International Histopathology Consensus for Unilateral Primary Aldosteronism

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 syntha...

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Published in:The journal of clinical endocrinology and metabolism Vol. 106; no. 1; pp. 42 - 54
Main Authors: Williams, Tracy Ann, Gomez-Sanchez, Celso E, Rainey, William E, Giordano, Thomas J, Lam, Alfred K, Marker, Alison, Mete, Ozgur, Yamazaki, Yuto, Zerbini, Maria Claudia Nogueira, Beuschlein, Felix, Satoh, Fumitoshi, Burrello, Jacopo, Schneider, Holger, Lenders, Jacques W M, Mulatero, Paolo, Castellano, Isabella, Knösel, Thomas, Papotti, Mauro, Saeger, Wolfgang, Sasano, Hironobu, Reincke, Martin
Format: Journal Article
Language:English
Published: US Oxford University Press 01.01.2021
Copyright Oxford University Press
Subjects:
Adrenal Glands - metabolism
Adrenal Glands - pathology
Adrenalectomy - methods
Adrenalectomy - standards
Adult
Aldosterone
Aldosterone synthase
Clinical s
Cohort Studies
Consensus
Corticosteroids
Cytochrome P-450
Cytochrome P-450 CYP11B2 - metabolism
Cytodiagnosis - methods
Cytodiagnosis - standards
Diagnosis
Diagnostic Techniques, Endocrine - standards
Female
Germany
Histological Techniques - standards
Histopathology
Humans
Hyperaldosteronism
Hyperaldosteronism - complications
Hyperaldosteronism - diagnosis
Hyperaldosteronism - surgery
Hypertension
Hypertension - diagnosis
Hypertension - etiology
Hypertension - surgery
Immunohistochemistry
Internationality
Male
Medical screening
Middle Aged
Nomenclature
Practice Guidelines as Topic - standards
Societies, Medical - standards
Germany
Japan
diagnostic histopathology
adrenal gland
immunohistochemistry
CYP11B2
primary aldosteronism
ISSN:0021-972X, 1945-7197, 1945-7197
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Summary: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.
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These authors contributed equally.
ISSN:0021-972X
1945-7197
1945-7197
DOI:10.1210/clinem/dgaa484