Adrenal aldosterone synthase (CYP11B2) histopathology and its association with disease-induced sudden death: a cross-sectional studyResearch in context
Summary: Background: Unidentified cardiovascular risk factors may account for approximately half of sudden deaths, a devastating event with limited preventive tools. We investigated whether adrenal histopathology suggestive of primary aldosteronism, pheochromocytoma, or adrenal masses could explain...
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Elsevier
2025-04-01
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| Series: | The Lancet Regional Health. Europe |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666776225000183 |
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| author | Antero Ylänen Juhani Isojärvi Antti Virtanen Helena Leijon Tiina Vesterinen Aapo L. Aro Heini Huhtala Eeva Kokko Ilkka Pörsti Marianna Viukari Pasi I. Nevalainen Niina Matikainen |
| author_facet | Antero Ylänen Juhani Isojärvi Antti Virtanen Helena Leijon Tiina Vesterinen Aapo L. Aro Heini Huhtala Eeva Kokko Ilkka Pörsti Marianna Viukari Pasi I. Nevalainen Niina Matikainen |
| author_sort | Antero Ylänen |
| collection | DOAJ |
| description | Summary: Background: Unidentified cardiovascular risk factors may account for approximately half of sudden deaths, a devastating event with limited preventive tools. We investigated whether adrenal histopathology suggestive of primary aldosteronism, pheochromocytoma, or adrenal masses could explain part of the risk for disease-induced sudden death (DSD). Methods: In this study, autopsies and histopathological analyses, including aldosterone synthase staining of adrenal glands, were performed on 403 consecutive individuals who experienced sudden death. These individuals were classified into 258 cases of DSD and 144 deaths caused by trauma, suicide, or intoxication, i.e., non-disease-induced sudden death (nDSD). This trial was registered at ClinicalTrials.gov (NCT05446779). Findings: Adrenal histopathology revealed changes in 31 (7.7%) subjects of the cohort. Of these, the most prevalent findings [25 (6.2%)] were aldosterone-producing adenomas (APA) or nodules (APN), which were associated with myocardial infarction and atherosclerosis at autopsy. Individuals in the DSD group and the subgroup with sudden cardiac death (SCD) were more likely to have APA or APN than individuals in the nDSD group [23 (8.9%) vs. 2 (1.4%), p = 0.002; 16 (8.8%) vs. 2 (1.4%), p = 0.003, respectively]. APA or APN were explanatory factors for DSD (odds ratio [OR] 6.47, 95% confidence interval [CI] 1.40–29.88, p = 0.017) and SCD (OR 10.68, 95% CI 2.02–56.43, p = 0.005). Other findings included two pheochromocytomas, one bilateral adrenal metastasis, and two unilateral adrenal metastases. Interpretation: In this exploratory study, APA or APN were more frequently seen in DSD and SCD than nDSD cases. Whether primary aldosteronism constitutes a novel risk factor for sudden death warrants further study. Funding: Finnish State Research funds and independent research foundations: Aarne Koskelo Foundation, the Finnish Kidney Foundation, and the Finnish Foundation for Cardiovascular Research. |
| format | Article |
| id | doaj-art-d9566bce9b3d48cf83001809c8e3c819 |
| institution | Kabale University |
| issn | 2666-7762 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Regional Health. Europe |
| spelling | doaj-art-d9566bce9b3d48cf83001809c8e3c8192025-02-08T05:01:25ZengElsevierThe Lancet Regional Health. Europe2666-77622025-04-0151101226Adrenal aldosterone synthase (CYP11B2) histopathology and its association with disease-induced sudden death: a cross-sectional studyResearch in contextAntero Ylänen0Juhani Isojärvi1Antti Virtanen2Helena Leijon3Tiina Vesterinen4Aapo L. Aro5Heini Huhtala6Eeva Kokko7Ilkka Pörsti8Marianna Viukari9Pasi I. Nevalainen10Niina Matikainen11Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Internal Medicine, Tampere University Hospital, Tampere, FinlandFaculty of Medicine and Health Technology, Tampere University, Tampere, FinlandForensic Medicine Unit, Finnish Institute for Health and Welfare, Helsinki, FinlandHUS Diagnostic Center, HUSLAB, Department of Pathology, Helsinki University Hospital and University of Helsinki, Helsinki, FinlandHUS Diagnostic Center, HUSLAB, Department of Pathology, Helsinki University Hospital and University of Helsinki, Helsinki, FinlandHeart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, FinlandHealth Sciences, Faculty of Social Sciences, Tampere University, Tampere, FinlandFaculty of Medicine and Health Technology, Tampere University, Tampere, FinlandFaculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Internal Medicine, Tampere University Hospital, Tampere, FinlandEndocrinology, Helsinki University Hospital, ENDO-ERN (European Reference Network on Rare Endocrine Conditions) and University of Helsinki, Helsinki, FinlandFaculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Internal Medicine, Tampere University Hospital, Tampere, FinlandEndocrinology, Helsinki University Hospital, ENDO-ERN (European Reference Network on Rare Endocrine Conditions) and University of Helsinki, Helsinki, Finland; Corresponding author.Summary: Background: Unidentified cardiovascular risk factors may account for approximately half of sudden deaths, a devastating event with limited preventive tools. We investigated whether adrenal histopathology suggestive of primary aldosteronism, pheochromocytoma, or adrenal masses could explain part of the risk for disease-induced sudden death (DSD). Methods: In this study, autopsies and histopathological analyses, including aldosterone synthase staining of adrenal glands, were performed on 403 consecutive individuals who experienced sudden death. These individuals were classified into 258 cases of DSD and 144 deaths caused by trauma, suicide, or intoxication, i.e., non-disease-induced sudden death (nDSD). This trial was registered at ClinicalTrials.gov (NCT05446779). Findings: Adrenal histopathology revealed changes in 31 (7.7%) subjects of the cohort. Of these, the most prevalent findings [25 (6.2%)] were aldosterone-producing adenomas (APA) or nodules (APN), which were associated with myocardial infarction and atherosclerosis at autopsy. Individuals in the DSD group and the subgroup with sudden cardiac death (SCD) were more likely to have APA or APN than individuals in the nDSD group [23 (8.9%) vs. 2 (1.4%), p = 0.002; 16 (8.8%) vs. 2 (1.4%), p = 0.003, respectively]. APA or APN were explanatory factors for DSD (odds ratio [OR] 6.47, 95% confidence interval [CI] 1.40–29.88, p = 0.017) and SCD (OR 10.68, 95% CI 2.02–56.43, p = 0.005). Other findings included two pheochromocytomas, one bilateral adrenal metastasis, and two unilateral adrenal metastases. Interpretation: In this exploratory study, APA or APN were more frequently seen in DSD and SCD than nDSD cases. Whether primary aldosteronism constitutes a novel risk factor for sudden death warrants further study. Funding: Finnish State Research funds and independent research foundations: Aarne Koskelo Foundation, the Finnish Kidney Foundation, and the Finnish Foundation for Cardiovascular Research.http://www.sciencedirect.com/science/article/pii/S2666776225000183Primary aldosteronismSudden deathAldosterone synthaseCYP11B2HypertensionPheochromocytoma |
| spellingShingle | Antero Ylänen Juhani Isojärvi Antti Virtanen Helena Leijon Tiina Vesterinen Aapo L. Aro Heini Huhtala Eeva Kokko Ilkka Pörsti Marianna Viukari Pasi I. Nevalainen Niina Matikainen Adrenal aldosterone synthase (CYP11B2) histopathology and its association with disease-induced sudden death: a cross-sectional studyResearch in context The Lancet Regional Health. Europe Primary aldosteronism Sudden death Aldosterone synthase CYP11B2 Hypertension Pheochromocytoma |
| title | Adrenal aldosterone synthase (CYP11B2) histopathology and its association with disease-induced sudden death: a cross-sectional studyResearch in context |
| title_full | Adrenal aldosterone synthase (CYP11B2) histopathology and its association with disease-induced sudden death: a cross-sectional studyResearch in context |
| title_fullStr | Adrenal aldosterone synthase (CYP11B2) histopathology and its association with disease-induced sudden death: a cross-sectional studyResearch in context |
| title_full_unstemmed | Adrenal aldosterone synthase (CYP11B2) histopathology and its association with disease-induced sudden death: a cross-sectional studyResearch in context |
| title_short | Adrenal aldosterone synthase (CYP11B2) histopathology and its association with disease-induced sudden death: a cross-sectional studyResearch in context |
| title_sort | adrenal aldosterone synthase cyp11b2 histopathology and its association with disease induced sudden death a cross sectional studyresearch in context |
| topic | Primary aldosteronism Sudden death Aldosterone synthase CYP11B2 Hypertension Pheochromocytoma |
| url | http://www.sciencedirect.com/science/article/pii/S2666776225000183 |
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