Advertisement

The clinical investigator

, Volume 70, Issue 5, pp 392–395 | Cite as

Cellular origin of aldosteronomas

  • A. Ganguly
Review

Abstract

In the 1950s, after years of suspicion and work by many investigators regarding a potent mineralocorticoid hormone from the adrenal cortex, aldosterone was at last isolated and chemically identified [40, 41]. Soon after, Jerome Conn was the first to report [11] the clinical correlate of excessive secretion of aldosterone from a benign adrenocortical tumor manifested by hypertension and hypokalemia with the increased urinary excretion of aldosterone. This tumor is often called as aldosteronoma, and the disorder produced by it has been called primary aldosteronism by Conn. In the vast majority of patients harboring such tumors, the hypertension is cured by the resection of the tumor [12, 51], although some suggest that the hypertension may recur in a proportion of apparently cured patients [3, 36]. Thus, primary aldosteronism represents one of a few potentially curable forms of hypertension. Since aldosterone is elaborated normally by the zona glomerulosa cells of the adrenal, it has been assumed that all aldosteronomas originate from the cells of the glomerulosa zone. A clonal origin of aldosteronomas has also been suggested [28]. Some earlier and recent developments, however, indicate that functionally there may be more than one type of aldosteronomas and that their cellular origins might be different.

Key words

Adrenal gland Aldosterone Hypertension Mineralocorticoid Renin 

Abbreviations

ACTH

corticotrophin

CMO

corticosterone methyl oxidases

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Bertholet JT (1980) Proliferative activity and cell migration in the adrenal cortex of the fetal and neonatal rats: an autoradiographic study. J Endocrinol 87:1–8Google Scholar
  2. 2.
    2.Biglieri EG, Hane S, Slaton PE, Forsham PH (1963) In vivo and in vitro studies of adrenal secretion in vivo and in vitro in Cushing's syndrome and primary aldosteronism. J Clin Invest 42:516–524Google Scholar
  3. 3.
    Biglieri EG, Schambelan M, Slaton PE, Stockigt JR (1970) The intercurrent hypertension of primary aldosteronism. Circ Res 26 [Suppl 1]:I-195-I-202Google Scholar
  4. 4.
    Biglieri EG, Schambelan M, Brust N, Chang B, Hogan M (1974) Plasma aldosterone concentration. Further characterization of aldosterone-producing adenomas. Circ Res 34 [Suppl 1]:I-183-I-189Google Scholar
  5. 5.
    Biglieri EG, Irony I, Kater CE (1989) Identification and implications of new types of mineralocorticoid hypertension. J Steroid Biochem 32:199–204Google Scholar
  6. 6.
    Bloodworth JMB (1966) The adrenal. In: Sommers SC (ed) Pathology annual, vol l. Appleton-Century-Crofts, New York, pp 172–192Google Scholar
  7. 7.
    Brown C, Douglas J, Bravo E (1980) Angiotensin II receptor and in vitro aldosterone responses of aldosterone-producing adenomas, adjacent non-tumorous tissue and normal human adrenal glomerulosa. J Clin Endocrinol Metab 51:718–723Google Scholar
  8. 8.
    Caplan RH, Virata RC (1974) Functional black adenoma of the adrenal cortex. A rare cause of primary aldosteronism. Am J Clin Pathol 62:97–103Google Scholar
  9. 9.
    Carey RM, Ayers CP, Vaughn ED, Peach MJ, Herf SM (1979) Activity of (des-aspartyl1)-angiotensin II in primary aldosteronism. J Clin Invest 63:718–726Google Scholar
  10. 10.
    Cater JB, Lever JD (1954) The zona intermedia of the adrenal cortex. A correlation-of-possible functional significance with development, morphology and histochemistry. J Anat 88:437–454Google Scholar
  11. 11.
    Conn JW (1955) Presidential address. Primary aldosteronism, a new clinical syndrome. J Lab Clin Med 45:3–17Google Scholar
  12. 12.
    Conn JW (1966–1967) The evolution of primary aldosteronism: 1954–1967. Harvey Lect 62:257–291Google Scholar
  13. 13.
    Chu MD, Ulick S (1982) Isolation and identification of 18-hydroxycortisol from the urine of patients with primary aldosteronism. J Biol Chem 257:2218–2224Google Scholar
  14. 14.
    Ferriss JB, Beevers DG, Brown JJ, Davies DL, Fraser R, Lever AF, Mason P, Neville AM, Robertson JIS (1978) Clinical, biochemical and pathological features of low-renin (“primary”) hyperaldosteronism. Am Heart J 95:375–388Google Scholar
  15. 15.
    Fraser R, Beretta-Piccoli C, Brown JJ, Cumming AMM, Lever AF, Mason PA, Morton JJ, Robertson JIS (1981) Responses of aldosterone and 18-hydroxycorticosterone to angiotensin II in normal subjects and patients with essential hypertension, Conn's syndrome, and nontumorous hyperaldosteronism. Hypertension 3 [Suppl 1]:I-87-I-92Google Scholar
  16. 16.
    Ganguly A (1990) Glucocorticoid-suppressible hyperaldosteronism: an update. Am J Med 88:321–324Google Scholar
  17. 17.
    Ganguly A, Donohue JP (1983) Primary aldosteronism: pathophysiology, diagnosis and treatment. J Urol 129:241–247Google Scholar
  18. 18.
    Ganguly A, Melada GA, Luetscher JA, Dowdy AJ (1973) Control of plasma aldosterone in primary aldosteronism: distinction between adenoma and hyperplasia. J Clin Endocrinol Metab 37:765–775Google Scholar
  19. 19.
    Ganguly A, Chavarri M, Luetscher JA, Dowdy A (1976) ACTH control of aldosterone secretion in aldosterone-producing adenoma (APA): further evidence. Program of the 58th annual meeting of the Endocrine Society, San Francisco, abstract no. 386Google Scholar
  20. 20.
    Ganguly A, Luetscher JA, Weinberger MH (1983) Primary aldosteronism; effects of inhibition of ACTH and potassium administration on plasma aldosterone concentration. Clin Exp Hypertens [A]5:133–154Google Scholar
  21. 21.
    Gomez-Sanchez CE, Montgomery M, Ganguly A, Holland OB, Gomez-Sanchez EP, Grim CE, Weinberger MH (1984) Elevated urinary excretion of 18-oxocortisol in glucocorticoid-suppressible aldosteronism. J Clin Endocrinol Metab 59:1022–1024Google Scholar
  22. 22.
    Gomez-Sanchez CE, Gill JR, Ganguly A, Gordon RD (1988) Glucocorticoid-suppressible aldosteronism: a disorder of the adrenal transitional zone. J Clin Endocrinol Metab 67:444–448Google Scholar
  23. 23.
    Gordon RD, Hamlet SM, Tunny TJ, Klemm SA (1987) Aldosterone-producing adenoma responsive to angiotensin poses problems in diagnosis. Clin Exp Pharmacol Physiol 14:175–179Google Scholar
  24. 24.
    Greep RO, Deane HW (1949) The cytology and cytochemistry of the adrenal cortex. Ann NY Acad Sci 50:596–615Google Scholar
  25. 25.
    Guthrie GP (1981) Multiple plasma steroid responses to graded ACTH infusions in patients with primary aldosteronism. J Lab Clin Med 98:364–373Google Scholar
  26. 26.
    Hamlet SM, Gordon RD, Gomez-Sanchez CE, Tunny TJ, Klemm SA (1988) Adrenal transitional zone steroids, 18-oxo and 18-hydroxycortisol, useful in the diagnosis of primary aldosteronism are ACTH-dependent. Clin Exp Pharmacol Physiol 15:317–322Google Scholar
  27. 27.
    Horton R (1969) Stimulation and suppression in plasma of normal man and in primary aldosteronism. J Clin Invest 48:1231–1236Google Scholar
  28. 28.
    Jackson CE, Cerny JC, Block MA, Falkow AJ (1982) Probable clonal origin of aldosteronomas versus multicellular origin of parathyroid “adenomas”. Surgery 92:875–879Google Scholar
  29. 29.
    Kawamoto T, Mitsuchi Y, Ohnishi T, Ichikawa Y, Yokoyama Y, Sumimoto H, Toda K, Miyahara K, Kuribayashi I, Nakao K, Hosoda K, Yamamoto Y, Imura H, Shizuta Y (1990) Cloning and expression of a cDNA for human cytochrome P-450 aldo as related to primary aldosteronism. Biochem Biophys Res Commun 173:309–316Google Scholar
  30. 30.
    Kay S (1976) Hyperplasia and neoplasia of the adrenal gland. In: Sommers SC (ed) Pathology annual, vol 11. Appleton-Century-Crofts, New York, pp 103–139Google Scholar
  31. 31.
    Kem DC, Weinberger MH, Gomez-Sanchez CE, Kramer NJ, Lerman R, Furuyama S, Nugent CA (1973) Circadian rhythm of plasma aldosterone concentration in patients with primary aldosteronism. J Clin Invest 52:2272–2277Google Scholar
  32. 32.
    Kern DC, Weinberger MH, Higgins JH, Kramer NJ, Gomez-Sanchez C, Holland OB (1978) Plasma aldosterone response to ACTH in primary aldosteronism and in patients with low renin hypertension. J Clin Endocrinol Metab 46:552–560Google Scholar
  33. 33.
    Komiya I, Koizumi Y, Kobayashi Y, Kotani M, Yamada T, Maruyama Y (1979) Concurrent hypersecretion of aldosterone and cortisol from the adrenal cortical adenoma. Am J Med 67:516–518Google Scholar
  34. 34.
    Long JA (1975) Zonation of the mammalian adrenal cortex. In: Greep RO, Astwood EB (eds) Handbook of physiology, vol VI. Adrenal gland. American Physiological Society, Washington, pp 13–24Google Scholar
  35. 35.
    Mantero F, Fallo F, Opocher G, Armanini D, Boscaro M, Scaroni C (1981) Effect of angiotensin II and converting enzyme inhibitor (captopril) on blood pressure, plasma renin activity, and aldosterone in primary aldosteronism. Clin Sci 61:289s-293sGoogle Scholar
  36. 36.
    Melby JC (1984) Primary aldosteronism. Kidney Int 26:769–778Google Scholar
  37. 37.
    Neville A, O'Hare MJ (1985) Histopathology of the human adrenal cortex. Clin Endocrinol Metab 14:791–820Google Scholar
  38. 38.
    Nomura K, Naruse M, Naruse K, Demura H, Shizume K (1984) In vivo evidence of cortisol secretion by aldosterone-producing adenoma. Acta Endocrinol (Copenh) 106:516–520Google Scholar
  39. 39.
    Priestley JT, Ferris DO, ReMine WH, Woolner LB (1968) Primary aldosteronism: surgical management and pathological findings. Mayo Clinic Proc 48:761–775Google Scholar
  40. 40.
    Simpson SA, Tait JF, Bush IE (1952) Secretion of a salt-retaining hormone by the mammalian adrenal cortex. Lancet 11:226–227Google Scholar
  41. 41.
    Simpson SA, Tait JF, Wettstein A, Neher R, Schindler JVEO, Reichstein T (1954) Konstitution des aldosterons, des neuen mineralocorticoids. Experimentia 10:132–133Google Scholar
  42. 42.
    Slaton PE, Schambelan M, Biglieri EG (1969) Stimulation and suppression of aldosterone secretion in patients with an aldosterone-producing adenoma. J Clin Endocrinol Metab 29:239–250Google Scholar
  43. 43.
    Spark RF, Dale SL, Kahn PC, Melby JC (1969) Activation of aldosterone secretion in primary aldosteronism. J Clin Invest 48:96–104Google Scholar
  44. 44.
    Symington T (1969) Functional pathology of the adrenal gland. Livingstone, Edinburgh, pp 3–216Google Scholar
  45. 45.
    Tannenbaum M (1973) Ultrastructural pathology of the adrenal cortex. In: Sommers SC (ed) Pathology annual, vol 8. Appleton-Century-Crofts, New York, pp 109–156Google Scholar
  46. 46.
    Ulick S (1976) Diagnosis and nomenclature of the disorders of terminal portion of the aldosterone biosynthetic pathway. J Clin Endocrinol Metab 43:92–96Google Scholar
  47. 47.
    Ulick S (1982) Hypersecretion of a new corticosteroid, 18-hydroxycortisol in two types of adrenocortical hypertension. Clin Exp Hypertens [A]4 (9&10):1771–1777Google Scholar
  48. 48.
    Ulick S, Chu MD, Land M (1983) Biosynthesis of 18-oxocortisol by aldosterone-producing adrenal tissue. J Biol Chem 258:5498–5502Google Scholar
  49. 49.
    Ulick S, Chan CK, Gill JR, Gutkin M, Letcher L, Mantero F, New MI (1990) Defective fasciculata zone function as the mechanism of glucocorticoid-remediable aldosteronism. J Clin Endocrinol Metab 71:1151–1157Google Scholar
  50. 50.
    Vetter H, Berger M, Armbruster H, Siegenthaler W, Werning C, Vetter W (1974) Episodic secretion of aldosterone in primary aldosteronism: relationship to cortisol. Clin Endocrinol (Oxf) 3:41–48Google Scholar
  51. 51.
    Weinberger MH, Grim CE, Hollifield JW, Ganguly A, Kramer NJ, Yune HY, Wellman H (1979) Primary aldosteronism. Diagnosis, localization, and treatment. Ann Intern Med 90:386–395Google Scholar
  52. 52.
    Wenting GJ, Veld AJ Man In't, Derks FH, Brummelan PV, Schalekamp MADH (1978) ACTH-dependent adrenocortical adenoma. A variant of primary aldosteronism. J Clin Endocrinol Metab 46:326–335Google Scholar
  53. 53.
    Wisgerhof M, Brown RD, Hogan MJ, Carpenter PC, Edis AJ (1981) The plasma aldosterone response to angiotensin II infusion in aldosterone-producing adenoma and idiopathic hyperaldosteronism. J Clin Endocrinol Metab 52:195–198Google Scholar
  54. 54.
    Witzgall H, Muller DA, Weber PC (1983) Clinical and biochemical features of patients with aldosterone-producing adenoma and idiopathic aldosteronism. Klin Wochenschr 61:35–42Google Scholar
  55. 55.
    Yamagibashi K, Haniu M, Shively JE, Shen WH, Hall PF (1986) The synthesis of aldosterone by the adrenal cortex. Two zones (fasciculata and glomerulosa) possess one enzyme for l1β/18-hydroxylation and aldehyde synthesis. J Biol Chem 261:3556–3562Google Scholar
  56. 56.
    Zajicek G, Ariel I, Arber N (1985) The streaming adrenal cortex: direct evidence of centripetal migration of adrenocytes by estimation of cell turnover rate. J Endocrinol 111:477–482Google Scholar

Copyright information

© Springer-Verlag 1992

Authors and Affiliations

  • A. Ganguly
    • 1
  1. 1.Medical ServiceJames A. Haley Veterans Hospital and the University of South Florida College of MedicineTampaUSA

Personalised recommendations