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[PMID]:29348113
[Au] Autor:Monticone S; Buffolo F; Tetti M; Veglio F; Pasini B; Mulatero P
[Ad] Endereço:Division of Internal Medicine and Hypertension UnitDepartment of Medical Sciences, University of Torino, Torino, Italy.
[Ti] Título:GENETICS IN ENDOCRINOLOGY: The expanding genetic horizon of primary aldosteronism.
[So] Source:Eur J Endocrinol;178(3):R101-R111, 2018 Mar.
[Is] ISSN:1479-683X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Aldosterone is the main mineralocorticoid hormone in humans and plays a key role in maintaining water and electrolyte homeostasis. Primary aldosteronism (PA), characterized by autonomous aldosterone overproduction by the adrenal glands, affects 6% of the general hypertensive population and can be either sporadic or familial. Aldosterone-producing adenoma (APA) and bilateral adrenal hyperplasia (BAH) are the two most frequent subtypes of sporadic PA and 4 forms of familial hyperaldosteronism (FH-I to FH-IV) have been identified. Over the last six years, the introduction of next-generation sequencing has significantly improved our understanding of the molecular mechanisms responsible for autonomous aldosterone overproduction in both sporadic and familial PA. Somatic mutations in four genes ( and ), differently implicated in intracellular ion homeostasis, have been identified in nearly 60% of the sporadic APAs. Germline mutations in and cause FH-III and FH-IV, respectively, while germline mutations in cause the rare PASNA syndrome, featuring primary aldosteronism seizures and neurological abnormalities. Further studies are warranted to identify the molecular mechanisms underlying BAH and FH-II, the most common forms of sporadic and familial PA whose molecular basis is yet to be uncovered.
[Mh] Termos MeSH primário: Canais de Cálcio Tipo L/genética
Canais de Potássio Corretores do Fluxo de Internalização Acoplados a Proteínas G/genética
Hiperaldosteronismo/genética
ATPases Transportadoras de Cálcio da Membrana Plasmática/genética
ATPase Trocadora de Sódio-Potássio/genética
[Mh] Termos MeSH secundário: Aldosterona/biossíntese
Variação Genética
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (CACNA1D protein, human); 0 (Calcium Channels, L-Type); 0 (G Protein-Coupled Inwardly-Rectifying Potassium Channels); 0 (KCNJ5 protein, human); 4964P6T9RB (Aldosterone); EC 3.6.1.- (ATP1A1 protein, human); EC 3.6.3.8 (ATP2B3 protein, human); EC 3.6.3.8 (Plasma Membrane Calcium-Transporting ATPases); EC 3.6.3.9 (Sodium-Potassium-Exchanging ATPase)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180120
[St] Status:MEDLINE
[do] DOI:10.1530/EJE-17-0946


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[PMID]:28468286
[Au] Autor:Inoue K; Omura M; Sugisawa C; Tsurutani Y; Saito J; Nishikawa T
[Ad] Endereço:Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Yokohama 222-0036, Japan. koinoue-tky@umin.ac.jp.
[Ti] Título:Clinical Utility of the Adrenocorticotropin Stimulation Test with/without Dexamethasone Suppression for Definitive and Subtype Diagnosis of Primary Aldosteronism.
[So] Source:Int J Mol Sci;18(5), 2017 Apr 30.
[Is] ISSN:1422-0067
[Cp] País de publicação:Switzerland
[La] Idioma:eng
[Ab] Resumo:The adrenocorticotropin (ACTH) stimulation test (AST) has been reported to be useful for diagnosing primary aldosteronism (PA), particularly for differentiating PA subtypes under 1-mg dexamethasone suppression (DS). The aim of our study was to clarify the effect of 1-mg DS on AST results. A retrospective cohort study was conducted using data for 48 patients (PA: 30/48). We estimated the difference in plasma aldosterone concentration (PAC) responsiveness to ACTH stimulation with single (AST alone) and combined (AST under 1-mg DS) tests within the same patient. We compared the diagnostic accuracy of these two tests for PA and the laterality of hyperaldosteronism. We found no differences in PAC responsiveness to ACTH stimulation between single and combined tests, and observed a significant positive linear relationship (30 min, ² = 0.75, -value < 0.01). Both tests showed the highest diagnostic accuracy for PA following 30 min of ACTH stimulation. The ability to detect the laterality of hyperaldosteronism was inconsistent and differed according to the two definitions: lateralization ratio and the absolute aldosterone levels in adrenal venous sampling. PAC responsiveness to ACTH stimulation was similar for AST with and without 1-mg DS. AST can be performed under both conditions with similar accuracy to detect PA.
[Mh] Termos MeSH primário: Testes de Função do Córtex Suprarrenal/métodos
Hormônio Adrenocorticotrópico/administração & dosagem
Aldosterona/sangue
Dexametasona/administração & dosagem
Hiperaldosteronismo/sangue
[Mh] Termos MeSH secundário: Testes de Função do Córtex Suprarrenal/normas
Adulto
Feminino
Seres Humanos
Masculino
Meia-Idade
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Nm] Nome de substância:
4964P6T9RB (Aldosterone); 7S5I7G3JQL (Dexamethasone); 9002-60-2 (Adrenocorticotropic Hormone)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180202
[Lr] Data última revisão:
180202
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE


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[PMID]:27777363
[Au] Autor:Zhou J; Lam B; Neogi SG; Yeo GS; Azizan EA; Brown MJ
[Ad] Endereço:From the Centre for Clinical Pharmacology, William Harvey Research Institute, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, United Kingdom (J.Z., M.J.B.); Clinical Pharmacology Unit, Department of Medicine, University of Cambridge (J.Z.), University of Cam
[Ti] Título:Transcriptome Pathway Analysis of Pathological and Physiological Aldosterone-Producing Human Tissues.
[So] Source:Hypertension;68(6):1424-1431, 2016 12.
[Is] ISSN:1524-4563
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Primary aldosteronism is present in ≈10% of hypertensives. We previously performed a microarray assay on aldosterone-producing adenomas and their paired zona glomerulosa and fasciculata. Confirmation of top genes validated the study design and functional experiments of zona glomerulosa selective genes established the role of the encoded proteins in aldosterone regulation. In this study, we further analyzed our microarray data using AmiGO 2 for gene ontology enrichment and Ingenuity Pathway Analysis to identify potential biological processes and canonical pathways involved in pathological and physiological aldosterone regulation. Genes differentially regulated in aldosterone-producing adenoma and zona glomerulosa were associated with steroid metabolic processes gene ontology terms. Terms related to the Wnt signaling pathway were enriched in zona glomerulosa only. Ingenuity Pathway Analysis showed "NRF2-mediated oxidative stress response pathway" and "LPS (lipopolysaccharide)/IL-1 (interleukin-1)-mediated inhibition of RXR (retinoid X receptor) function" were affected in both aldosterone-producing adenoma and zona glomerulosa with associated genes having up to 21- and 8-fold differences, respectively. Comparing KCNJ5-mutant aldosterone-producing adenoma, zona glomerulosa, and zona fasciculata samples with wild-type samples, 138, 56, and 59 genes were differentially expressed, respectively (fold-change >2; P<0.05). ACSS3, encoding the enzyme that synthesizes acetyl-CoA, was the top gene upregulated in KCNJ5-mutant aldosterone-producing adenoma compared with wild-type. NEFM, a gene highly upregulated in zona glomerulosa, was upregulated in KCNJ5 wild-type aldosterone-producing adenomas. NR4A2, the transcription factor for aldosterone synthase, was highly expressed in zona fasciculata adjacent to a KCNJ5-mutant aldosterone-producing adenoma. Further interrogation of these genes and pathways could potentially provide further insights into the pathology of primary aldosteronism.
[Mh] Termos MeSH primário: Adenoma/genética
Aldosterona/metabolismo
Canais de Potássio Corretores do Fluxo de Internalização Acoplados a Proteínas G/genética
Hiperaldosteronismo/genética
Fatores de Transcrição/genética
[Mh] Termos MeSH secundário: Adenoma/fisiopatologia
Córtex Suprarrenal/patologia
Córtex Suprarrenal/fisiologia
Perfilação da Expressão Gênica
Regulação da Expressão Gênica
Seres Humanos
Hiperaldosteronismo/fisiopatologia
Feocromocitoma/genética
Feocromocitoma/fisiopatologia
Amostragem
Regulação para Cima
Via de Sinalização Wnt
Zona Fasciculada/metabolismo
Zona Glomerulosa/metabolismo
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (G Protein-Coupled Inwardly-Rectifying Potassium Channels); 0 (KCNJ5 protein, human); 0 (Transcription Factors); 4964P6T9RB (Aldosterone)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:180112
[Lr] Data última revisão:
180112
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161026
[St] Status:MEDLINE


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[PMID]:29052707
[Au] Autor:Brown JM; Robinson-Cohen C; Luque-Fernandez MA; Allison MA; Baudrand R; Ix JH; Kestenbaum B; de Boer IH; Vaidya A
[Ad] Endereço:From Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Vanderbilt University, Nashville, Tennessee; University of Washington, Seattle, Washington; London School of Hygiene & Tropical Medicine, London, United Kingdom; Pontificia Universidad Católic
[Ti] Título:The Spectrum of Subclinical Primary Aldosteronism and Incident Hypertension: A Cohort Study.
[So] Source:Ann Intern Med;167(9):630-641, 2017 Nov 07.
[Is] ISSN:1539-3704
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Background: Primary aldosteronism is recognized as a severe form of renin-independent aldosteronism that results in excessive mineralocorticoid receptor (MR) activation. Objective: To investigate whether a spectrum of subclinical renin-independent aldosteronism that increases risk for hypertension exists among normotensive persons. Design: Cohort study. Setting: National community-based study. Participants: 850 untreated normotensive participants in MESA (Multi-Ethnic Study of Atherosclerosis) with measurements of serum aldosterone and plasma renin activity (PRA). Measurements: Longitudinal analyses investigated whether aldosterone concentrations, in the context of physiologic PRA phenotypes (suppressed, ≤0.50 µg/L per hour; indeterminate, 0.51 to 0.99 µg/L per hour; unsuppressed, ≥1.0 µg/L per hour), were associated with incident hypertension (defined as systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or initiation of antihypertensive medications). Cross-sectional analyses investigated associations between aldosterone and MR activity, assessed via serum potassium and urinary fractional excretion of potassium. Results: A suppressed renin phenotype was associated with a higher rate of incident hypertension than other PRA phenotypes (incidence rates per 1000 person-years of follow-up: suppressed renin phenotype, 85.4 events [95% CI, 73.4 to 99.3 events]; indeterminate renin phenotype, 53.3 events [CI, 42.8 to 66.4 events]; unsuppressed renin phenotype, 54.5 events [CI, 41.8 to 71.0 events]). With renin suppression, higher aldosterone concentrations were independently associated with an increased risk for incident hypertension, whereas no association between aldosterone and hypertension was seen when renin was not suppressed. Higher aldosterone concentrations were associated with lower serum potassium and higher urinary excretion of potassium, but only when renin was suppressed. Limitation: Sodium and potassium were measured several years before renin and aldosterone. Conclusion: Suppression of renin and higher aldosterone concentrations in the context of this renin suppression are associated with an increased risk for hypertension and possibly also with increased MR activity. These findings suggest a clinically relevant spectrum of subclinical primary aldosteronism (renin-independent aldosteronism) in normotension. Primary Funding Source: National Institutes of Health.
[Mh] Termos MeSH primário: Hiperaldosteronismo/complicações
Hipertensão/complicações
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Aldosterona/sangue
Estudos Transversais
Feminino
Seres Humanos
Hiperaldosteronismo/sangue
Hipertensão/epidemiologia
Incidência
Estudos Longitudinais
Masculino
Meia-Idade
Potássio/sangue
Potássio/urina
Receptores de Mineralocorticoides/metabolismo
Renina/sangue
Fatores de Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Nm] Nome de substância:
0 (Receptors, Mineralocorticoid); 4964P6T9RB (Aldosterone); EC 3.4.23.15 (Renin); RWP5GA015D (Potassium)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171113
[Lr] Data última revisão:
171113
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171021
[St] Status:MEDLINE
[do] DOI:10.7326/M17-0882


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[PMID]:28893861
[Au] Autor:Kline G; Holmes DT
[Ad] Endereço:Division of Endocrinology, Department of Medicine, University of Calgary, Calgary, Canada.
[Ti] Título:Adrenal venous sampling for primary aldosteronism: laboratory medicine best practice.
[So] Source:J Clin Pathol;70(11):911-916, 2017 Nov.
[Is] ISSN:1472-4146
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Primary aldosteronism (PA) is the most common form of secondary hypertension and is critical to identify because when caused by an aldosterone-producing adenoma (APA) or another unilateral form, it is potentially curable, and even when caused by bilateral disease, antihypertensives more specific to PA treatment can be employed (ie, aldosterone antagonists). Identification of unilateral forms is not generally accomplished with imaging because APAs may be small and elude detection, and coincidental identification of a non-functioning incidentaloma contralateral to an APA may lead to removal of an incorrect gland. For this reason, the method of choice for identifying unilateral forms of PA is selective adrenal venous sampling (AVS) followed by aldosterone and cortisol analysis on collected samples. This procedure is technically difficult from a radiological standpoint and, from the laboratory perspective, is fraught with opportunities for preanalytical, analytical and postanalytical error. We review the process of AVS collection, analysis and reporting. Suggestions are made for patient preparation, specimen labelling practices and nomenclature, analytical dilution protocols, which numerical results to report, and the necessary subsequent calculations. We also identify and explain frequent sources of confusion in the aldosterone and cortisol results and provide an example of tabular reporting to facilitate interpretation and communication between laboratorian, radiologist and clinician.
[Mh] Termos MeSH primário: Testes de Função do Córtex Suprarrenal/normas
Glândulas Suprarrenais/irrigação sanguínea
Aldosterona/sangue
Coleta de Amostras Sanguíneas/normas
Hidrocortisona/sangue
Hiperaldosteronismo/diagnóstico
Guias de Prática Clínica como Assunto
Veias
[Mh] Termos MeSH secundário: Biomarcadores/sangue
Seres Humanos
Hiperaldosteronismo/sangue
Hiperaldosteronismo/complicações
Hiperaldosteronismo/terapia
Hipertensão/etiologia
Valor Preditivo dos Testes
Prognóstico
Reprodutibilidade dos Testes
Fluxo de Trabalho
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Biomarkers); 4964P6T9RB (Aldosterone); WI4X0X7BPJ (Hydrocortisone)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171107
[Lr] Data última revisão:
171107
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170913
[St] Status:MEDLINE
[do] DOI:10.1136/jclinpath-2017-204423


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[PMID]:28794160
[Au] Autor:Salcuni AS; Carnevale V; Battista C; Palmieri S; Eller-Vainicher C; Guarnieri V; Pugliese F; Guglielmi G; Desina G; Minisola S; Chiodini I; Scillitani A
[Ad] Endereço:Endocrinology Unit.
[Ti] Título:Primary aldosteronism as a cause of secondary osteoporosis.
[So] Source:Eur J Endocrinol;177(5):431-437, 2017 Nov.
[Is] ISSN:1479-683X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Patients with primary aldosteronism (PA) have a high prevalence of osteoporosis (OP) and fractures (Fx). We evaluated the presence of PA in patients admitted to our metabolic bone disease outpatient clinic. DESIGN: Study conducted on an in- and outpatient basis in a referral Italian endocrinology unit. METHODS: A total of 2632 patients were evaluated. 2310 were excluded because they were taking drugs known to affect bone or mineralocorticoids metabolism or were diagnosed to have a secondary cause of osteoporosis. The remaining 322 subjects (304 females, 18 males) took part in the study. Bone mineral density (BMD) and thoracic and lumbar spine vertebral morphometry were performed by dual X-ray absorptiometry. All patients were screened for PA with aldosterone-to-renin ratio. In those who had positive results, confirmatory tests were performed. RESULTS: Among 322 subjects, 213 were osteoporotics and 109 were not. PA was diagnosed in eleven out of 213 osteoporotic patients (5.2%) and one out of 109 non-osteoporotic subjects (0.9%, = 0.066). PA was observed in the 26.1% of patients with the concomitant presence of osteoporosis, hypertension and hypercalciuria. Compared with patients without PA, patients with PA had mean values of urinary calcium excretion, 4.8 ± 2.5 mmol/day vs 7.6 ± 3.2 mmol/day, < 0.001 and serum PTH levels, 5.4 pmol/L vs 7.3 pmol/L, < 0.01, significantly higher. CONCLUSIONS: PA should be considered among the causes of secondary OP.
[Mh] Termos MeSH primário: Hiperaldosteronismo/complicações
Hiperaldosteronismo/diagnóstico por imagem
Osteoporose/diagnóstico por imagem
Osteoporose/etiologia
[Mh] Termos MeSH secundário: Absorciometria de Fóton/métodos
Idoso
Estudos Transversais
Feminino
Fraturas Ósseas/diagnóstico por imagem
Fraturas Ósseas/etiologia
Seres Humanos
Masculino
Meia-Idade
Admissão do Paciente/tendências
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171012
[Lr] Data última revisão:
171012
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170811
[St] Status:MEDLINE
[do] DOI:10.1530/EJE-17-0417


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[PMID]:28699986
[Au] Autor:Vilela LAP; Almeida MQ
[Ad] Endereço:Unidade de Suprarrenal, Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular - LIM42, Divisão de Endocrinologia e Metabologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brasil.
[Ti] Título:Diagnosis and management of primary aldosteronism.
[So] Source:Arch Endocrinol Metab;61(3):305-312, 2017 May-Jun.
[Is] ISSN:2359-4292
[Cp] País de publicação:Brazil
[La] Idioma:eng
[Ab] Resumo:Primary aldosteronism (PA) is the most common form of secondary hypertension (HTN), with an estimated prevalence of 4% of hypertensive patients in primary care and around 10% of referred patients. Patients with PA have higher cardiovascular morbidity and mortality than age- and sex-matched patients with essential HTN and the same degree of blood pressure elevation. PA is characterized by an autonomous aldosterone production causing sodium retention, plasma renin supression, HTN, cardiovascular damage, and increased potassium excretion, leading to variable degrees of hypokalemia. Aldosterone-producing adenomas (APAs) account for around 40% and idiopathic hyperaldosteronism for around 60% of PA cases. The aldosterone-to-renin ratio is the most sensitive screening test for PA. There are several confirmatory tests and the current literature does not identify a "gold standard" confirmatory test for PA. In our institution, we recommend starting case confirmation with the furosemide test. After case confirmation, all patients with PA should undergo adrenal CT as the initial study in subtype testing to exclude adrenocortical carcinoma. Bilateral adrenal vein sampling (AVS) is the gold standard method to define the PA subtype, but it is not indicated in all cases. An experienced radiologist must perform AVS. Unilateral laparoscopic adrenalectomy is the preferential treatment for patients with APAs, and bilateral hyperplasia should be treated with mineralocorticoid antagonist (spironolactone or eplerenone). Cardiovascular morbidity caused by aldosterone excess can be decreased by either unilateral adrenalectomy or mineralocorticoid antagonist. In this review, we address the most relevant issues regarding PA screening, case confirmation, subtype classification, and treatment.
[Mh] Termos MeSH primário: Hiperaldosteronismo/complicações
Hiperaldosteronismo/diagnóstico
Hiperaldosteronismo/terapia
Hipertensão/etiologia
[Mh] Termos MeSH secundário: Glândulas Suprarrenais/diagnóstico por imagem
Adrenalectomia
Aldosterona/sangue
Seres Humanos
Hiperaldosteronismo/sangue
Antagonistas de Receptores de Mineralocorticoides/uso terapêutico
Renina/sangue
Tomografia Computadorizada por Raios X
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Mineralocorticoid Receptor Antagonists); 4964P6T9RB (Aldosterone); EC 3.4.23.15 (Renin)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170925
[Lr] Data última revisão:
170925
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170713
[St] Status:MEDLINE


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[PMID]:28662194
[Au] Autor:Jedrusik P; Symonides B; Wojciechowska E; Gryglas A; Gaciong Z
[Ad] Endereço:Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland.
[Ti] Título:Diagnostic value of potassium level in a spot urine sample as an index of 24-hour urinary potassium excretion in unselected patients hospitalized in a hypertension unit.
[So] Source:PLoS One;12(6):e0180117, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Primary hyperaldosteronism may be associated with elevated 24-hour urinary potassium excretion. We evaluated the diagnostic value of spot urine (SU) potassium as an index of 24-hour urinary potassium excretion. METHODS: We measured SU and 24-hour urinary collection potassium and creatinine in 382 patients. Correlations between SU and 24-hour collections were assessed for potassium levels and potassium/creatinine ratios. We used the PAHO formula to estimate 24-hour urinary potassium excretion based on SU potassium level. The agreement between estimated and measured 24-hour urinary potassium excretion was evaluated using the Bland-Altman method. To evaluate diagnostic performance of SU potassium, we calculated areas under the curve (AUC) for SU potassium/creatinine ratio and 24-hour urinary potassium excretion estimated using the PAHO formula. RESULTS: Strongest correlation between SU and 24-hour collection was found for potassium/creatinine ratio (r = 0.69, P<0.001). The PAHO formula underestimated 24-hour urinary potassium excretion by mean 8.3±18 mmol/d (95% limits of agreement -28 to +44 mmol/d). Diagnostic performance of SU potassium/creatinine ratio was borderline good only if 24-hour urinary potassium excretion was largely elevated (AUC 0.802 for 120 mmol K+/24 h) but poor with lower values (AUC 0.696 for 100 mmol K+/24 h, 0.636 for 80 mmol K+/24 h, 0.675 for 40 mmol K+/24 h). Diagnostic performance of 24-hour urinary potassium excretion estimated by the PAHO formula was excellent with values above 120 mmol/d and good with lower values (AUC 0.941 for 120 mmol K+/24 h, 0.819 for 100 mmol K+/24 h, 0.823 for 80 mmol K+/24 h, 0.836 for 40 mmol K+/24 h). CONCLUSIONS: Spot urine potassium/creatinine ratio might be a marker of increased 24-hour urinary potassium excretion and a potentially useful screening test when reliable 24-hour urine collection is not available. The PAHO formula allowed estimation of the 24-hour urinary potassium excretion based on SU measurements with reasonable clinical accuracy.
[Mh] Termos MeSH primário: Unidades Hospitalares
Hospitalização
Hiperaldosteronismo/urina
Hipertensão/urina
Pacientes Internados
Potássio/urina
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Feminino
Seres Humanos
Masculino
Meia-Idade
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
RWP5GA015D (Potassium)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171002
[Lr] Data última revisão:
171002
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170630
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0180117


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[PMID]:28652474
[Au] Autor:Morimoto R; Ono Y; Tezuka Y; Kudo M; Yamamoto S; Arai T; Gomez-Sanchez CE; Sasano H; Ito S; Satoh F
[Ad] Endereço:From the Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine (R.M., Y.O., Y.T., M.K., S.I., F.S.) and Department of Pathology (H.S.), Tohoku University Hospital, Sendai, Miyagi, Japan; Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University
[Ti] Título:Rapid Screening of Primary Aldosteronism by a Novel Chemiluminescent Immunoassay.
[So] Source:Hypertension;70(2):334-341, 2017 Aug.
[Is] ISSN:1524-4563
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Measurement of plasma aldosterone and renin concentration, or activity, is useful for selecting antihypertensive agents and detecting hyperaldosteronism in hypertensive patients. However, it takes several days to get results when measured by radioimmunoassay and development of more rapid assays has been long expected. We have developed chemiluminescent enzyme immunoassays enabling the simultaneous measurement of both aldosterone and renin concentrations in 10 minutes by a fully automated assay using antibody-immobilized magnetic particles with quick aggregation and dispersion. We performed clinical validation of diagnostic ability of this newly developed assay-based screening of 125 patients with primary aldosteronism from 97 patients with essential hypertension. Results of this novel assay significantly correlated with the results of radioimmunoassay (aldosterone, active renin concentration, and renin activity) and liquid chromatography-tandem mass spectrometry (aldosterone). The analytic sensitivity of this particularly novel active renin assay was 0.1 pg/mL, which was better than that of radioimmunoassay (2.0 pg/mL). The ratio of aldosterone-to-renin concentrations of 6.0 (ng/dL per pg/mL) provided 92.0% sensitivity and 76.3% specificity as a cutoff for differentiating primary aldosteronism from essential hypertension. This novel measurement is expected to be a clinically reliable alternative for conventional radioimmunoassay and to provide better throughput and cost effectiveness in diagnosis of hyperaldosteronism from larger numbers of hypertensive patients in clinical settings.
[Mh] Termos MeSH primário: Aldosterona
Anti-Hipertensivos/uso terapêutico
Hiperaldosteronismo
Hipertensão
Medições Luminescentes/métodos
Renina
[Mh] Termos MeSH secundário: Adulto
Aldosterona/análise
Aldosterona/sangue
Cromatografia Líquida/métodos
Pesquisa Comparativa da Efetividade
Feminino
Seres Humanos
Hiperaldosteronismo/sangue
Hiperaldosteronismo/diagnóstico
Hipertensão/tratamento farmacológico
Hipertensão/etiologia
Imunoensaio/métodos
Japão
Masculino
Programas de Rastreamento/métodos
Meia-Idade
Seleção de Pacientes
Testes Imediatos
Radioimunoensaio/métodos
Renina/análise
Renina/sangue
Reprodutibilidade dos Testes
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antihypertensive Agents); 4964P6T9RB (Aldosterone); EC 3.4.23.15 (Renin)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170927
[Lr] Data última revisão:
170927
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170628
[St] Status:MEDLINE
[do] DOI:10.1161/HYPERTENSIONAHA.117.09078


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[PMID]:28637561
[Au] Autor:Starker LF; Christakis I; Julien JS; Schwarz K; Graham P; Grubbs EG; Lee JE; Perrier ND
[Ti] Título:Considering Postoperative Functional Hypoaldosteronism after Unilateral Adrenalectomy.
[So] Source:Am Surg;83(6):598-604, 2017 Jun 01.
[Is] ISSN:1555-9823
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Conn's Syndrome is an uncommon condition. Patients who have undergone adrenalectomy in the early postoperative period can demonstrate biochemical hypoaldosteronism. Given the rare nature of this phenomenon we investigated its incidence and whether it translated to clinical findings. A single-institution retrospective review of all patients with biochemically proven hyperaldosteronism from 2005 to 2014 that underwent unilateral adrenalectomy. A total of 29 patients fit the inclusion criteria. Functional hypoaldosteronism had appreciated in 18/29 (62%) patients, whereas 11 patients (38%) had normal postoperative aldosterone. No significant differences between diagnostic groups were found in terms of clinical outcomes (length of stay, postoperative symptomatology, and readmissions P = 0.669, 0.154, and 0.268, respectively). Two (7%) patients required medical therapy. Biochemical evidence of functional hypoaldosteronism was identified in two-thirds of patients undergoing unilateral adrenalectomy. Although contralateral aldosterone suppression can be anticipated, the phenotypic response varied and the outcomes were similar to patients with normal aldosterone levels. Current guidelines make no formal recommendations for assessment of hypoaldosteronism after adrenalectomy, resulting in varying practice paradigms. Surgeons should consider the risk of postoperative hypoaldosteronism in these patients and counsel patients accordingly. Prospective investigations should be performed to assist in development of an outcomes-based care delivery model for these patients.
[Mh] Termos MeSH primário: Adrenalectomia/efeitos adversos
Aldosterona/sangue
Hiperaldosteronismo/cirurgia
Hipoaldosteronismo/diagnóstico
Hipoaldosteronismo/etiologia
[Mh] Termos MeSH secundário: Adrenalectomia/métodos
Adulto
Biomarcadores/sangue
Feminino
Seguimentos
Seres Humanos
Hipoaldosteronismo/sangue
Incidência
Masculino
Meia-Idade
Período Pós-Operatório
Valor Preditivo dos Testes
Estudos Retrospectivos
Sensibilidade e Especificidade
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Biomarkers); 4964P6T9RB (Aldosterone)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171106
[Lr] Data última revisão:
171106
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170623
[St] Status:MEDLINE



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