The Potential Role of Aldosterone-Producing Cell Clusters in Adrenal Disease

• Published in: Hormone and metabolic research Vol. 52; no. 6; pp. 427 - 434
• Main Authors: Lim, Jung Soo, Rainey, William E.
• Format: Journal Article
• Language: English
• Published: Stuttgart · New York Georg Thieme Verlag KG 01.06.2020
• Subjects: Adrenal Cortex - cytology; Adrenal Cortex - metabolism; Adrenal Cortex - pathology; Adrenal Cortex Neoplasms - genetics; Adrenal Cortex Neoplasms - metabolism; Adrenal Cortex Neoplasms - pathology; Adrenal Glands - cytology; Adrenal Glands - metabolism; Adrenal Glands - pathology; Adrenocortical Adenoma - genetics; Adrenocortical Adenoma - metabolism; Adrenocortical Adenoma - pathology; Aldosterone - metabolism; Cytochrome P-450 CYP11B2 - genetics; Cytochrome P-450 CYP11B2 - metabolism; High-Throughput Nucleotide Sequencing; Humans; Hyperaldosteronism - complications; Hyperaldosteronism - genetics; Hyperaldosteronism - metabolism; Hyperaldosteronism - pathology; Hypertension - etiology; Hypertension - metabolism; Hypertension - pathology; Immunohistochemistry; Review; aldosterone-producing cell clusters; cytochrome P-450; CYP11B2; primary aldosteronism; aldosterone-producing micronodules
• ISSN: 0018-5043; 1439-4286
• DOI: 10.1055/a-1128-0421

Abstract Primary aldosteronism (PA) is the most common cause of secondary hypertension. The hallmark of PA is adrenal production of aldosterone under suppressed renin conditions. PA subtypes include adrenal unilateral and bilateral hyperaldosteronism. Considerable progress has been made in defining the role for somatic gene mutations in aldosterone-producing adenomas (APA) as the primary cause of unilateral PA. This includes the use of next-generation sequencing (NGS) to define recurrent somatic mutations in APA that disrupt calcium signaling, increase aldosterone synthase (CYP11B2) expression, and aldosterone production. The use of CYP11B2 immunohistochemistry on adrenal glands from normal subjects, patients with unilateral and bilateral PA has allowed the identification of CYP11B2-positive cell foci, termed aldosterone-producing cell clusters (APCC). APCC lie beneath the adrenal capsule and like APA, many APCC harbor somatic gene mutations known to increase aldosterone production. These findings suggest that APCC may play a role in pathologic progression of PA. Herein, we provide an update on recent research directed at characterizing APCC and also discuss the unanswered questions related to the role of APCC in PA.