Risk Stratification on Pheochromocytoma and Paraganglioma from Laboratory and Clinical Medicine

Pheochromocytoma (PCC) and sympathetic paraganglioma (PGL) are rare neuroendocrine tumors characterized by catecholamine production in the adrenal medulla and extra-adrenal paraganglia. PCC and PGL (PPGL) with metastasis was termed malignant PPGL. However, the distinction between “benign” and “malignant” PPGLs has been debated. Currently, all PPGLs are believed to have some metastatic potential and are assigned malignant tumors (ICD-O/3) by the WHO Classification of Endocrine Organs (2017, 4th edition). Therefore, the previous categories benign and malignant PPGL have been eliminated in favor of risk stratification approach. The Grading of Adrenal Pheochromocytoma and Paraganglioma (GAPP) is a tool for risk stratification for predicting metastasis and the prognosis of patients. At least 30% of PPGLs are hereditary, with 20 genes identified and genotype-phenotype correlations clarified. Of these genes, VHL, RET and NF1 have been well investigated and are the primary cause of bilateral PCC. In addition, mutation of succinate dehydrogenase gene subunits SDHB and SDHD are strongly correlated with extra-adrenal location, younger age, multiple tumors, metastasis and poor prognosis. Disease stratification by catecholamine phenotype and molecular profiling correlates with histological grading by GAPP. PPGLs should be understood comprehensively based on clinical, biochemical, molecular and pathological data for patient care. A flow chart for pathological diagnosis is included

Heterogeneous circulating miRNA profiles of PBMAH

ObjectivePrimary bilateral macronodular adrenal hyperplasia (PBMAH), a rare cause of Cushing syndrome, is often diagnosed as a bilateral adrenal incidentaloma with subclinical cortisol production. Circulating microRNAs (miRNAs) are a characteristic of adrenocortical adenomas, but miRNA expression in PBMAH has not been investigated. We aimed to evaluate the circulating miRNA expression in patients with PBMAH and compare them with those in patients with non-functioning adrenocortical adenoma (NFA) and cortisol-producing adrenocortical adenoma (CPA).MethodsmiRNA profiling of plasma samples from four, five, and five patients with NFA, CPA, and PBMAH, respectively, was performed. Selected miRNA expressions were validated using quantitative RT-PCR.ResultsPBMAH samples showed distinct miRNA expression signatures on hierarchical clustering while NFA and CPA samples were separately clustered. PBMAH was distinguished from the adenoma group of NFA and CPA by 135 differentially expressed miRNAs. Hsa-miR-1180-3p, hsa-miR-4732-5p, and hsa-let-7b-5p were differentially expressed between PBMAH and adenoma (P = 0.019, 0.006, and 0.003, respectively). Furthermore, PBMAH could be classified into two subtypes based on miRNA profiling: subtype 1 with a similar profile to those of adenoma and subtype 2 with a distinct profile. Hsa-miR-631, hsa-miR-513b-5p, hsa-miR-6805-5p, and hsa-miR-548av-5p/548k were differentially expressed between PBMAH subtype 2 and adenoma (P = 0.027, 0.027, 0.027, and 1.53E-04, respectively), but not between PBMAH, as a whole, and adenoma.ConclusionCirculating miRNA signature was identified specific for PBMAH. The existence of subtype-based miRNA profiles may be associated with the pathophysiological heterogeneity of PBMAH

Diabetes mellitus itself increases cardio- cerebrovascular risk and renal complications in primary aldosteronism

This is a pre-copyedited, author-produced version of an article accepted for publication in The Journal of Clinical Endocrinology & Metabolism following peer review. The version of record Aya Saiki, Michio Otsuki, Daisuke Tamada, Tetsuhiro Kitamura, Iichiro Shimomura, Isao Kurihara, Takamasa Ichijo, Yoshiyu Takeda, Takuyuki Katabami, Mika Tsuiki, Norio Wada, Toshihiko Yanase, Yoshihiro Ogawa, Junji Kawashima, Masakatsu Sone, Nobuya Inagaki, Takanobu Yoshimoto, Ryuji Okamoto, Katsutoshi Takahashi, Hiroki Kobayashi, Kouichi Tamura, Kohei Kamemura, Koichi Yamamoto, Shoichiro Izawa, Miki Kakutani, Masanobu Yamada, Akiyo Tanabe, Mitsuhide Naruse, Diabetes Mellitus Itself Increases Cardio-Cerebrovascular Risk and Renal Complications in Primary Aldosteronism, The Journal of Clinical Endocrinology & Metabolism, Volume 105, Issue 7, July 2020, Pages e2531–e2537 is available online at: https://doi.org/10.1210/clinem/dgaa177

Clinical Consensus Guideline on the Management of Phaeochromocytoma and Paraganglioma in Patients Harbouring Germline SDHD Pathogenic Variants

Patients with germline SDHD pathogenic variants (encoding succinate dehydrogenase subunit D; ie, paraganglioma 1 syndrome) are predominantly affected by head and neck paragangliomas, which, in almost 20% of patients, might coexist with paragangliomas arising from other locations (eg, adrenal medulla, para-aortic, cardiac or thoracic, and pelvic). Given the higher risk of tumour multifocality and bilaterality for phaeochromocytomas and paragangliomas (PPGLs) because of SDHD pathogenic variants than for their sporadic and other genotypic counterparts, the management of patients with SDHD PPGLs is clinically complex in terms of imaging, treatment, and management options. Furthermore, locally aggressive disease can be discovered at a young age or late in the disease course, which presents challenges in balancing surgical intervention with various medical and radiotherapeutic approaches. The axiom-first, do no harm-should always be considered and an initial period of observation (ie, watchful waiting) is often appropriate to characterise tumour behaviour in patients with these pathogenic variants. These patients should be referred to specialised high-volume medical centres. This consensus guideline aims to help physicians with the clinical decision-making process when caring for patients with SDHD PPGLs

Risk Stratification on Pheochromocytoma and Paraganglioma from Laboratory and Clinical Medicine

Pheochromocytoma (PCC) and sympathetic paraganglioma (PGL) are rare neuroendocrine tumors characterized by catecholamine production in the adrenal medulla and extra-adrenal paraganglia. PCC and PGL (PPGL) with metastasis was termed malignant PPGL. However, the distinction between “benign” and “malignant” PPGLs has been debated. Currently, all PPGLs are believed to have some metastatic potential and are assigned malignant tumors (ICD-O/3) by the WHO Classification of Endocrine Organs (2017, 4th edition). Therefore, the previous categories benign and malignant PPGL have been eliminated in favor of risk stratification approach. The Grading of Adrenal Pheochromocytoma and Paraganglioma (GAPP) is a tool for risk stratification for predicting metastasis and the prognosis of patients. At least 30% of PPGLs are hereditary, with 20 genes identified and genotype-phenotype correlations clarified. Of these genes, VHL, RET and NF1 have been well investigated and are the primary cause of bilateral PCC. In addition, mutation of succinate dehydrogenase gene subunits SDHB and SDHD are strongly correlated with extra-adrenal location, younger age, multiple tumors, metastasis and poor prognosis. Disease stratification by catecholamine phenotype and molecular profiling correlates with histological grading by GAPP. PPGLs should be understood comprehensively based on clinical, biochemical, molecular and pathological data for patient care. A flow chart for pathological diagnosis is included

妊娠ラット子宮動脈結紮による慢性胎児胎盤低酸素症における胎盤のエンドセリン遺伝子発現の検討

エンドセリン-1(ET)は培養血管内皮細胞より発見された強力な血管収縮性ペプチドであり,低酸素環境下でその産生が増加することが知られている.ETはその受容体とともに胎盤で発現することから,慢性胎児低酸素症の胎盤血流調節因子としてのETの関与を明らかとするために,ラット胎盤でのET遺伝子発現を検討した.今回我々は,妊娠18日齢のSprague-Dawleyラットの片側の子宮動脈を結紮し,非結紮側を対照として結紮の6,12,24,48,72時間後に胎盤を摘出後,RNAを抽出した.RT-PCR法によるサザンプロット解析によりET遺伝子発現を検討した,また,比較として母体低栄養による胎児発育遅延を妊娠18日から21日までの72時間,水分のみを与えることによる飢餓により作製し,胎盤のET遺伝子発現を同様に検討した.その結果,子宮動脈結紮後,胎仔体重,ならびに胎盤重量は24時間以降で減少を示し,72時間ではそれぞれ対照の62%(n=31, p<0.01),75%(n=31, p<0.01)となった.一方,母体低栄養では胎仔体重,ならびに胎盤重量はそれぞれ対照の79%(n=20, p<0.01), 83%(n=20, p<0.05)と減少した.ラット胎盤のETmRNA relative abundance (preproET-1/GAPDH; mean±SEM)は慢性胎児低酸素症モデルでは対照群と結紮群でそれぞれ0.128±0.011 vs 0.237±0.022 (p<0.01)と結紮群で約2倍の有意の増加を示した.一方,母体低栄養モデルでは胎盤のET mRNA relative abundanceは対照群と低栄養群とでそれぞれ0.135±0.010, 0.145±0・006と差を認めなかった. 以上より,子宮動脈結紮によって惹起された慢性胎児低酸素症モデルにおいて,胎盤のET遺伝子発現の増加を確認した.子宮動脈結紮により母体からの胎児への栄養の物質輸送の障害が胎盤のET遺伝子発現に関与している可能性は,母体低栄養によるIUGRにおいて胎盤のET遺伝子発現に差が認められなかったことから否定的と考えられた.以上より,ETは低酸素負荷に反応して胎盤局所で産生,放出されるautocrmeあるいはparacrme因子として胎盤血管の収縮にあずかっていると考えられた.A vasoactive peptide, endothelin-1 (ET-1) has been identified in the mammalian placenta. Its increase in the fetal circulation was demonstrated not only in acute but also in chronic fetal hypoxia in human. The aim of this study was to examine the effect of chronic fetoplacental hypoxia induced by uterine artery ligation on ET-1 gene expression in the rat placenta. Unilateral uterine artery ligation was performed to the pregnant Sprague-Dawley rats on Day 18 of gestation and the pregnancy was terminated on Day 21 of gestation. The effect of maternal starvation on the placental ET-1 messenger ribonucleic acid (mRNA) levels was also examined for comparison with the same time period. Relative abundance of the placental ET-1 mRNA was determined by quantitative reversed transcriptase polymerase chain reaction coupled with Southern blotting. Both maternal starvation and uterine artery ligation significantly reduced fetal and placental weight. In contrast, the placental ET-1 mRNA levels increased 2-fold by the uterine artery ligation whereas those in the maternal starvation group did not. Thus, it is unlikely that the reduced meterno-fetal transfer of nutrients by the uterine artery ligation could enhance the placental ET-1 gene expression. These results suggest that the enhanced placental ET-1 gene expression upon chronic fetoplacental hypoxia may contribute to the pathophysiology of the placental circulation in the fetal growth retardation