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Immunohistochemistry improves histopathologic diagnosis in primary aldosteronism
  1. Cristina Volpe1,2,
  2. Anders Höög3,4,
  3. Tadashi Ogishima5,
  4. Kuniaki Mukai6,
  5. Ming Lu1,
  6. Marja Thorén1,7,
  7. Bertil Hamberger1,8
  1. 1Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
  2. 2Division of Endocrinology, Department of Internal Medicine, Södersjukhuset, Stockholm, Sweden
  3. 3Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
  4. 4Department of Clinical Pathology and Cytology, Karolinska University Hospital Solna, Stockholm, Sweden
  5. 5Department of Chemistry, Faculty of Sciences, Kyushu University, Fukuoka, Japan
  6. 6Department of Biochemistry, School of Medicine, Keio University 35 Shinanomachi, Tokyo, Japan
  7. 7Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital Solna, Stockholm, Sweden
  8. 8Department of Breast and Endocrine Surgery, Karolinska University Hospital Solna, Stockholm, Sweden
  1. Correspondence to Dr Cristina Volpe, Department of Internal Medicine, Division of Endocrinology, Södersjukhuset, Stockholm S-118 83, Sweden; cristina.dahlqvist-volpe{at}sodersjukhuset.se

Abstract

Background In primary aldosteronism (PA) the main source of aldosterone hypersecretion is an aldosterone-producing adenoma (APA) or a bilateral hyperplasia. Histopathology of the adrenal gland from patients with PA has been difficult, as there are no morphological criteria to ascertain which are the cells that produce aldosterone. We therefore applied new specific antibodies to explore which cells in the adrenal contain the enzymes for aldosterone and cortisol production, respectively.

Methods Adrenals from 24 patients with PA were studied. After routine preparation, consecutive sections were stained with antibodies for CYP11B1 (cortisol) and CYP11B2 (aldosterone) enzymes.

Results APA had a strong immunoreactivity for CYB11B2. In adrenals from seven patients, we found no APA, but several nodules with strong CYB11B2 immunoreactivity, indicating aldosterone-producing nodular hyperplasia.

Conclusions Immunohistochemistry of adrenal steroidogenic enzymes provides novel diagnostic information. This may become an important part of routine histopathology, and contribute to improved clinical management in PA.

  • Aldosterone
  • Adrenal Gland
  • Endocrine Pathology
  • Immunohistochemistry
  • Cytochromes

https://doi.org/10.1136/jclinpath-2012-201287

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