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The Genotype-Based Morphology of Aldosterone-Producing Adrenocortical Disorders and Their Association with Aging

Endocrinology and Metabolism 2021년 36권 1호 p.12 ~ 21
Gao Xin, Yamazaki Yuto, Tezuka Yuta, Omata Kei, Ono Yoshikiyo, Morimoto Ryo, Nakamura Yasuhiro, Satoh Fumitoshi, Sasano Hironobu,
소속 상세정보
 ( Gao Xin ) - Tohoku University Graduate School of Medicine Department of Pathology
 ( Yamazaki Yuto ) - Tohoku University Graduate School of Medicine Department of Pathology
 ( Tezuka Yuta ) - Tohoku University Graduate School of Medicine Division of Clinical Hypertension, Endocrinology and Metabolism
 ( Omata Kei ) - Tohoku University Graduate School of Medicine Division of Clinical Hypertension, Endocrinology and Metabolism
 ( Ono Yoshikiyo ) - Tohoku University Hospital Division of Nephrology, Endocrinology and Vascular Medicine
 ( Morimoto Ryo ) - Tohoku University Hospital Division of Nephrology, Endocrinology and Vascular Medicine
 ( Nakamura Yasuhiro ) - Tohoku Medical and Pharmaceutical University Faculty of Medicine Division of Pathology
 ( Satoh Fumitoshi ) - Tohoku University Graduate School of Medicine Division of Clinical Hypertension, Endocrinology and Metabolism
 ( Sasano Hironobu ) - Tohoku University Graduate School of Medicine Department of Pathology

Abstract


Primary aldosteronism (PA) is the most common cause of secondary hypertension, and is associated with an increased incidence of cardiovascular events. PA itself is clinically classified into the following two types: unilateral PA, mostly composed of aldosterone-producing adenoma (APA); and bilateral hyperaldosteronism, consisting of multiple aldosterone-producing micronodules (APMs) and aldosterone-producing diffuse hyperplasia. Histopathologically, those disorders above are all composed of compact and clear cells. The cellular morphology in the above-mentioned aldosterone-producing disorders has been recently reported to be closely correlated with patterns of somatic mutations of ion channels including KCNJ5, CACNA1D, ATP1A1, ATP2B3, and others. In addition, in non-pathological adrenal glands, APMs are frequently detected regardless of the status of the renin-angiotensin-aldosterone system (RAAS). Aldosterone-producing nodules have been also proposed as non-neoplastic nodules that can be identified by hematoxylin and eosin staining. These non-neoplastic CYP11B2-positive nodules could represent possible precursors of APAs possibly due to the presence of somatic mutations. On the other hand, aging itself also plays a pivotal role in the development of aldosterone-producing lesions. For instance, the number of APMs was also reported to increase with aging. Therefore, recent studies indicated the novel classification of PA into normotensive PA (RAAS-independent APM) and clinically overt PA.

키워드

Adrenal glands; Aldosterone; Adenoma; Pathology

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