International Histopathology Consensus for Unilateral Primary Aldosteronism

Tracy Ann Williams, Celso E. Gomez-Sanchez, William E. Rainey, Thomas J. Giordano, Alfred K. Lam, Alison Marker, Ozgur Mete, Yuto Yamazaki, Maria Claudia Nogueira Zerbini, Felix Beuschlein, Fumitoshi Satoh, Jacopo Burrello, Holger Schneider, Jacques W.M. Lenders, Paolo Mulatero, Isabella Castellano, Thomas Knösel, Mauro Papotti, Wolfgang Saeger, Hironobu SasanoMartin Reincke

Research output: Contribution to journalArticlepeer-review

77 Citations (Scopus)


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 hematoxylin-eosin (HE) and CYP11B2 immunostained sections, and a consensus was established to define the identifiable features. The consensus was subsequently used by 6 additional pathologists (Group 2 from Australia, Brazil, Canada, Japan, United Kingdom, United States) 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 HE 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.

Original languageEnglish
Pages (from-to)42-54
Number of pages13
JournalJournal of Clinical Endocrinology and Metabolism
Issue number1
Publication statusPublished - 2021 Jan 1


  • CYP11B2
  • adrenal gland
  • diagnostic histopathology
  • immunohistochemistry
  • primary aldosteronism

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical


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