Tracy Ann Williams1,2, Celso E Gomez-Sanchez3, William E Rainey4,5, Thomas J Giordano5,6, Alfred K Lam7, Alison Marker8, Ozgur Mete9,10, Yuto Yamazaki11, Maria Claudia Nogueira Zerbini12, Felix Beuschlein1,13, Fumitoshi Satoh14, Jacopo Burrello2, Holger Schneider1, Jacques W M Lenders15,16, Paolo Mulatero2, Isabella Castellano17, Thomas Knösel18, Mauro Papotti19, Wolfgang Saeger20, Hironobu Sasano11, Martin Reincke1. 1. Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Germany. 2. Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Turin, Italy. 3. Endocrine Division, G.V. (Sonny) Montgomery VA Medical Center, and Department of Pharmacology and Toxicology and Medicine, University of Mississippi Medical Center, Jackson, MS, USA. 4. Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, USA. 5. Division of Metabolism, Endocrine, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA. 6. Department of Pathology and Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA. 7. School of Medicine, Griffith University, Gold Coast, Australia. 8. Department of Histopathology, Cambridge University NHS Foundation Trust, Cambridge, UK. 9. Department of Pathology, University Health Network, Toronto, Canada. 10. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada. 11. Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan. 12. Departamento de Patologia, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil. 13. Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, Universitätsspital Zürich, Zürich, Switzerland. 14. Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Japan. 15. Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands. 16. Department of Medicine III, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany. 17. Division of Pathology, Department of Medical Sciences, University of Turin, Turin, Italy. 18. Institute of Pathology, Ludwig-Maximilians-Universität München, Germany. 19. Department of Oncology, University of Turin, Turin, Italy. 20. Institute of Pathology, Universität Hamburg, Germany.
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, 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.
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.
Authors: Lucie S Meyer; Xiao Wang; Eva Sušnik; Jacopo Burrello; Alessio Burrello; Isabella Castellano; Graeme Eisenhofer; Francesco Fallo; Gregory A Kline; Thomas Knösel; Tomaz Kocjan; Jacques W M Lenders; Paolo Mulatero; Mitsuhide Naruse; Tetsuo Nishikawa; Mirko Peitzsch; Lars C Rump; Felix Beuschlein; Stefanie Hahner; Celso E Gomez-Sanchez; Martin Reincke; Tracy Ann Williams Journal: Hypertension Date: 2018-09 Impact factor: 10.190
Authors: Na Sun; Lucie S Meyer; Annette Feuchtinger; Thomas Kunzke; Thomas Knösel; Martin Reincke; Axel Walch; Tracy Ann Williams Journal: Hypertension Date: 2020-01-20 Impact factor: 10.190
Authors: Yuta Tezuka; Nanako Atsumi; Amy R Blinder; Juilee Rege; Thomas J Giordano; William E Rainey; Adina F Turcu Journal: J Clin Endocrinol Metab Date: 2021-04-23 Impact factor: 5.958