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Expression of aldosterone synthase and adrenocorticotropic hormone receptor in adrenal incidentalomas from normotensive and hypertensive patients: Distinguishing subclinical or atypical primary aldosteronism from adrenal incidentaloma.
[adrenal incidentaloma]
The
present
study
aimed
to
investigate
the
expression
of
aldosterone
synthase
(
CYP
11
B
2
)
,
adrenocorticotropic
hormone
receptor
(
ACTH-R
)
and
their
regulating
transcription
factors
in
adrenal
incidentalomas
(
AIs
)
from
normotensive
and
hypertensive
patients
to
distinguish
subclinical
or
atypical
primary
aldosteronism
(
PA
)
from
AIs
.
Total
RNA
was
extracted
from
8
normal
adrenal
cortices
(
NAs
)
,
46
AIs
,
15
aldosterone-producing
adenomas
(
APAs
)
and
6
idiopathic
hyperaldosteronisms
(
IHAs
)
.
Real-time
quantitative
polymerase
chain
reaction
(
PCR
)
and
immunohistochemistry
were
performed
to
determine
the
mRNA
and
protein
expression
of
CYP
11
B
2
,
ACTH-R
,
steroidogenic
factor
-
1
(
SF
1
)
and
dosage-sensitive
sex
reversal
,
adrenal
hypoplasia
congenita
,
critical
region
on
the
X
chromosome
,
gene
-
1
(
DAX-
1
)
in
the
different
tissues
.
The
AI
hypertensive
subgroup
displayed
increased
plasma
aldosterone
concentration
(
PAC
)
and
PAC
/
PRA
ratio
(
ARR
)
and
decreased
plasma
renin
activity
(
PRA
)
compared
to
the
normotensive
group
.
CYP
11
B
2
,
ACTH-R
and
SF
1
mRNAs
were
signiï¬cantly
higher
in
the
APA
group
compared
to
the
other
groups
,
and
gradually
increased
in
AI
hypertensive
samples
.
DAX-
1
mRNA
was
expressed
faintly
in
PA
compared
with
NA
.
In
normotensive-
AI
samples
,
DAX-
1
mRNA
was
higher
compared
to
PA
and
AI
hypertensive
samples
.
Significant
differences
in
gene
expression
levels
in
AIs
were
observed
between
probable
and
improbable
PA
patients
.
Immunohistochemical
results
were
consistent
with
those
of
real-time
PCR
.
Plasma
aldosterone
levels
were
positively
correlated
with
CYP
11
B
2
,
ACTH-R
and
SF
1
mRNA
and
inversely
correlated
with
DAX-
1
mRNA
.
In
conclusion
,
a
significant
number
of
hypertensive-
AI
patients
may
have
subclinical
forms
of
PA
.
CYP
11
B
2
,
ACTH-R
and
their
regulating
transcription
factors
may
be
noteworthy
in
distinguishing
subclinical
PA
from
AIs
.
Diseases
Validation
Diseases presenting
"sex reversal"
symptom
adrenal incidentaloma
neonatal adrenoleukodystrophy
This symptom has already been validated
