Primary aldosteronism: functional histopathology and long-term follow-up after unilateral adrenalectomy
| Autor: | Jan Zedenius, Hans Wahrenberg, Cristina Volpe, Bertil Hamberger, Anders Höög, Kuniaki Mukai, Jan Calissendorff, Marja Thorén |
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| Rok vydání: | 2014 |
| Předmět: |
Aldosterone synthase
Adenoma Adult Male medicine.medical_specialty Adolescent Hydrocortisone Endocrinology Diabetes and Metabolism medicine.medical_treatment Adrenal Gland Neoplasms chemistry.chemical_compound Young Adult Endocrinology Primary aldosteronism Internal medicine Hyperaldosteronism medicine Cytochrome P-450 CYP11B2 Humans Aldosterone In Situ Hybridization Aged Retrospective Studies Hyperplasia biology business.industry Adrenalectomy Steroid 17-alpha-Hydroxylase Retrospective cohort study Middle Aged medicine.disease Immunohistochemistry Hospitals chemistry Hypertension biology.protein Steroid 11-beta-Hydroxylase Histopathology Female business Follow-Up Studies |
| Zdroj: | Clinical endocrinology. 82(5) |
| ISSN: | 1365-2265 |
| Popis: | SummaryObjectives To investigate the long-term outcome after unilateral adrenalectomy in patients with primary aldosteronism (PA) and to establish the role of functional pathology for the final diagnosis of aldosterone-producing adenoma (APA) or hyperplasia. Design A single-centre, retrospective cohort study in a hospital setting. Patients Consecutive patients with PA, n = 120, who underwent unilateral adrenalectomy between 1985 and 2010. Preoperative and postoperative data were analysed. To indicate the site of aldosterone secretion in the resected adrenal, we added functional methods to routine histopathology, using in situ hybridization and immunohistochemistry to detect the presence of enzymes needed for aldosterone (CYP11B2) and cortisol (CYP11B1, CYP17A1) synthesis. Results The median follow-up was 5 years and the cure rate of PA 91%. Hypertension was improved in 97% and normalized in 38%. Functional histopathology changed the final diagnosis from APA to hyperplasia in 6 cases (7%). Five of these had no expression of or staining for aldosterone synthase in the adenoma, but only in nodules in the adjacent cortex. All except one APA patient were cured of PA. They had lower preoperative serum potassium and higher 24-h urinary aldosterone than patients with hyperplasia. Among patients with hyperplasia 16 of 26 were cured. Conclusions Most patients were cured of PA by unilateral adrenalectomy. Almost all noncured benefitted from the operation as the blood pressure improved. Functional histopathology proved helpful in the distinction between APA and hyperplasia, and we recommend that functional histopathology should be added to routine histopathology to improve the diagnostic evaluation and aid in tailoring the follow-up. |
| Databáze: | OpenAIRE |
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