Response to Renal Function in Primary Aldosteronism: Is Glomerular Hyperfiltration a Hallmark of Primary Aldosteronism? Further Results from the Primary Aldosteronism Prevalence in Hypertension (PAPY) Study

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a comprehensive approach to adrenal incidentalomas

Improvements in abdominal imaging techniques have increased the detection of clinically inapparent adrenal masses, or incidentalomas (AI), the appropriate diagnosis and management of which have become a common clinical problem for health care professionals. Once an adrenal mass has been detected, the clinician needs to address two questions: 1) is the tumor hormonally active? and 2) is there any chance of the mass being malignant? The majority of AI is non-hypersecretory cortical adenomas, but an endocrine evaluation can lead to the identification of subtle hormone excess. An overnight low-dose dexamethasone suppression test, fractionated urinary or plasma metanephrine assay and, in hypertensive patients, establishing the upright plasma aldosterone/plasma renin activity ratio are recommended as preliminary screening steps. Masses greater than 4cm are at greater risk of malignancy. Morphological imaging features may be helpful in the distinction between benign and malignant forms. Fine-needle aspiration biopsy is an important tool in the evaluation of oncological patients to establish any metastatic disease. Adrenalectomy is indicated by evidence of a functional adrenal mass, or a suspected malignant form. We advocate adrenalectomy of subtle hypercortisolism, especially in the presence of hypertension, obesity, diabetes or osteoporosis potentially aggravated by glucocorticoid excess. A close follow-up is needed, particularly in the first year after diagnosis

Ensayo de preservación de madera tratada con Zn y Mn efectividad de tratamiento antilixiviante con bórax luego de cinco años de contacto con el suelo

A través de un ensayo de campo implementado de acuerdo a la norma EN 252, se evaluó la efectividad de tratamientos en etapas, tendientes a disminuir la lixiviación de una solución rica en Zn y Mn obtenida a partir de un proceso de reciclado aplicada en la madera por el método Bethell. La segunda etapa antilixiviante agregó bórax por pincelado o por el método Bethell. Se utilizó madera de Pinus taeda. Este trabajo presenta el análisis de la evolución del proceso de deterioro a lo largo de 5 años de ensayo de campo y su evaluación. Se utilizó el índice climático de Scheffer como método de evaluación del riesgo microbiológico en el sitio del ensayo y se realizó un análisis microscópico de la madera, para verificar el tipo de deterioro presente. Los tratamientos al 3% y al 6% en Zn con agregado de bórax por el método Bethell fueron los de mejor desempeño entre los evaluados a pesar de no haber superado el desempeño del preservante de referencia. Se observó la presencia de los tres tipos de pudrición, blanca, marrón y blanda tanto en controles sin tratamiento como en maderas tratadas, en un sitio con condiciones intermedias para el deterioro

The role of inferior petrosal sinus sampling in ACTH-dependent Cushing's syndrome: review and joint opinion statement by members of the Italian Society for Endocrinology, Italian Society for Neurosurgery, and Italian Society for Neuroradiology

In the management of adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome, inferior petrosal sinus sampling (IPSS) provides information for the endocrinologist, the neurosurgeon, and the neuroradiologist. To the endocrinologist who performs the etiological diagnosis, results of IPSS confirm or exclude the diagnosis of Cushing's disease with 80%-100% sensitivity and over 95% specificity. Baseline central-peripheral gradients have suboptimal accuracy, and stimulation with corticotropin-releasing hormone (CRH), possibly desmopressin, has to be performed. The rationale for the use of IPSS in this context depends on other diagnostic means, taking availability of CRH and reliability of dynamic testing and pituitary imaging into account. As regards the other specialists, the neuroradiologist may collate results of IPSS with findings at imaging, while IPSS may prove useful to the neurosurgeon to chart a surgical course. The present review illustrates the current standpoint of these 3 specialists on the role of IPSS

The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline.

Abstract Objective: To develop clinical practice guidelines for the management of patients with primary aldosteronism. Participants: The Task Force included a chair, selected by the Clinical Guidelines Subcommittee of the Endocrine Society, six additional experts, a methodologist, and a medical writer. The guideline was cosponsored by American Heart Association, American Association of Endocrine Surgeons, European Society of Endocrinology, European Society of Hypertension, International Association of Endocrine Surgeons, International Society of Endocrinology, International Society of Hypertension, Japan Endocrine Society, and The Japanese Society of Hypertension. The Task Force received no corporate funding or remuneration. Evidence: We searched for systematic reviews and primary studies to formulate the key treatment and prevention recommendations. We used the Grading of Recommendations, Assessment, Development, and Evaluation group criteria to describe both the quality of evidence and the strength of recommendations. We used "recommend" for strong recommendations and "suggest" for weak recommendations. Consensus Process: We achieved consensus by collecting the best available evidence and conducting one group meeting, several conference calls, and multiple e-mail communications. With the help of a medical writer, the Endocrine Society's Clinical Guidelines Subcommittee, Clinical Affairs Core Committee, and Council successfully reviewed the drafts prepared by the Task Force. We placed the version approved by the Clinical Guidelines Subcommittee and Clinical Affairs Core Committee on the Endocrine Society's website for comments by members. At each stage of review, the Task Force received written comments and incorporated necessary changes. Conclusions: For high-risk groups of hypertensive patients and those with hypokalemia, we recommend case detection of primary aldosteronism by determining the aldosterone-renin ratio under standard conditions and recommend that a commonly used confirmatory test should confirm/exclude the condition. We recommend that all patients with primary aldosteronism undergo adrenal computed tomography as the initial study in subtype testing and to exclude adrenocortical carcinoma. We recommend that an experienced radiologist should establish/exclude unilateral primary aldosteronism using bilateral adrenal venous sampling, and if confirmed, this should optimally be treated by laparoscopic adrenalectomy. We recommend that patients with bilateral adrenal hyperplasia or those unsuitable for surgery should be treated primarily with a mineralocorticoid receptor antagonist

G-protein-coupled receptors in aldosterone-producing adenomas: a potential cause of hyperaldosteronism

The source of aldosterone in 30–40% of patients with primary hyperaldosteronism (PA) is unilateral aldosterone-producing adenoma (APA). The mechanisms causing elevated aldosterone production in APA are unknown. Herein, we examined the expression of G-protein-coupled receptors (GPCRs) in APA and demonstrated that when compared with normal adrenals, there is a general elevation of certain GPCR in many APA and/or ectopic expression of GPCR in others. RNA samples from normal adrenals (n = 5), APAs (n = 10), and cortisol-producing adenomas (CPAs; n = 13) were used on 15 genomic expression arrays, each of which included 223 GPCR transcripts presented in at least 1 out of 15 of the independent microarrays. The array results were confirmed using real-time RT-PCR (qPCR). Four GPCR transcripts exhibited a statistically significant increase that was greater than threefold when compared with normal adrenals, suggesting a general increase in expression when compared with normal adrenal glands. Four GPCR transcripts exhibited a > 15-fold increase of expression in one or more of the APA samples when compared with normal adrenals. qPCR analysis confirmed array data and found the receptors with the highest fold increase in APA expression to be LH receptor, serotonin receptor 4, GnRH receptor, glutamate receptor metabotropic 3, endothelin receptor type B-like protein, and ACTH receptor. There are also sporadic increased expressions of these genes in the CPAs. Together, these findings suggest a potential role of altered GPCR expression in many cases of PA and provide candidate GPCR for further study

Preservación de madera tratada con Zn y Mn y efectividad de tratamiento antilixiviante con bórax

Continuando con el estudio del uso de una solución obtenida en un proceso de reciclado de baterías domésticas como preservante para madera, se estableció un primer cementerio de estacas basado en la norma EN 252, que evalúa la durabilidad adquirida por probetas de Pinus taeda L. Dicha solución es ácida, contiene 32 g l-1 de Zn y 15 g l-1 de Mn como sulfatos, libre de metales pesados; en ensayos de laboratorio ha demostrado propiedades funguicidas e insecticidas específi cos, a concentraciones menores a 3% en Zn (máxima concentración obtenida del reciclado). A las probetas tratadas con la mencionada solución por el método de célula llena, se les realizó un tratamiento posterior antilixiviante con bórax al 2%, por pincelado y por célula. Se comparó la durabilidad natural y la adquirida, con dicha solución (con o sin bórax), con arseniato de cobre cromatado (CCA) a dos retenciones. A 32 meses del inicio del ensayo, las concentraciones de Zn de 3% y mayores con el bórax aplicado por el método de célula llena son las más efectivas. Se analizaron además los agentes de deterioro de madera (insectos, hongos y bacterias) presentes en las probetas. AbstractAs part of the study of the application of a solution obtained from a domestic batteries recycling process as a wood preservative, a field stakes test was established to assess the acquired durability in loblolly pine (Pinus taeda L.) specimens following the internationally accepted standard EN 252. This solution is acidic, containing 32 g l-1 Zn and 15 g l-1 of Mn as sulfates and free of heavy metals; in laboratory tests the solution proved to have specific fungicidal and insecticidal properties against organisms that degrade wood, at concentrations lower than 3% Zn (the highest concentration obtained from the recycling process). The specimens treated by the full cell method with the mentioned solution were afterwards treated with 2% in borax by the full cell method and by brushing in order to prevent leaching. Natural and acquired durability are compared using different concentrations of the studied solution as well as chromated copper arsenate (CCA) at two different retention levels. At 32 months, 3 % and higher concentrations of Zn and borax applied by full cell method showed to be the most effective. Main degrading agents (insects, fungi and bacteria) found in the specimens are also described

A Novel Mutation in the Upstream Open Reading Frame of the CDKN1B Gene Causes a MEN4 Phenotype

PubMed ID: 23555276This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited