Ramcharan S, Rossipal E, Tait JF, Tait SA. An investigation of the urinary metabolites and secretion rates of aldosterone and cortisol in man and a description of methods for their measurement.  Acta Endocrinol (Copenh). 1961;  36 237-264
    Search in Google Scholar
  • 21 Hiramatsu K, Yamada T, Yukimura Y, Komiya I, Ichikawa M, Nagata H, Izumiyama T. A screening test to identify aldosterone-producing adenoma by measuring plasma renin activity. Results in hypertensive patients.  Arch Intern Med. 1981;  141 1589-1593
    Search in Google Scholar
  • 22 Born-Frontsberg E, Reincke M, Beuschlein F, Quinkler M. Tumor size of Conn's adenoma and comorbidities.  Horm Metab Res. 2009;  41 785-788
    Search in Google Scholar
  • 23 Rossi GP, Sacchetto A, Pavan E, Scognamiglio R, Pietra M, Pessina AC. Left ventricular systolic function in primary aldosteronism and hypertension.  J Hypertension. 1998;  16 2075-2077
    Search in Google Scholar
  • 24 Rossi GP, Di Bello V, Ganzaroli C, Sacchetto A, Cesari M, Bertini A, Giorgi D, Scognamiglio R, Mariani M, Pessina AC. Excess aldosterone is associated with alterations of myocardial texture in primary aldosteronism.  Hypertension. 2002;  40 23-27
    Search in Google Scholar
  • 25 Rossi GP. Cardiac consequences of aldosterone excess in human hypertension.  Am J Hypertens. 2006;  19 10-12
    Search in Google Scholar
  • 26 Rossi GP, Bernini G, Desideri G, Fabris B, Ferri C, Giacchetti G, Letizia C, Maccario M, Mannelli M, Matterello MJ, Montemurro D, Palumbo G, Rizzoni D, Rossi E, Pessina AC, Mantero F. Renal damage in primary aldosteronism: results of the PAPY Study.  Hypertension. 2006;  48 232-238
    Search in Google Scholar
  • 27 Milliez P, Girerd X, Plouin PF, Blacher J, Safar ME, Mourad JJ. Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism.  J Am Coll Cardiol. 2005;  45 1243-1248
    Search in Google Scholar
  • 28 Catena C, Colussi G, Nadalini E, Chiuch A, Baroselli S, Lapenna R, Sechi LA. Cardiovascular outcomes in patients with primary aldosteronism after treatment.  Arch Intern Med. 2008;  168 80-85
    Search in Google Scholar
  • 29 Montori VM, Young  Jr  WF. Use of plasma aldosterone concentration-to-plasma renin activity ratio as a screening test for primary aldosteronism. A systematic review of the literature.  Endocrinol Metab Clin North Am. 2002;  31 619-632 , xi 
    Search in Google Scholar
  • 30 Stowasser M, Gordon RD. Primary aldosteronism – careful investigation is essential and rewarding.  Mol Cell Endocrinol. 2004;  217 33-39
    Search in Google Scholar
  • 31 Mulatero P, Rabbia F, Milan A, Paglieri C, Morello F, Chiandussi L, Veglio F. Drug effects on aldosterone/plasma renin activity ratio in primary aldosteronism.  Hypertension. 2002;  40 897-902
    Search in Google Scholar
  • 32 Lim PO, Jung RT, MacDonald TM. Raised aldosterone to renin ratio predicts antihypertensive efficacy of spironolactone: a prospective cohort follow-up study.  Br J Clin Pharmacol. 1999;  48 756-760
    Search in Google Scholar
  • 33 Bravo EL, Tarazi RC, Dustan HP, Fouad FM, Textur SC, Gifford RW, Vidt DG. The changing clinical spectrum of primary aldosteronism.  Am J Med. 1983;  74 641-651
    Search in Google Scholar
  • 34 Kem DC, Weinberger MH, Gomez-Sanchez CE, Kramer NJ, Lerman R, Ferman R, Furuyama S, Nugent CA. Circadian rhythms of plasma aldosterone concentration in normal subjects and patients with primary aldosteronism.  J Clin Invest. 1973;  52 2272-2277
    Search in Google Scholar
  • 35 Weinberger MH, Kem DC, Gomez-Sanchez CE, Kramer NJ, Martin BT, Nugent CA. The role of renin, ACTH, and potassium in the control of episodic variation of plasma aldosterone concentration in normal, recumbent humans.  Res Steroids. 1975;  6 35-48
    Search in Google Scholar
  • 36 Kem DC, Weinberger MH, Gomez-Sanchez CE, Higgins JR, Kramer NJ. The role of ACTH in the episodic release of aldosterone in patients with idiopathic adrenal hyperplasia, hypertension, and hyperaldosteronism.  J Lab Clin Med. 1976;  88 261-270
    Search in Google Scholar
  • 37 Rossi GP, Seccia TM, Palumbo G, Belfiore A, Bernini G, Caridi G, Desideri G, Fabris B, Ferri C, Giacchetti G, Letizia C, Maccario M, Mallamaci F, Mannelli M, Patalano A, Rizzoni D, Rossi E, Pessina A, Mantero F. Within-patient Reproducibility of the Aldosterone/Renin Ratio (ARR) in Primary Aldosteronism.  Hypertension. 2009 Nov 23;  [Epub ahead of print] 
    Search in Google Scholar
  • 38 Ferrari P, Shaw SG, Nicod J, Saner E, Nussberger J. Active renin versus plasma renin activity to define aldosterone-to-renin ratio for primary aldosteronism.  J Hypertens. 2004;  22 377-381
    Search in Google Scholar
  • 39 Young WF, Stanson AW, Thompson GB, Grant CS, Farley DR, van Heerden JA. Role for adrenal venous sampling in primary aldosteronism.  Surgery. 2004;  136 1227-1235
    Search in Google Scholar
  • 40 Streeten DHP, Tomycz N, Anderson GH. Reliability of screening methods for the diagnosis of primary aldosteronism.  Am J Med. 1979;  67 403-413
    Search in Google Scholar
  • 41 Gordon RD, Gomez-Sanchez CE, Hamlet SM, Tunny TJ, Klemm SA. Angiotensin-responsive aldosterone-producing adenoma masquerades as idiopathic hyperaldosteronism (IHA: adrenal hyperplasia) or low-renin essential hypertension.  J Hypertens Suppl. 1987;  5 S103-S106
    Search in Google Scholar
  • 42 Irony I, Kater CE, Biglieri EG, Shackleton CH. Correctable subsets of primary aldosteronism. Primary adrenal hyperplasia and renin responsive adenoma.  Am J Hypertens. 1990;  3 576-582
    Search in Google Scholar
  • 43 Phillips JL, Walther MM, Pezzullo JC, Rayford W, Choyke PL, Berman AA, Linehan WM, Doppman JL, Gill  Jr  JR. Predictive value of preoperative tests in discriminating bilateral adrenal hyperplasia from an aldosterone producing adrenal adenoma.  J Clin Endocrinol Metab. 2000;  85 4526-4533
    Search in Google Scholar
  • 44 Rossi GP, Belfiore A, Bernini G, Desideri G, Fabris B, Ferri C, Giacchetti G, Letizia C, Maccario M, Mallamaci F, Mannelli M, Montemurro D, Palumbo G, Rizzoni D, Rossi E, Semplicini A, Agabiti-Rosei E, Pessina AC, Mantero F. Prospective evaluation of the saline infusion test for excluding primary aldosteronism due to aldosterone-producing adenoma.  J Hypertens. 2007;  25 1433-1442
    Search in Google Scholar
  • 45 Rossi GP, Belfiore A, Bernini G, Desideri G, Fabris B, Ferri C, Giacchetti G, Letizia C, Maccario M, Mallamaci F, Mannelli M, Palumbo G, Rizzoni D, Rossi E, Agabiti-Rosei E, Pessina AC, Mantero F. Comparison of the captopril and the saline infusion test for excluding aldosterone-producing adenoma.  Hypertension. 2007;  50 424-431
    Search in Google Scholar
  • 46 Letavernier E, Peyrard S, Amar L, Zinzindohoue F, Fiquet B, Plouin PF. Blood pressure outcome of adrenalectomy in patients with primary hyperaldosteronism with or without unilateral adenoma.  J Hypertens. 2008;  26 1816-1823
    Search in Google Scholar
  • 47 Ferriss JB, Beevers DG, Brown JJ, Fraser R, Lever AF, Padfield PL, Robertson JI. Low-renin (“primary”) hyperaldosteronism. Differential diagnosis and distinction of sub-groups within the syndrome.  Am Heart J. 1978;  95 641-658
    Search in Google Scholar
  • 48 Connell JM, MacKenzie SM, Freel EM, Fraser R, Davies E. A lifetime of aldosterone excess: long-term consequences of altered regulation of aldosterone production for cardiovascular function.  Endocr Rev. 2008;  29 133-154
    Search in Google Scholar
  • 49 Padfield PL, Brown JJ, Davies D, Fraser R, Lever AF, Morton JJ, Robertson JI. The myth of idiopathic hyperaldosteronism.  Lancet. 1981;  2 83-84
    Search in Google Scholar
  • 50 Padfield PL, Brown JJ, Lever AF, Schalekamp MA, Beevers DG, Davies DL, Robertson JI, Tree M. Is low-renin hypertension a stage in the development of essential hypertension or a diagnostic entity?.  Lancet. 1975;  1 548-550
    Search in Google Scholar
  • 51 Biglieri EG, Schambelan M, Slaton PE, Stockigt JR. The intercurrent hypertension of primary aldosteronism.  Circ Res. 1970;  26/27 ((Suppl I)) I195-I202
    Search in Google Scholar
  • 52 Spark RF, Melby JC. Aldosteronism in hypertension. The spironolactone response test.  Ann Int Med. 1968;  69 685-691
    Search in Google Scholar
  • 53 Plouin PF, Jeunemaitre X. Would wider screening for primary aldosteronism give any health benefits?.  Eur J Endocrinol. 2004;  151 305-308
    Search in Google Scholar
  • 54 Vasan RS, Evans JC, Larson MG, Wilson PW, Meigs JB, Rifai N, Benjamin EJ, Levy D. Serum aldosterone and the incidence of hypertension in nonhypertensive persons.  N Engl J Med. 2004;  351 33-41
    Search in Google Scholar
  • 55 Newton-Cheh C, Guo CY, Gona P, Larson MG, Benjamin EJ, Wang TJ, Kathiresan S, O'Donnell CJ, Musone SL, Camargo AL, Drake JA, Levy D, Hirschhorn JN, Vasan RS. Clinical and genetic correlates of aldosterone-to-renin ratio and relations to blood pressure in a community sample.  Hypertension. 2007;  49 846-856
    Search in Google Scholar
  • 56 Helber A, Wambach G, Hummerich W, Bönner G, Meurer KA, Kaufmann W. Evidence for a subgroup of essential hypertensives with non-suppressible excretion of aldosterone during sodium loading.  Klin Wochenschr. 1980;  58 439-447
    Search in Google Scholar
  • 57 Collins RD, Weinberger MH, Dowdy AJ, Nokes GW, Gonzales CM, Luetscher JA. Abnormally sustained aldosterone secretion during salt loading in patients with various forms of benign hypertension; relation to plasma renin activity.  J Clin Invest. 1970;  49 1415-1426
    Search in Google Scholar
  • 58 Wambach G, Meiners U, Bonner G, Konrads A, Helber A. Cardiovascular and adrenal sensitivity to angiotensin II in essential hypertension.  Klin Wochenschr. 1984;  62 1097-1101
    Search in Google Scholar
  • 59 Wisgerhof M, Brown RD, Hogan MJ, Carpenter PC, Edis AJ. The plasma aldosterone response to angiotensin II infusion in aldosterone-producing adenoma and idiopathic hyperaldosteronism.  J Clin Endocrinol Metab. 1981;  52 195-198
    Search in Google Scholar
  • 60 Oelkers W, Brown JJ, Fraser R, Lever AF, Morton JJ, Robertson JI. Sensitization of the adrenal cortex to angiotensin II in sodium-deplete man.  Circ Res. 1974;  40 69-77
    Search in Google Scholar
  • 61 Oelkers W, Schoneshofer M, Schultze G, Brown JJ, Fraser R, Morton JJ, Lever AF, Robertson JI. Effect of prolonged low-dose angiotensin II infusion on the sensitivity of adrenal cortex in man.  Circ Res. 1975;  36 49-56
    Search in Google Scholar
  • 62 Neville AM, O'Hare MJ. Histopathology of the human adrenal cortex.  Clin Endocrinol Metab. 1985;  14 791-820
    Search in Google Scholar
  • 63 Neville AM, O’Hare MJ. The human adrenal cortex, pathology and biology. An integrated approach. Heidelberg: Springer-Verlag 1982
    Search in Google Scholar
  • 64 Lack E. AFIP Atlas of tumor pathology, fourth series, fascicle 8. Tumors of the adrenal glands and extraadrenal paraganglia. Washington, DC: ARP Press 2007
    Search in Google Scholar
  • 65 Enberg U, Volpe C, Hoog A, Wedell A, Farnebo LO, Thoren M, Hamberger B. Postoperative differentiation between unilateral adrenal adenoma and bilateral adrenal hyperplasia in primary aldosteronism by mRNA expression of the gene CY11B2.  Eur J Endocrinol. 2004;  151 73-85
    Search in Google Scholar
  • 66 Shigematsu K, Kawai K, Irie J, Sakai H, Nakashima O, Iguchi A, Shimamatsu J, Shimamatsu K, Kusaba Y, Takahara O. Analysis of unilateral adrenal hyperplasia with primary aldosteronism from the aspect of messenger ribonucleic acid expression for steroidogenic enzymes: a comparative study with adrenal cortices adhering to aldosterone-producing adenoma.  Endocrinology. 2006;  147 999-1006
    Search in Google Scholar
  • 67 Shigematsu K, Yamaguchi N, Nakagaki T, Sakai H. A case of unilateral adrenal hyperplasia being difficult to distinguish from aldosterone-producing adenoma.  Exp Clin Endocrinol Diabetes. 2009;  117 124-128
    Search in Google Scholar
  • 68 Lenzini L, Seccia TM, Aldighieri E, Belloni AS, Bernante P, Giuliani L, Nussdorfer GG, Pessina AC, Rossi GP. Heterogeneity of aldosterone-producing adenomas revealed by a whole transcriptome analysis.  Hypertension. 2007;  50 1106-1113
    Search in Google Scholar
  • 69 Kem DC, Weinberger MH, Higgins JR, Kramer NJ, Gomez-Sanchez CE, Holland OB. Plasma aldosterone response to ACTH in primary aldosteronism and in patients with low renin hypertension.  J Clin Endocrinol Metab. 1978;  46 552-560
    Search in Google Scholar
  • 70 Gordon RD, Hamlet SM, Tunny TJ, Klemm SA. Aldosterone-producing adenoma responsive to angiotensin poses problems in diagnosis.  Clin Expt Pharm Phys. 1987;  14 175-179
    Search in Google Scholar
  • 71 Hamlet SM, Gordon RD, Gomez-Sanchez CE, Tunny TJ, Klemm SA. Adrenal transitional zone steroids, 18-oxo and 18-hydroxycortisol, useful in the diagnosis of primary aldosteronism are ACTH-dependent.  Clin Expt Pharm Phys. 1988;  15 317-322
    Search in Google Scholar
  • 72 Tunny TJ, Gordon RD, Klemm SA, Cohn D. Histological and biochemical distinctiveness of atypical aldosterone-producing adenomas responsive to upright posture and angiotensin.  Clin Endocrinol. 1991;  34 363-369
    Search in Google Scholar
  • 73 Stowasser M, Tunny TJ, Klemm SA, Gordon RD. Cortisol production by aldosterone-producing adenomas in vitro.  Clin Expt Pharm Phys. 1993;  20 292-295
    Search in Google Scholar
  • 74 Tunny TJ, Klemm SA, Stowasser M, Gordon RD. Angiotensin-responsive aldosterone-producing adenomas: postoperative disappearance of aldosterone response to angiotensin.  Clin Expt Pharmacol Physiol. 1993;  20 306-309
    Search in Google Scholar
  • 75 Biglieri EG, Irony I, Kater CE. Identification and implications of new types of mineralocorticoid hypertension.  J Steroid Biochem. 1989;  32 199-204
    Search in Google Scholar
  • 76 Fallo F, Barzon L, Biasi F, Altavilla G, Boscaro M, Sonino N. Zona fasciculata-like histotype and aldosterone response to upright posture are not related in aldosterone-producing adenomas.  Expt Clin Endo Diabetes. 1998;  106 74-78
    Search in Google Scholar
  • 77 Lampron A, Bourdeau I, Oble S, Godbout A, Schurch W, Arjane P, Hamet P, Lacroix A. Regulation of aldosterone secretion by several aberrant receptors including for glucose-dependent insulinotropic peptide in a patient with an aldosteronoma.  J Clin Endocrinol Metab. 2009;  94 750-756
    Search in Google Scholar
  • 78 Lacroix A, Bourdeau I, Lampron A, Mazzuco TL, Tremblay J, Hamet P. Aberrant G-protein coupled receptor expression in relation to adrenocortical overfunction.  Clin Endocrinol (Oxf). 2009 Aug 29;  [Epub ahead of print] 
    Search in Google Scholar
  • 79 Ye P, Mariniello B, Mantero F, Shibata H, Rainey WE. G-protein-coupled receptors in aldosterone-producing adenomas: a potential cause of hyperaldosteronism.  J Endocrinol. 2007;  195 39-48
    Search in Google Scholar
  • 80 Zwermann O, Suttmann Y, Bidlingmaier M, Beuschlein F, Reincke M. Screening for membrane hormone receptor expression in primary aldosteronism.  Eur J Endocrinol. 2009;  160 443-451
    Search in Google Scholar
  • 81 Willenberg HS, Schinner S, Ansurudeen I. New mechanisms to control aldosterone synthesis.  Horm Metab Res. 2008;  40 435-441
    Search in Google Scholar
  • 82 Ansurudeen I, Kopprasch S, Ehrhart-Bornstein M, Willenberg HS, Krug AW, Funk RH, Bornstein SR. Vascular-adrenal niche-endothelial cell-mediated sensitization of human adrenocortical cells to angiotensin II.  Horm Metab Res. 2006;  38 476-480
    Search in Google Scholar
  • 83 Georgopoulos NA, Sykiotis GP, Sgourou A, Papachatzopoulou A, Markou KB, Kyriazopoulou V, Papavassiliou AG, Vagenakis AG. Autonomously functioning thyroid nodules in a former iodine-deficient area commonly harbor gain-of-function mutations in the thyrotropin signaling pathway.  Eur J Endocrinol. 2003;  149 287-292
    Search in Google Scholar
  • 84 Krohn K, Fuhrer D, Bayer Y, Eszlinger M, Brauer V, Neumann S, Paschke R. Molecular pathogenesis of euthyroid and toxic multinodular goiter.  Endocr Rev. 2005;  26 504-524
    Search in Google Scholar
  • 85 Davies E, Bonnardeaux A, Plouin PF, Corvol P, Clauser E. Somatic mutations of the angiotensin II (AT1) receptor gene are not present in aldosterone-producing adenoma.  J Clin Endocrinol Metab. 1997;  82 611-615
    Search in Google Scholar
  • 86 Sachse R, Shao XJ, Rico A, Finckh U, Rolfs A, Reincke M, Hensen J. Absence of angiotensin II type 1 receptor gene mutations in human adrenal tumors.  Eur J Endocrinol. 1997;  137 262-266
    Search in Google Scholar
  • 87 Rossi GP, Pitter G, Bernante P, Motta R, Feltrin G, Miotto D. Adrenal vein sampling for primary aldosteronism: the assessment of selectivity and lateralization of aldosterone excess baseline and after adrenocorticotropic hormone (ACTH) stimulation.  J Hypertens. 2008;  26 989-997
    Search in Google Scholar
  • 88 Kline GA, Harvey A, Jones C, Hill MH, So B, Scott-Douglas N, Pasieka JL. Adrenal vein sampling may not be a gold-standard diagnostic test in primary aldosteronism: final diagnosis depends upon which interpretation rule is used. Variable interpretation of adrenal vein sampling.  Int Urol Nephrol. 2008;  40 1035-1043
    Search in Google Scholar
  • 89 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;  54 885-889
    Search in Google Scholar
  • 90 Mengozzi G, Rossato D, Bertello C, Garrone C, Milan A, Pagni R, Veglio F, Mulatero P. Rapid cortisol assay during adrenal vein sampling in patients with primary aldosteronism.  Clin Chem. 2007;  53 1968-1971
    Search in Google Scholar
  • 91 Auchus RJ, Michaelis C, Wians  FH, Dolmatch BL, Josephs SC, Trimmer CK, Anderson ME, Nwariaku FE. Rapid cortisol assays improve the success rate of adrenal vein sampling for primary aldosteronism.  Ann Surg. 2009;  249 318-321
    Search in Google Scholar
  • 92 Carr CE, Cope C, Cohen DL, Fraker DL, Trerotola SO. Comparison of sequential versus simultaneous methods of adrenal venous sampling.  J Vasc Interv Radiol. 2004;  15 1245-1250
    Search in Google Scholar
  • 93 Shade RE, Grim CE. Suppression of renin and aldosterone by small amounts of DOCA in normal man.  J Clin Endocrinol Metab. 1975;  40 652-658
    Search in Google Scholar
  • 94 Shamma AH, Goddard JW, Sommers SC. A study of the adrenal status in hypertension.  J Chronic Dis. 1958;  8 587-595
    Search in Google Scholar
  • 95 Commons RR, Callaway CP. Adenomas of the adrenal cortex.  Arch Intern Med. 1948;  81 37-41
    Search in Google Scholar
  • 96 Russi S, Blumenthal HT, Gray SH. Small adenomas of the adrenal cortex in hypertension and diabetes.  Arch Intern Med. 1945;  76 284-291
    Search in Google Scholar
  • 97 Kokko JP, Brown TC, Berman MM. Adrenal adenoma and hypertension.  Lancet. 1967;  1 468-470
    Search in Google Scholar
  • 98 Diaz-Cano S, de Miguel M, Blanes A, Tashjiam R, Galera H, Wolfe H. Clonality as expression of distinctive cell kinetics patterns in nodular hyperplasias and adenomas of the adrenal cortex.  Am J Pathol. 2000;  156 311-319
    Search in Google Scholar
  • 99 Romero DG, Yanes LL, de Rodriguez AF, Plonczynski MW, Welsh BL, Reckelhoff JF, Gomez-Sanchez EP, Gomez-Sanchez CE. Disabled-2 is expressed in adrenal zona glomerulosa and is involved in aldosterone secretion.  Endocrinology. 2007;  148 2644-2652
    Search in Google Scholar
  • 100 Shigematsu K, Nakagaki T, Yamaguchi N, Kawai K, Sakai H, Takahara O. Analysis of mRNA expression for steroidogenic enzymes in the remaining adrenal cortices attached to adrenocortical adenomas.  Eur J Endocrinol. 2008;  158 867-878
    Search in Google Scholar
  • 101 Rossi GP, Bolognesi M, Rizzoni D, Seccia TM, Piva A, Porteri E, Tiberio GA, Giulini SM, Agabiti-Rosei E, Pessina AC. Vascular remodeling and duration of hypertension predict outcome of adrenalectomy in primary aldosteronism patients.  Hypertension. 2008;  51 1366-1371
    Search in Google Scholar
  • 102 Sawka AM, Young WF, Thompson GB, Grant CS, Farley DR, Leibson C, van Heerden JA. Primary aldosteronism: factors associated with normalization of blood pressure after surgery.  Ann Intern Med. 2001;  135 258-261
    Search in Google Scholar
  • 103 Rutherford JC, Taylor WL, Stowasser M, Gordon RD. Success of surgery for primary aldosteronism judged by residual autonomous aldosterone production.  World J Surg. 1998;  22 1243-1245
    Search in Google Scholar
  • 104 Sukor N, Gordon RD, Ku YK, Jones M, Stowasser M. Role of unilateral adrenalectomy in bilateral primary aldosteronism: a 22-year single center experience.  J Clin Endocrinol Metab. 2009;  94 2437-2445
    Search in Google Scholar

Correspondence

C. E. Gomez-SanchezMD 

Division of Endocrinology G.V. (Sonny)

Montgomery VA Medical Center

1500 E Woodrow Wilson Drive

MS 39216 Jackson

USA

Phone: +1 601 368 3844

Fax: +1 601 364 1236

Email: cgomez-sanchez@medicine.umsmed.edu