Evidence map›Paper›PMID 39995489›Full record

ArticleThe Lancet regional health. Europe2025

Adrenal aldosterone synthase (CYP11B2) histopathology and its association with disease-induced sudden death: a cross-sectional study.

Antero Ylänen, Juhani Isojärvi, Antti Virtanen, Helena Leijon, Tiina Vesterinen, Aapo L Aro, Heini Huhtala, Eeva Kokko, Ilkka Pörsti, Marianna Viukari and 2 more

Registry-linked trialAbstract read
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In one paragraph

Article in The Lancet regional health. Europe, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05446779 (Postmortem Evaluation of Adrenal and Other Endocrine Tumors in Patients With Sudden Death Without Definitive Causative Diagnosis), which is not on this map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05446779 active not recruitingnot on this map

Postmortem Evaluation of Adrenal and Other Endocrine Tumors in Patients With Sudden Death Without Definitive Causative Diagnosis (PEA-SuddenDeath)

TypeobservationalSponsorHelsinki University Central HospitalRan2022 to 2026Enrolled400ConditionsPrimary Aldosteronism, Adrenal Cushing Syndrome, Pheochromocytoma, Endocrine NeoplasiaArmsAdrenal aldosterone synthase (CYP11B2) staining, Adrenal cortisol synthase (CYP11B1) staining, Histopathological analysis
3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Review
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Antero YlänenFaculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Juhani IsojärviFaculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Antti VirtanenForensic Medicine Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.
Helena LeijonHUS Diagnostic Center, HUSLAB, Department of Pathology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Tiina VesterinenHUS Diagnostic Center, HUSLAB, Department of Pathology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Aapo L AroHeart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Heini HuhtalaHealth Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland.
Eeva KokkoFaculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Ilkka PörstiFaculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Marianna ViukariEndocrinology, Helsinki University Hospital, ENDO-ERN (European Reference Network on Rare Endocrine Conditions) and University of Helsinki, Helsinki, Finland.
Pasi I NevalainenFaculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Niina MatikainenEndocrinology, Helsinki University Hospital, ENDO-ERN (European Reference Network on Rare Endocrine Conditions) and University of Helsinki, Helsinki, Finland.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: Unidentified cardiovascular risk factors may account for approximately half of sudden deaths, a devastating event with limited preventive tools. We investigated whether adrenal histopathology suggestive of primary aldosteronism, pheochromocytoma, or adrenal masses could explain part of the risk for disease-induced sudden death (DSD). Methods: In this study, autopsies and histopathological analyses, including aldosterone synthase staining of adrenal glands, were performed on 403 consecutive individuals who experienced sudden death. These individuals were classified into 258 cases of DSD and 144 deaths caused by trauma, suicide, or intoxication, i.e., non-disease-induced sudden death (nDSD). This trial was registered at ClinicalTrials.gov (NCT05446779). Findings: Adrenal histopathology revealed changes in 31 (7.7%) subjects of the cohort. Of these, the most prevalent findings [25 (6.2%)] were aldosterone-producing adenomas (APA) or nodules (APN), which were associated with myocardial infarction and atherosclerosis at autopsy. Individuals in the DSD group and the subgroup with sudden cardiac death (SCD) were more likely to have APA or APN than individuals in the nDSD group [23 (8.9%) vs. 2 (1.4%), p = 0.002; 16 (8.8%) vs. 2 (1.4%), p = 0.003, respectively]. APA or APN were explanatory factors for DSD (odds ratio [OR] 6.47, 95% confidence interval [CI] 1.40-29.88, p = 0.017) and SCD (OR 10.68, 95% CI 2.02-56.43, p = 0.005). Other findings included two pheochromocytomas, one bilateral adrenal metastasis, and two unilateral adrenal metastases. Interpretation: In this exploratory study, APA or APN were more frequently seen in DSD and SCD than nDSD cases. Whether primary aldosteronism constitutes a novel risk factor for sudden death warrants further study. Funding: Finnish State Research funds and independent research foundations: Aarne Koskelo Foundation, the Finnish Kidney Foundation, and the Finnish Foundation for Cardiovascular Research.

Indexed as

Aldosterone-producing adenomaAldosterone-producing micronoduleAldosterone-producing noduleAldosterone synthaseCYP11B2Histopathological classificationHypertensionPheochromocytomaPrimary aldosteronismSudden death

Identifiers

PMID39995489
PMCPMC11849129

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.