TY - JOUR
T1 - International Histopathology Consensus for Unilateral Primary Aldosteronism
AU - Williams, Tracy Ann
AU - Gomez-Sanchez, Celso E.
AU - Rainey, William E.
AU - Giordano, Thomas J.
AU - Lam, Alfred K.
AU - Marker, Alison
AU - Mete, Ozgur
AU - Yamazaki, Yuto
AU - Zerbini, Maria Claudia Nogueira
AU - Beuschlein, Felix
AU - Satoh, Fumitoshi
AU - Burrello, Jacopo
AU - Schneider, Holger
AU - Lenders, Jacques W.M.
AU - Mulatero, Paolo
AU - Castellano, Isabella
AU - Knösel, Thomas
AU - Papotti, Mauro
AU - Saeger, Wolfgang
AU - Sasano, Hironobu
AU - Reincke, Martin
N1 - Funding Information:
This work was supported by the European Research Council (ERC) under the European Union's Horizon 2020 research and innovation program (grant agreement No [694913] to M Reincke) and by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) project number: 314061271-TRR 205 to F Beuschlein, JWM Lenders, M Reincke and TA Williams and the Clinician Scientist PRogram In Vascular MEdicine (PRIME) project number MA 2186/14-1 to H Schneider. This work was also supported by the Else Kröner-Fresenius Stiftung in support of the German Conn Registry-Else-Kröner Hyperaldosteronism Registry (2015-A171, and 2019-A104 to M Reincke) and by the Clinical Research Priority Program of the University of Zurich for the CRPP Hypertension Research Network (HYRENE) to F Beuschlein. CE Gomez-Sanchez is supported by National Heart, Lung and Blood Institute grant R01 HL144847, and the National Institute of General Medical Sciences grant U54 GM115428 and WE Rainey is supported by National Institute of Diabetes and Digestive and Kidney Diseases grant R01 DK106618. F Satoh is supported by JSPS KAKENHI (Japan Society for the Promotion of Science, Grants-in- Aid for Scientific Research) grant number JP18K08500 and Health Labour Sciences Research grant number H29-Nanji-Ippan-046.
Publisher Copyright:
© 2020 The Author(s).
PY - 2021/1/1
Y1 - 2021/1/1
N2 - 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.
AB - 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.
KW - CYP11B2
KW - adrenal gland
KW - diagnostic histopathology
KW - immunohistochemistry
KW - primary aldosteronism
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U2 - 10.1210/clinem/dgaa484
DO - 10.1210/clinem/dgaa484
M3 - Article
C2 - 32717746
AN - SCOPUS:85099072620
VL - 106
SP - 42
EP - 54
JO - Journal of Clinical Endocrinology and Metabolism
JF - Journal of Clinical Endocrinology and Metabolism
SN - 0021-972X
IS - 1
ER -
