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Steroid Profiling and Immunohistochemistry for Subtyping and Outcome Prediction in Primary Aldosteronism—a Review

  • Hypertension and the Kidney (RM Carey, Section Editor)
  • Published:
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Abstract

Purpose of Review

Steroid profiling and immunohistochemistry are both promising new tools used to improve diagnostic accuracy in the work-up of primary aldosteronism (PA) and to predict treatment outcomes. Herein, we review the recent literature and present an outlook to the future of diagnostics and therapeutic decision-making in patients with PA.

Recent Finding

PA is the most common endocrine cause of arterial hypertension and unilateral forms of the disease are potentially curable by surgical resection of the overactive adrenal. Recent studies have shown that adrenal steroid profiling by liquid chromatography-tandem mass spectrometry (LC-MS/MS) can be helpful for subtyping unilateral and bilateral forms of PA, classifying patients with a unilateral aldosterone-producing adenoma (APA) according to the presence of driver mutations of aldosterone production in APAs, and potentially predicting the outcomes of surgical treatment for unilateral PA. Following adrenalectomy, immunohistochemistry of aldosterone synthase (CYP11B2) in resected adrenals is a new tool to analyze “functional” histopathology and may be an indicator of biochemical outcomes after surgery.

Summary

Biochemical and clinical outcomes of therapy in PA vary widely among patients. Peripheral venous steroid profiling at baseline could improve diagnostic accuracy and help in surgical decision-making in cases of a suspected APA; results of “functional” histopathology could help determine which patients are likely to need close post-surgical follow-up for persistent aldosteronism.

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Funding

This work was supported by the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation program (grant agreement no. 694913 to MR) and by the Deutsche Forschungsgemeinschaft (DFG) (within the CRC/Transregio 205/1 “The Adrenal: Central Relay in Health and Disease” to GE, MR, and TAW and grant RE 752/20-1 to MR) and the Else Kröner-Fresenius Stiftung in support of the German Conns Registry-Else-Kröner Hyperaldosteronism Registry (2013_A182 and 2015_A171 to MR).

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Authors and Affiliations

  1. Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ziemssenstraße 1, 80336, Munich, Germany

    Finn Holler, Daniel A. Heinrich, Christian Adolf, Benjamin Lechner, Martin Bidlingmaier, Tracy Ann Williams & Martin Reincke

  2. Department of Medicine III and Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany

    Graeme Eisenhofer

  3. Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Turin, Italy

    Tracy Ann Williams

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  1. Finn Holler
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  4. Benjamin Lechner
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Holler, F., Heinrich, D.A., Adolf, C. et al. Steroid Profiling and Immunohistochemistry for Subtyping and Outcome Prediction in Primary Aldosteronism—a Review. Curr Hypertens Rep 21, 77 (2019). https://doi.org/10.1007/s11906-019-0985-0

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