Tag: adrenal glands

Categories : Cardiovascular DiseaseTags :

New Treatment Offers a Quick Cure for Common Cause of Hypertension

On By ModernMedia
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Doctors at Queen Mary University of London, Barts Health NHS Trust and University College London have developed a groundbreaking, minimally invasive treatment, Triple T, offering hope for millions of people with high blood pressure caused by a commonly overlooked condition. 

The treatment, which could transform blood pressure management, has been published in The Lancet.

Triple T, also known as endoscopic ultrasound-guided radiofrequency ablation, is poised to change the way we address primary aldosteronism (PA) – a hormonal disorder that causes high blood pressure in one in 20 patients with blood pressure yet is often undiagnosed and untreated. This treatment has shown promising results in clinical trials and could become an accessible alternative to surgery, offering relief to those who suffer from this condition. 

The hidden cause of high blood pressure  

High blood pressure, affecting one in three adults, has several underlying causes, with PA being one of the most common yet underdiagnosed. In this condition, benign nodules in the adrenal glands produce excess aldosterone, a hormone that raises blood pressure by increasing salt levels in the body. Patients with PA often do not respond to standard medications and face increased risks of heart attacks, strokes and kidney failure. 

Until now, the only effective treatment for PA has been the surgical removal of the affected adrenal gland. However, this procedure requires general anaesthesia, a hospital stay, and weeks of recovery, causing many patients to go untreated. Triple T provides a faster, safer, and less invasive alternative by targeting and destroying the malfunctioning adrenal nodule without removing the gland.  

How Triple T works 

The procedure uses a combination of radiofrequency or microwaves and ultrasound to deliver targeted heat to the adrenal nodule. A fine needle is inserted through the stomach to the adrenal gland, guided by real-time ultrasound imaging, where short bursts of heat are used to destroy the problematic tissue. This targeted approach ensures minimal damage to surrounding healthy tissues. The entire procedure lasts only 20 minutes and requires no incision.   

Triple T’s success stems from recent advances in diagnostic scans, which use molecular dyes to accurately locate even the smallest adrenal nodules. These breakthroughs, combines with the ability to directly target nodules adjacent to the stomach, have enabled this minimally invasive approach. 

Successful trial and promising results  

The Feasibility study of radiofrequency endoscopic ABlation, with ULtrasound guidance (FABULAS) trial which tested Triple T on 28 patients with PA, showed excellent results. The procedure was found to be safe and effective, with most patients experiencing normalised hormones levels within six months. Many participants were able to stop all blood pressure medications, and the condition did not recur. 

Professor Morris Brown, co-senior author of the study and Professor of Endocrine Hypertension at Queen Mary University of London, reflected on the significance of this milestone: “It is 70 years since the discovery in London of the hormone aldosterone, and, a year later, of the first patient in USA with severe hypertension due to an aldosterone-producing tumour. This patient’s doctor, Jerome Conn, predicted, with perhaps only minor exaggeration, that 10-20% of all hypertensions might one day be traced to curable nodules in one or both glands. We are now able to realise this prospect, offering 21st-century breakthroughs in diagnosis and treatment.”  

One trial participant, Michelina Alfieri, shared her experience: “Before the study, I suffered from debilitating headaches for years despite multiple GP visits. As a full-time worker and single parent, my daily life was severely affected. This non-invasive treatment provided an immediate recovery—I was back to my normal routine straight away. I’m incredibly grateful to the team for giving me this choice.”  

What’s next?  

The success of the FABULAs trial has led to a larger study, WAVE, which will compare Triple T with traditional surgery in 120 patients. Results are expected in 2027. 

Professor Stephen Pereira, Chief Investigator of FABULAS, emphasised the potential global impact of Triple T. he said: “This less invasive technique could be widely offered in endoscopy units across the UK and internationally.”  

Clinical Endocrinology Lead at Addenbrooke’s Hospital and Professor of Clinical Endocrinology at the University of Cambridge, Professor Mark Gurnell, said: “Thanks to this work, we may finally be able to diagnose and treat more people with primary aldosteronism, lowering their risk of developing cardiovascular diseases and other complications, and reducing the number of people dependent on long-term blood pressure medication.” 

The research was primarily supported by Barts Charity, National Institute for Health and Care Research (NIHR) through the Barts and Cambridge Biomedical Research Centres (BRCs), and the British Heart Foundation.  

It is being followed by a larger randomised trial, called ‘WAVE’, which will compare TTT to traditional surgery in 120 patients. The results are expected in 2027.  

Source: Queen Mary University of London

Categories : Diseases, Syndromes and ConditionsTags :

Timed Cortisol Delivery Improves Adrenal Condition Symptoms

On By ModernMedia
Photo by Karolina Grabowska on Pexels

A trial of a hormone replacement therapy that more closely replicates the natural circadian and ultradian rhythms of hormones has shown to improve symptoms in patients with adrenal conditions. Results from the University of Bristol-led clinical trial are published in the Journal of Internal Medicine.

Low cortisol levels typically result from conditions such as Addison’s and Congenital Adrenal Hyperplasia. The hormone regulates a range of vital processes, from cognitive processes such as memory formation, metabolism and immune responses, through to blood pressure and blood sugar levels. When low, it can trigger symptoms of debilitating fatigue, nausea, muscle weakness, dangerously low blood pressure and depression. Although rare, these adrenal conditions require lifelong daily hydrocortisone replacement therapy.

Although existing oral hormone replacement treatment can restore cortisol levels, it is still associated with an impaired quality of life for patients. Scientists believe this is because the current treatment does not mimic the body’s normal physiological timing, missing cortisol’s anticipatory rise and lacking its underlying ultradian and circadian rhythms.

The new ‘Pulsatility’ therapy, the culmination of ten years research by the Bristol team, is designed to deliver standard hydrocortisone replacement to patients via a pump which replicates more closely cortisol’s natural rhythmic secretion pattern. The pulsatile subcutaneous pump has now revealed promising results in its first clinical trial.

The double-blinded PULSES six-week trial recruited 20 participants aged 18 to 64 years with adrenal insufficiency conditions. They treated with usual dose hydrocortisone replacement therapy administered either via the pump or the standard three times daily oral treatment.

While only psychological and metabolic symptoms were assessed during the trial, results revealed the pump therapy decreased patient fatigue by approximately 10%, improved mood and increased energy levels by 30% first thing in the morning – when many patients struggle the most. MRI scans also revealed alteration in the way that the brain processes emotional information.

Dr Georgina Russell, Honorary Lecturer at the University’s Bristol Medical School, and the lead author, explained: “Patients on cortisol replacement therapy often have side effects which makes it difficult for them to lead normal lives. We hope this new therapy will offer greater hope for the thousands of people living with hormone insufficiency conditions.”

Stafford Lightman, a neuroendocrinology expert and Professor of Medicine at Bristol Medical School: Translational Health Sciences (THS), and the study’s joint lead author, added: “Besides reduction in dosage, cortisol replacement has remained unchanged for many decades. It is widely recognised that current replacement therapy is unphysiological due to its lack of pre-awakening surge, ultradian rhythmicity, and post dose supraphysiological peaks. The new therapy clearly shows that the timing of cortisol delivery, in line with the body’s own rhythmic pattern of cortisol secretion, is important for normal cognition and behaviour.

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Categories : Cardiovascular Disease Lab Tests and ImagingTags :

A Quick Scan Can Pinpoint Hypertension-causing Adrenal Nodules

On By ModernMedia
Stethoscope
Photo by Hush Naidoo on Unsplash

Doctors have demonstrated a new type of CT scan that lights up tiny nodules in the adrenal glands which give rise to hypertension in about 5% of hypertensive patients. enabling hypertension to be cured by their removal. The nodules are discovered in about 5% of hypertensive patients.

Published in The Journal of Hypertension, this work solves a 60-year problem of how to detect the hormone-producing nodules without a difficult and failure-prone catheter study that is available in only a few hospitals. The research also found that, when combined with a urine test, the scan detects a group of patients who come off all their blood pressure medicines after treatment.

The study, led by doctors at Queen Mary University of London and Barts Hospital, and Cambridge University Hospital, involved 128 participants for whom hypertension was found to be caused by aldosterone. The scan found that in two thirds of patients with elevated aldosterone secretion, this is coming from a benign nodule in just one of the adrenal glands, which can then be safely removed. The scan uses a very short-acting dose of metomidate, a radioactive dye that sticks only to the aldosterone-producing nodule.

The scan was as accurate as the old catheter test, but quick, painless and technically successful in every patient. Until now, the catheter test was unable to predict which patients would be completely cured of hypertension by surgical removal of the gland. By contrast, the combination of a ‘hot nodule’ on the scan and urine steroid test detected 18 of the 24 patients who achieved a normal blood pressure off all their drugs.

Professor Morris Brown, co-senior author of the study and Professor of Endocrine Hypertension at Queen Mary University of London, said: “These aldosterone-producing nodules are very small and easily overlooked on a regular CT scan. When they glow for a few minutes after our injection, they are revealed as the obvious cause of hypertension, which can often then be cured. Until now, 99% are never diagnosed because of the difficulty and unavailability of tests. Hopefully this is about to change.”

In most people with hypertension, the cause is unknown, and the condition requires life-long treatment by drugs. Previous research by the group at Queen Mary University discovered that in 5–10% of people with hypertension the cause is a gene mutation in the adrenal glands, which results in excessive amounts of the steroid hormone, aldosterone, being produced. Aldosterone causes salt retention, driving up blood pressure. Patients with excessive aldosterone levels in the blood are resistant to treatment with standard antihypertensives, and at increased risk of cardiovascular disease.

Source: Queen Mary University of London