Key words
aldosterone - renin - adrenal adenoma - secondary hypertension - endocrine hypertension
Introduction
Fourteen years ago, in July 2009, we held the first Progress in Primary
Aldosteronism (PIPA) meeting in Munich. Our idea was that a meeting
dedicated to primary aldosteronism (PA) would facilitate collaborative research and
scientific exchange in the field. Since then, five more PIPA meetings in
2011, 2013, 2015, 2017 and 2019 gathered scientists from around the world and led
to
the Progress in Primary Aldosteronism special issues in Hormone and Metabolic
Research (2011, 2015, 2017, 2020) and in the European Journal of
Endocrinology (2013) that covered current knowledge by PIPA
participants. Also, numerous collaborative projects were initiated at these
conferences.
Then, in 2020, the COVID-19 outbreak caused an unprecedented challenge to humanity,
science and research. Worldwide public and private initiatives were undertaken to
fight the pandemic, and for 2 long years, everyone was stuck in a black hole.
Research related to the COVID-19 emergency increased dramatically, and increasing
resources were directed towards pandemic-related research areas. Research in many
fields, not directly related to the pandemic, suffered or was partially displaced
[1]. Due to the pandemic, we were unable to
hold our biennial PIPA meeting in 2021.
The Pipa 7 Conference In Munich 2022
Following the recovery in 2022, we believed that the ideal time had come to
reconvene. Major progress had been made during the past years, and key publications
have addressed new genetic events [2]
[3]
[4]
[5]
[6]
[7], diagnosis [8, 9] pathophysiology of aldosterone
excess [10]
[11]
[12]
[13]
[14]
[15], imaging [16], histopathologic
classifications [17], and treatment [18] but unresolved and controversial issues remain.
In October 2022, PIPA 7 took place in the usual location at Castle
Nymphenburg in Munich. With the generous support of the Deutsche
Forschungsgemeinschaft and the Carl Friedrich von Siemens Stiftung we
were able to invite many of the internationally renowned researchers in the field
[Fig. 1]. The present volume of
Experimental and Clinical Endocrinology and Diabetes is entirely
dedicated to reviews based on PIPA 7 presentations. To avoid overlap with
prior PIPA proceedings the current reviews focus on areas, which can be considered
as ‘hot topics’ or those which have not been recently covered. They
are written by experts in their respective fields and include seven invited articles
summarizing main presentations given at the symposium.
The first article by Celso and Elisa Gomez-Sanchez presents an abbreviated history
of
aldosterone metabolism, including the most relevant mineralocorticoid steroids
implicated in PA [19].
Primary aldosteronism is characterized by dysregulated, renin-independent aldosterone
excess. Long perceived as rare, PA has emerged as one of the most common causes of
secondary hypertension. The first review by Charoensri & Turcu summarize the
reports on PA prevalence among the general population and in specific high-risk
subgroups, highlighting the impact of rigid versus permissive criteria on PA
prevalence perception [20].
Despite the well-established data on prevalence of PA, the current rate of PA
detection is appallingly low. The review by Libianto et al. explores the challenges
that clinicians often face in diagnosing PA and offers strategies that may improve
the detection of this potentially curable form of hypertension [21].
Lenzini et al. review the current knowledge of the factors that contribute to the
resistant hypertension phenotype with a focus on PA and discuss the issues regarding
the screening for PA in this setting and the therapeutic approaches [22].
The article of Younes et al. analyses the role of different selectivity and
lateralization indices during adrenal vein sampling on guiding surgical decision
towards adrenalectomy in primary aldosteronism [23]. Current clinical guidelines recommend that adrenal vein sampling may
not be necessary in patients younger than 35 years who have marked aldosteronism and
a solitary adrenal adenoma on imaging. The review by Gkaniatsa & Ragnarsson
evaluates the more recent literature about imaging studies in young patients as a
predictor of unilateral PA [24].
Finally, the review by Lee & Drake summarizes current evidence concerning
radio frequency ablation of unilateral aldosterone-producing lesions as an
alternative to unilateral adrenalectomy [25].
We hope our readers find these articles interesting.
Fig. 1 Participants of PIPA 7 in the Carl Friedrich von Siemens
Foundation in Nymphenburg, Munich. Source: Martin Reincke.
Martin Reincke
Editor-in-Chief
Experimental and clinical Endocrinology and Diabetes
William E. Rainey
Tracy Ann Williams
