Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Malaysia.
Front Endocrinol (Lausanne). 2021 Mar 3;12:631848. doi: 10.3389/fendo.2021.631848. eCollection 2021.
Primary aldosteronism (PA) is one of the most frequent curable forms of secondary hypertension. It can be caused by the overproduction of aldosterone in one or both adrenal glands. The most common subtypes of PA are unilateral aldosterone over-production due to aldosterone-producing adenomas (APA) or bilateral aldosterone over-production due to bilateral hyperaldosteronism (BHA). Utilizing the immunohistochemical (IHC) detection of aldosterone synthase (CYP11B2) has allowed the identification of aldosterone-producing cell clusters (APCCs) with unique focal localization positive for CYP11B2 expression in the subcapsular portion of the human adult adrenal cortex. The presence of CYP11B2 supports that synthesis of aldosterone can occur in these cell clusters and therefore might contribute to hyperaldosteronism. However, the significance of the steroidogenic properties of APCCs especially in regards to PA remains unclear. Herein, we review the available evidence on the presence of APCCs in normal adrenals and adrenal tissues adjacent to APAs, their aldosterone-stimulating somatic gene mutations, and their accumulation during the ageing process; raising the possibility that APCCs may play a role in the development of PA and age-related hypertension.
原醛症（PA）是继发性高血压最常见的可治愈形式之一。它可能是由于一个或两个肾上腺过度产生醛固酮引起的。PA 最常见的亚型是单侧醛固酮过度产生，原因是醛固酮瘤（APA）或双侧醛固酮过度产生，原因是双侧高醛固酮血症（BHA）。利用醛固酮合酶（CYP11B2）的免疫组织化学（IHC）检测，可以识别醛固酮产生细胞簇（APCCs），其在人类成年肾上腺皮质的包膜下部分具有独特的局灶性 CYP11B2 表达阳性。CYP11B2 的存在支持在这些细胞簇中可以发生醛固酮的合成，因此可能导致高醛固酮血症。然而，APCCs 的甾体生成特性，特别是在 PA 方面的意义尚不清楚。在此，我们回顾了关于正常肾上腺和 APA 附近肾上腺组织中 APCCs 的存在、它们的醛固酮刺激体细胞基因突变以及它们在衰老过程中的积累的现有证据；提出了 APCCs 可能在 PA 和与年龄相关的高血压的发展中发挥作用的可能性。
