Cellular and genetic causes of idiopathic hyperaldosteronism

Kei Omata, Fumitoshi Satoh, Ryo Morimoto, Sadayoshi Ito, Yuto Yamazaki, Yasuhiro Nakamura, Sharath K. Anand, Zeng Guo, Michael Stowasser, Hironobu Sasano, Scott A. Tomlins, William E. Rainey

Research output: Contribution to journalArticlepeer-review

127 Citations (Scopus)


Primary aldosteronism affects ≈5% to 10% of hypertensive patients and has unilateral and bilateral forms. Most unilateral primary aldosteronism is caused by computed tomography-detectable aldosterone-producing adenomas, which express CYP11B2 (aldosterone synthase) and frequently harbor somatic mutations in aldosterone-regulating genes. The cause of the most common bilateral form of primary aldosteronism, idiopathic hyperaldosteronism (IHA), is believed to be diffuse hyperplasia of aldosterone-producing cells within the adrenal cortex. Herein, a multi-institution cohort of 15 IHA adrenals was examined with CYP11B2 immunohistochemistry and next-generation sequencing. CYP11B2 immunoreactivity in adrenal glomerulosa harboring non-nodular hyperplasia was only observed in 4/15 IHA adrenals suggesting that hyperplasia of CYP11B2-expressing cells may not be the major cause of IHA. However, the adrenal cortex of all IHA adrenals harbored at least 1 CYP11B2-positive aldosterone-producing cell cluster (APCC) or micro-aldosterone-producing adenomas. The number of APCCs per case (and individual APCC area) in IHA adrenals was significantly larger than in normotensive controls. Next-generation sequencing of DNA from 99 IHA APCCs demonstrated somatic mutations in genes encoding the L-type calcium voltage-gated channel subunit α 1-D (CACNA1D, n=57; 58%) and potassium voltage-gated channel subfamily J-5 (KCNJ5, n=1; 1%). These data suggest that IHA may result from not only hyperplasia but also the accumulation or enlargement of computed tomography-undetectable APCC harboring somatic aldosterone-driver gene mutations. The high prevalence of mutations in the CACNA1D L-type calcium channel provides a potential actionable therapeutic target that could complement mineralocorticoid blockade and inhibit aldosterone overproduction in some IHA patients.

Original languageEnglish
Pages (from-to)874-880
Number of pages7
Issue number4
Publication statusPublished - 2018


  • Adrenal cortex
  • Aldosterone
  • Calcium channels
  • Hyperaldosteronism
  • Hypertension


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