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  • International histopathology consensus for unilateral primary aldosteronism

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    Lam439120-Acceptted.pdf (1.517Mb)
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    Accepted Manuscript (AM)
    Author(s)
    Williams, Tracy Ann
    Gomez-Sanchez, Celso E
    Rainey, William E
    Giordano, Thomas J
    Lam, Alfred K
    Marker, Alison
    Mete, Ozgur
    Yamazaki, Yuto
    Zerbini, Maria Claudia Nogueira
    Beuschlein, Felix
    Satoh, Fumitoshi
    Burrello, Jacopo
    Schneider, Holger
    Lenders, Jacques WM
    et al.
    Griffith University Author(s)
    Lam, Alfred K.
    Year published
    2020
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    Abstract
    OBJECTIVE: Develop a consensus for the nomenclature and definition of adrenal histopathologic features in unilateral primary aldosteronism (PA). CONTEXT: Unilateral PA is the most common surgically-treated form of hypertension. Morphologic examination combined with CYP11B2 (aldosterone synthase) immunostaining reveals diverse histopathologic features of lesions in the resected adrenals. PATIENTS AND METHODS: Surgically removed adrenals (n= 37) from 90 patients operated from 2015 to 2018 in Munich, Germany, were selected to represent the broad histologic spectrum of unilateral PA. Five pathologists (Group 1 from Germany, Italy ...
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    OBJECTIVE: Develop a consensus for the nomenclature and definition of adrenal histopathologic features in unilateral primary aldosteronism (PA). CONTEXT: Unilateral PA is the most common surgically-treated form of hypertension. Morphologic examination combined with CYP11B2 (aldosterone synthase) immunostaining reveals diverse histopathologic features of lesions in the resected adrenals. PATIENTS AND METHODS: Surgically removed adrenals (n= 37) from 90 patients operated from 2015 to 2018 in Munich, Germany, were selected to represent the broad histologic spectrum of unilateral PA. Five pathologists (Group 1 from Germany, Italy and Japan) evaluated the histopathology of haematoxylin-eosin and CYP11B2 immunostained sections and a consensus was established to define the identifiable features. The consensus was subsequently used by six additional pathologists (Group 2 from Australia, Brazil, Canada, Japan, UK, USA) for the assessment of all adrenals with disagreement for histopathologic diagnoses among group 1 pathologists. RESULTS: Consensus was achieved to define histopathologic features associated with PA. Use of CYP11B2 immunostaining resulted in a change of the original haematoxylin-eosin morphology-driven diagnosis in 5 (14%) of 37 cases. Using the consensus criteria, group 2 pathologists agreed for the evaluation of 11 of the 12 cases of disagreement among group 1 pathologists. CONCLUSION: The HISTALDO (histopathology of primary aldosteronism) consensus is useful to standardize nomenclature and achieve consistency among pathologists for the histopathologic diagnosis of unilateral PA. CYP11B2 immunohistochemistry should be incorporated into the routine clinical diagnostic workup to localize the likely source of aldosterone production.
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    Journal Title
    The Journal of Clinical Endocrinology & Metabolism
    DOI
    https://doi.org/10.1210/clinem/dgaa484
    Copyright Statement
    © 2020 Oxford University Press. This is a pre-copy-editing, author-produced PDF of an article accepted for publication in the Journal of Clinical Endocrinology and Metabolism following peer review. The definitive publisher-authenticated version International histopathology consensus for unilateral primary aldosteronism, Journal of Clinical Endocrinology and Metabolism, 2020 is available online at: https://doi.org/10.1210/clinem/dgaa484.
    Subject
    Clinical sciences
    CYP11B2
    Primary aldosteronism
    adrenal gland
    diagnostic histopathology
    immunohistochemistry
    Publication URI
    http://hdl.handle.net/10072/396399
    Collection
    • Journal articles

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