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Last modified date:2024.06.03

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1. Maki Yokomoto-Umakoshi, Ryuichi Sakamoto, Hironobu Umakoshi, Yayoi Matsuda, Hiromi Nagata, Tazuru Fukumoto, Masatoshi Ogata, Yoshihiro Ogawa, Unilateral primary aldosteronism as an independent risk factor for vertebral fracture., Clinical endocrinology, 10.1111/cen.14145, 92, 3, 206-213, 2020.03, CONTEXT: Primary aldosteronism (PA) is known to increase vertebral fracture (VF), although the detailed mechanism remains to be elucidated. We hypothesized that the PA subtype is associated with VF. OBJECTIVE: To evaluate whether unilateral PA is associated with the prevalence of VF. DESIGN: This was a retrospective cross-sectional study in a single referral centre. PATIENTS: We identified 210 hypertensive patients whose clinical data were available for case-detection results. One hundred and fifty-two patients were diagnosed with PA using captopril challenge tests. MEASUREMENTS: We measured the prevalence of VF, according to PA subtype. RESULTS: One hundred thirteen patients with PA were subtype classified by adrenal vein sampling. Of these, 37 patients had unilateral PA, 76 patients had bilateral PA, 58 patients had non-PA; 39 patients with PA were not subtype-classified. Patients with PA had a higher prevalence of VF (29%, 44/152) than those with non-PA (12%, 7/58; P = .011). Moreover, unilateral PA had a higher prevalence of VF (46%, 17/37) than bilateral PA (20%, 15/76; P = .021). There was no significant difference in the prevalence of VF between bilateral PA and non-PA. Unilateral PA was an independent risk factor for VF after adjusting for age and sex (OR: 3.16, 95% confidence interval: 1.12-8.92; P = .017). Among patients with unilateral PA, serum cortisol concentrations after 1-mg dexamethasone suppression test were higher in those with VF (1.32 ± 0.67 g/dL) than those without (0.96 ± 0.33 g/dL; P = .048). CONCLUSIONS: Unilateral PA is an independent risk factor for VF..
2. Maki Yokomoto-Umakoshi, Hironobu Umakoshi, Ryuichi Sakamoto, Tazuru Fukumoto, Masatoshi Ogata, Yui Nakano, Norifusa Iwahashi, Hiroki Kaneko, Noriko Mizoguchi, Akiko Hattori, Takashi Miyazawa, Yayoi Matsuda, Hisaya Kawate, Yoshihiro Ogawa, Role of Deteriorated Bone Quality in the Development of Osteoporosis in Pheochromocytoma and Paraganglioma., Bone, 10.1016/j.bone.2020.115607, 142, 115607-115607, 2020.08, Context Pheochromocytoma (PHEO) and paraganglioma (PGL) (PHEO and PGL: PPGLs), catecholamine-producing tumors, represent an emerging cause of secondary osteoporosis. However, despite decreased bone mineral density (BMD), vertebral fracture (VF) is not associated with BMD in PPGLs. OBJECTIVE: To evaluate whether deteriorated bone quality is involved in the development of osteoporosis in PPGLs. PARTICIPANTS: Trabecular bone score (TBS), used to assess trabecular bone quality, was examined in 56 patients with PPGLs and 52 with non-functional adrenal tumors (AT). Radiograph of the spine was carried out in 35 patients with PPGLs, and TBS was analyzed in 18 patients with PPGLs at follow-up. Main outcome measure TBS and BMD at the lumbar spine in patients with PPGLs with and without VF. RESULTS: PPGLs had a lower TBS (n=56, 1.338 [1.294-1.420]) than non-functional AT (n=52, 1.394 [1.342-1.444]; p=0.033). Among those with PPGLs, patients with VF (n=14, 1.314 [1.289-1.346]) had a lower TBS than those without VF (n=21, 1.383 [1.324-1.426]; p=0.046), despite no significant difference in BMD at the lumbar spine between the two groups (p=0.501). An optimal cut-off level of TBS for diagnosing VF in PPGLs was 1.323, and its area under the curve was 0.702. The severity of catecholamine excess and maximal size of tumor were associated with decreased TBS in PPGLs patients (p=0.016 and p=0.020, respectively). Surgical resection of PPGLs improved TBS at follow-up, with 2.5% increase (p=0.007). CONCLUSIONS: This study provides evidence for the importance of deteriorated bone quality rather than decreased bone mass in the development of VF in PPGLs..
3. Hironobu Umakoshi, Ryuichi Sakamoto, Yayoi Matsuda, Maki Yokomoto-Umakoshi, Hiromi Nagata, Tazuru Fukumoto, Masatoshi Ogata, Yoshihiro Ogawa, Role of Aldosterone and Potassium Levels in Sparing Confirmatory Tests in Primary Aldosteronism., The Journal of clinical endocrinology and metabolism, 10.1210/clinem/dgz148, 105, 4, 1284-1289, 2020.04, CONTEXT: The current clinical guidelines suggest that confirmatory tests for primary aldosteronism (PA) may be excluded in some of patients who have elevated plasma aldosterone concentration (PAC) under plasma renin suppression. However, this has low-priority evidence and is under debate in use of serum potassium. OBJECTIVE: This study aimed to investigate an appropriate setting for sparing confirmatory tests in PA. DESIGN AND SETTING: A retrospective cross-sectional study in a single referral center. PARTICIPANTS: This study included 327 patients who had hypertension under plasma renin suppression and underwent the captopril challenge test (CCT) between January 2007 and April 2019. CCT results were used to diagnose PA. MAIN OUTCOME MEASURE: Diagnostic value of PAC and serum potassium in confirmation of PA. RESULTS: Of the studied patients, 252 of 327 (77%) were diagnosed with PA. All 61 patients with PAC > 30 ng/dL were diagnosed with PA. In patients with PAC between 20 and 30 ng/dL, 44 of 55 (80%) were diagnosed with PA, while all 26 with PAC between 20 to 30 ng/dL who had spontaneous hypokalemia were diagnosed with PA. The proportion of unilateral PA determined by adrenal vein sampling (AVS) was higher in patients who had PAC > 30 ng/dL or those with spontaneous hypokalemia who had PAC between 20 and 30 ng/dL than those who did not meet the criteria (76% vs. 17%, P