Primary Aldosteronism: A Glimpse into the Most Common Endocrine Cause of Arterial Hypertension

Compelling evidences showed that primary aldosteronism (PA) is a quite common disease. In spite of this, hypertensive patients are seldom screened for PA and, therefore, many patients are mislabelled as (low-renin) essential hypertension thereby remaining exposed to the nefarious consequences of long-term hyperaldosteronism. In this chapter we reviewed the clinical aspects of PA and the evidences supporting the need of implementing strategies aimed at diagnosing early PA patients. After reporting the prevalence rates of PA in different cohorts of hypertensive patients, we examined the reasons why PA is rarely searched for. The cardiovascular and renal damage associated with PA were also discussed, with particular emphasis to endothelial dysfunction, vascular remodeling, left ventricular changes, fibrosis, diastolic dysfunction, atrial fibrillation and chronic kidney disease. Studies supporting the concept that PA-associated organ damage can be prevented and even regressed with a timely diagnosis were also reviewed. A flowchart illustrating the proposal of a simplified diagnostic algorithm for screening and subtyping of PA, which allows circumventing the complexity of a diagnostic workup centred on confirmatory tests, is also proposed. Finally, the principles of treatment for PA are discussed

Acrocyanosis, digital ischemia and acronecrosis as first manifestations of endometrial adenocarcinoma: case presentation and literature review

The association between digital ischemia and cancer is rarely reported in literature and the exact mechanism of this occurrence has not been completely understood. We report here a case of a 73 yearold woman who presented digital ischemia as first manifestation of endometrial adenocarcinoma. Reporting this rare clinical case and with a brief literature review, we recommend to consider an intensive search for primary and metastatic cancer in all patients who experience a digital ischemia, with the aim to early detect and treat the disease

Editorial Disease of Adrenal Glands

International audienceThe adrenal gland has been historically an object of interest and scientific curiosity. This is also due to its very heterogeneous structure, number of hormones, complex neural innervation, and multiple and different physiological functions. The adrenal gland also entails an outstanding example of paracrine interactions occurring between histogenetically different tissues as the cortex and the medulla. This special issue is a great opportunity for the reader to learn the latest and emerging findings on the pathophysiol-ogy, diagnosis, and treatment of the adrenal glands disorders. The issue provides a variety of excellent articles covering a broad and contemporary spectrum of aspects of the diseases of the adrenal gland. Of particular interest and novelty is the interplay between hormones of the adrenal glands and other organs, such as the adipose tissue, the endothelium, the bone, and even the brain. In addition to the well-established effects on lipid and glucose metabolism, the hormones of the adrenal glands display a fascinating cross talk with the adipose tissue [1– 3]. The interaction between the adrenals and adipokines is extensively discussed by A. Y. Kargi and G. Iacobellis in a comprehensive and updated review paper. The potential of the fat depot surrounding the adrenal tumors to act like a brown adipose tissue (BAT) is a rapidly emerging topic that will certainly deserve further attention and investigation [4]. Interestingly the authors provided a theoretical basis for potential future pharmacological interventions aimed at adrenal hormone targets in the adipose tissue. Primary aldosteronism is the most common endocrine cause of arterial hypertension. It can cause excess damage to the organs that are target of hypertension and higher cardiometabolic risk [5]. This contention was supported by previous experimental data obtained by Karl Weber's group in rats infused with aldosterone, which exhibited hypercalciuria and raised parathyroid hormone (PTH) levels [6], and, more importantly, by findings in patients with aldosterone-producing adenoma who also showed elevated serum PTH levels that were then normalized by adrenalectomy [7]. The effect of the adrenal hormones on bone metabolism in patients with primary aldosteronism is nicely addressed by L. Petramala et al. The authors sought to test the hypothesis that hyperaldosteronism may influence mineral homeostasis through higher urinary calcium excretion leading eventually to secondary hyperparathyroidism. Of further interest, G. Mazzocchi et al. showed that PTH stimulates aldosterone secretion in a concentration-dependent manner [8], a finding that was complemented by the demonstration of the miner-alocorticoid receptor in the human parathyroid cells [9]. It is well established that a substantial amount of sodium is bound to proteoglycans of bone, connective tissue, and cartilage and that the osmotic force created by the high sodium concentration maintains the high water content in the latter tissue, allowing it to withstand high pressures during exercise [10]. In this special issue P. Alonso et al. further expand on the relationships between the adrenal gland and the skeleton by showing a reduction in the bone mineral densit

Perfluoroalkyl Acids are Common Environmental Pollutants That Potently Stimulate Aldosterone Biosynthesis

Supplemental dat

Coronary Sinus Diameter to Predict Residual Congestion and Survival in Hemodialysis Patients (CORSICO Study): A Pilot Study

Database reporting clinical data collected from patient

A Novel GPER Mediated Feed-forward Loop Enhancing Aldosterone Biosynthesis

Supplemental data The Journal of Clinical Endocrinology & Metabolism - JCEM submissio

Double CYP11B1/CYP11B2 Immunohistochemistry and Detection of KCNJ5 Mutations in Primary Aldosteronism

Supplemental Material - Double CYP11B1/CYP11B2 Immunohistochemistry and Detection of KCNJ5 Mutations in Primary Aldosteronis

Occupational and environmental exposure to extremely low frequency-magnetic fields in a large group of workers

The aim of this study was to provide: (a) an evaluation of current ELF-MF exposure in workers, (b) the specific contribution of occupational exposure to overall 24-hour exposure, and (c) the representativeness of a Job Exposure Matrix. 543 workers were monitored for 2 whole days using personal meters. Time-Weighted Average (TWA) levels at work, at home, and outside the home (respectively work TWA, home TWA and environmental TWA) were calculated. Tasks were classified according to the ISCO 88 International Standard Classification of Occupations. In about 10% of the entire sample, the monitoring was repeated after 6-9 months. In the whole sample, the median of TWA am during work was 0.14 µT (5°-95° percentiles: 0.04-2.50 µT). Median Home TWA and Environmental TWA were respectively 0.03 (5°-95° percentiles 0.01-0.24 µT) and 0.05 µT (5th-95th percentiles 0.02-0.28 µT). The correlation between TWA values during the first monitoring and the replication was r=0.80. The contribution of occupational exposure to the overall 24-hour exposure was estimated showing that, during working days, about the 60% of exposure is related to work. The variability of individual work TWA among subjects included in the same ISCO 88 task, evaluated using ANOVA, proved significant in 56% of the tasks