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Histopathological and genetic characterization of aldosterone-producing adenomas with concurrent subclinical cortisol hypersecretion: a case series

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Abstract

Purpose

Aldosterone-producing adenomas with concurrent subclinical cortisol hypersecretion are reported in an increasing number of patients. Five aldosterone-producing adenomas from patients with primary aldosteronism and subclinical hypercortisolism were examined. The aims of our study were: (1) to analyze pathological features and immunohistochemical expression of CYP11B1 (11β-hydroxylase) and CYP11B2 (aldosterone synthase) in these tumors; (2) to investigate somatic mutations involved in adrenal steroid hypersecretion and/or tumor growth.

Methods

Archival micro-dissected paraffin-embedded slides from tumor specimens were used for histological and molecular studies. Immunohistochemistry was performed using monoclonal anti-CYP11B1 and anti-CYP11B2 antibodies. Cellular composition was determined by examining for known features of zona fasciculata and zona glomerulosa, and immunoreactivity for CYP11B1 and CYP11B2 by McCarty H-score. Spot regions for mutations in KCNJ5, ATP1A1, ATP2B3, CACNA1D, PRKACA, and CTNNB1 gene sequences were evaluated.

Results

Four APAs showed a predominant (≥50%) zona fasciculata-like cell pattern: one tumor had CYP11B1 H-score = 150, no detectable CYP11B2 expression, and harbored a PRKACA p.Leu206Arg mutation (that we have reported previously elsewhere), one had no CYP11B1 expression, CYP11B2 H-score = 40, and no mutations; the remaining two adenomas had high CYP11B1 H-score (160 and 240, respectively) and low CYP11B2 H-score (30 and 15, respectively), with the latter harboring a CTNNB1 p.Ser45Phe activating mutation. One of five aldosterone-producing adenomas had a predominant zona glomerulosa-like pattern, CYP11B1 H-score = 15, CYP11B2 H-score = 180, and no mutations.

Conclusions

The majority of aldosterone-producing adenomas with concurrent subclinical cortisol hypersecretion were composed mainly of zona fasciculata-like cells, while CYP11B1 and CYP11B2 immunostaining demonstrated clear heterogeneity. In a subset of cases, different somatic mutations may be involved in hormone excess and tumor formation.

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Acknowledgements

The authors thank Dr. Vincenza Guzzardo for technical assistance.

Funding

This study was supported by Fondo Investimenti Ricerca di Base (FIRB) Accordi di Programma 2011, RBAP1153LS-02 from the Ministry of Education, University, and Research- Rome, Italy. Dr. C.E.G.S was supported by National Heart, Lung and Blood Institute grant R01 HL27255 and the National Institute of General Medical Sciences of the National Institutes of Health, USA, under Award Number 1U54GM115428.

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Authors and Affiliations

  1. Clinica Medica 3, Department of Medicine, University of Padova, Padova, Italy

    Francesco Fallo & Catia Pilon

  2. Division of Pathology, Department of Medical Sciences, University of Torino, Torino, Italy

    Isabella Castellano

  3. Endocrine Section, G.V. (Sonny) Montgomery VA Medical Center and University of Mississipi Medical Center, Jackson, MS, USA

    Celso E. Gomez-Sanchez

  4. Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany

    Yara Rhayem, Felix Beuschlein & Martin Reincke

  5. Endocrinology Unit, University of Bologna, Bologna, Italy

    Valentina Vicennati

  6. Pathology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy

    Donatella Santini

  7. Cytopathology Unit, Department of Medicine, University of Padova, Padova, Italy

    Valeria Maffeis & Ambrogio Fassina

  8. Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Torino, Italy

    Paolo Mulatero

Authors
  1. Francesco Fallo
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  2. Isabella Castellano
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  3. Celso E. Gomez-Sanchez
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  4. Yara Rhayem
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  5. Catia Pilon
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  6. Valentina Vicennati
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  7. Donatella Santini
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  8. Valeria Maffeis
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  9. Ambrogio Fassina
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  11. Felix Beuschlein
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  12. Martin Reincke
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Corresponding author

Correspondence to Francesco Fallo.

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The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Fallo, F., Castellano, I., Gomez-Sanchez, C.E. et al. Histopathological and genetic characterization of aldosterone-producing adenomas with concurrent subclinical cortisol hypersecretion: a case series. Endocrine 58, 503–512 (2017). https://doi.org/10.1007/s12020-017-1295-4

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