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 .

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adrenal incidentaloma

cushing syndrome

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