S38 How Do We Think About Aldosterone in 2015?

Program: Symposia
Clinical/Translational Session
Friday, March 6, 2015: 4:30 PM-6:00 PM
Room 20C (San Diego Convention Center)
**This session is eligible for CME credit**

Robert M Carey, MD, University of Virginia, Charlottesville, VA

Nothing to Disclose: RMC

This symposium is about primary aldosterone, and includes four talks: The first talk, by Professor Richard Warth, from University of Regensburg, Germany, is entitled "New Mechanisms and Targets in Primary Aldosteronism". Intracellular Ca2+ activity is critical for the control of aldosterone secretion in adrenal glomerulosa cells. In recent years, exome squencing has disclosed somatic mutations of four plasma membrane transport proteins to be associated with aldosterone-producing adenomas: the K+ channel KCNJ5, the voltage-gated Ca2+ channel CACNA1D, the Na+/K+ ATPase alpha subunit ATP1A1, and the Ca2+ ATPase APT2B3. The mutated proteins are believed to cause rises of cytosolic Ca2+ and, thereby, to stimulate aldosterone secretion and cell proliferation. The aldosterone-enhancing effect and the effect on cell proliferation will be discussed. The second talk, by Doctor Katharina Lang, from University of Wurzburg, Germany, is entitled ”Cancer and Aldosterone: Unanticipated Consequences of Hyperaldosteronism". Primary aldosteronism (PA) is the most common cause of secondary hypertension. Aldosterone excess can cause oxidative stress and respectively DNA damage in vitro and in vivo and increased levels of oxidative stress have been demonstrated in PA patients. Single case reports describe a coincidence of PA with renal cell carcinoma and other tumors. However, so far no data on the prevalence of benign and malignant neoplasms in patients with PA exists. In the multicenter MEPHISTO study the prevalence of benign and malignant tumors was investigated in 338 patients with confirmed PA both retro- and prospectively. In this cohort of PA patients a trend towards an increased lifetime prevalence for malignancies was observed which was particularly high for renal cell carcinomas (13 % of malignancies) and tumor formation clearly correlated with baseline aldosterone levels. The third talk, by Doctor Anna Riester, from University of Munich, Germany, is entitled "Adrenal Vein Sampling ". Adrenal vein sampling (AVS) is considered to be the gold standard to differentiate unilateral aldosterone producing adenomas from idiopathic bilateral hyperplasia. AVS is a technically challenging procedure and of only limited availability. Sequential sampling with cosyntropin stimulation and simultaneous bilateral sampling are the most common forms, but there is no evidence for preferring one of the methods. Rapid cortisol measurement was shown to improve the selectivity of the procedure. There is ongoing discussion about the selection of the right biomarker as well as about the impact of the contralateral suppression index. Several expert consensus statements have addressed the interpretation of AVS results. More recently, the influence of somatic mutations in aldosterone producing adenomas has become a focus of research. The presentation will give a comprehensive overview of the literature and an update on the experience with more than 300 AVS procedures performed in Munich since 2008. The forth talk, by Professor William Young, for the Mayo Clinic, Rochester, MN, is entitled “Perspectives on the Renaissance in Primary Aldosteronism”. Over the past 6 decades there has been a remarkable evolution in our understanding of the pathophysiology of primary aldosteronism. Pr Young will review some of the key advances in the field and the implications for clinical management.

4:30 PM
Richard Warth, Medical Cell Biology, Universitat Regensburg, Regensburg, Germany
Nothing to Disclose: RW
5:00 PM
Katharina Lang, Centre for Endocrinology and Metabolism, University of Birmingham, Birmingham, England
Nothing to Disclose: KL
5:15 PM
Anna Riester, Endocrinology, University of Munich, Munich, Germany
Nothing to Disclose: AR
5:30 PM
William F Young Jr., MD, MSc, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
Nothing to Disclose: WFY Jr.
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