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Expression of Genes Encoding Aldosterone Synthesis Pathway Enzymatic Proteins in Adrenocortical Adenomas in Patients With Conn Syndrome

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Ziaja J., Cholewa K., Chudek J., Król R., Kajor M., Więcek A., Mazurek U., Cierpka L.

Polish Journal of Surgery

2010

vol. 82

issue 1

47-52

One of the possibilities of explanation of persistent hypertension after adrenocortical adenoma excision in patients with Conn syndrome could be analysis of transcriptional activity of genes encoding aldosterone synthesis pathway enzymatic proteins within these tumours.The aim of the study was to analyze the expression of mentioned genes in adrenocortical adenomas in patients with primary hiperaldosteronism and to analyse correlations between their expression and results of hormonal tests of blood serum before surgery as well as maximal values of blood pressure before surgery and their decrease after operation.Material and methods. Thirteen patients with Conn syndrome subjected to surgical excision of adrenocortical tumour were analyzed. Expression of CYP 11A1, CYP 21A2, CYP 11B2 and HSD 3B2 genes in tissue of removed tumours was analyzed using RT real-time PCR method. GAPDH was used as reference gene. The results analysis was based on amplification threshold values CT. Analysis of clinical consequences of adrenalectomy was performed after a period of minimum 12 months after surgery.Results. Expression of mRNA, presented as 2-ΔΔCT, of CYP 11A1 gene was 1.58 (1.01-2.48), CYP 21A2-2.74 (1.78-4.24), CYP 11B2- 19.15 (11.28-32.50) and HSD 3B2-2.57 (1.47-4.50). Correlation analysis revealed only negative correlation between CYP 11A1 gene expression and plasma renin activity in upright position (r=-0.604; p=0.049) and positive correlation between HSD 3B2 gene expression and decrease of maximal values of systolic blood pressure in long term follow up (r=0.763; p=0.010).Conclusions. High expression of genes encoding aldosterone synthesis pathway enzymatic proteins is observed in adrenocortical adenomas in patients with Conn syndrome. The transcriptional activity of the genes does not correlate with results of preoperative hormonal tests and is not a prognostic factor of persistent hypertension after adrenal tumour excision.

Decrease of Arterial Hypertension After Adrenalectomy in Patients Without Confirmation of Adrenal Tumour Hyperfunction

100%

Ziaja J., Chudek J., Król R., Cierniak T., Adamczak M., Więcek A., Cierpka L.

Polish Journal of Surgery

2007

vol. 79

issue 4

273-279

Adrenal tumours incidentally found in patients with arterial hypertension pose a severe clinical problem when no endocrine hyperactivity is confirmed and their features in diagnostic imaging do not suggest malignancy.The aim of the study was to evaluate the clinical consequences of unilateral adrenalectomy in a long term follow up period for patients that have adrenal tumours without confirmed endocrine hyperactivity.Material and methods. We evaluated the clinical consequences of unilateral adrenalectomy in a long term follow up of 48 hypertensive patients with a unilateral adrenal tumour lacking biochemical confirmation of adrenal hyperactivity. The mean duration of hypertension was 87 months; observation time ranged from 6 to 62 months.Results. Normalisation of blood pressure was observed in 8.3% of patients. In addition, better blood pressure control was documented in 35.4% of patients. There were no significant differences between group of patients with normalization or improvement of blood pressure control and those with no improvement with respect to age, BMI, duration of hypertension, tumour size, renin activity, aldosterone to plasma renin activity ratio, or the preoperative plasma concentration of potassium, aldosterone, or cortisol. The maximum values of systolic, but not diastolic, blood pressure before surgery were lower in patients with normalization or improvement of blood pressure control.Conclusions. Improvement of blood pressure control after unilateral adrenalectomy in 43.7% of patients may suggest tumour endocrine hyperactivity which remains unconfirmed by laboratory tests. It is not possible to predict improvement of blood pressure control after adrenalectomy in this group of patients according to tumour size and routine biochemical examination.

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2 Polish Journal of Surgery

1 2010

1 2007

2 Chudek J.

2 Cierpka L.

2 Król R.

2 Więcek A.

2 Ziaja J.

1 Adamczak M.

1 Cholewa K.

1 Cierniak T.

1 Kajor M.

1 Mazurek U.

Search results

Expression of Genes Encoding Aldosterone Synthesis Pathway Enzymatic Proteins in Adrenocortical Adenomas in Patients With Conn Syndrome

Decrease of Arterial Hypertension After Adrenalectomy in Patients Without Confirmation of Adrenal Tumour Hyperfunction