Teresa Maria Seccia

Teresa Maria Seccia
University of Padua | UNIPD

MD, PhD; Associate Professor in Internal Medicine

About

249
Publications
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Publications

Publications (249)
Article
Disclosure: G. Pintus: None. T.M. Seccia: None. G. Rossitto: None. B. Caroccia: None. G. Ceolotto: None. L. Lenzini: None. G. Rossi: None. Background. Current guidelines suggest withdrawal of mineralocorticoid receptor antagonists (MRA) before subtyping primary aldosteronism (PA) by adrenal venous sampling (AVS), but this practice can cause severe...
Article
BACKGROUND Primary aldosteronism (PA), the most common curable salt-dependent form of arterial hypertension, features renal K ⁺ loss and enhanced Na ⁺ reabsorption. We investigated whether the electrolyte, water, and TonEBP (tonicity-responsive enhancer binding protein)/NFAT5 (nuclear factor of activated T cells 5) content is altered in the skin of...
Article
Introduction: A systematic screening of hypertensive patients for secondary arterial hypertension (SHT) is generally held to be not justified by the low prevalence of SHT but improved knowledge and diagnostic tools might change this view. Hypothesis: To challenge the notion that the prevalence of SHT is low, we prospectively submitted consenting hy...
Article
Background: Somatic mutations in the KCNJ5 potassium channel involve up to 70% of the patients presenting with primary aldosteronism (PA) caused by an aldosterone-producing adenoma (APA). Macrolides corrected the altered function of the two common mutations G151R and L168R, in vitro suggesting their potential usefulness for personalized management...
Article
Background: Anecdotal reports showed a decrease in blood pressure (BP) values in subjects assuming macrolide antibiotics when co-administered with calcium channel blockers. Recently, in the MAPA study, in patients with primary hypertension given a single dose of macrolide a decrease in BP was observed. However, whether macrolides induce per se vaso...
Article
Introduction: Primary aldosteronism (PA), the most common curable salt-dependent form of arterial hypertension, features renal K ⁺ loss and enhanced Na ⁺ reabsorption. Hypothesis: We assessed the hypothesis that alterations of electrolyte, water, and Tonicity-responsive Enhancer Binding Protein/NFAT5 mRNA content occur in the skin of PA patients an...
Article
Full-text available
Despite carrying an excess risk of cardiovascular events, primary aldosteronism (PA) is a commonly overlooked secondary form of arterial hypertension. An increased awareness of its high prevalence and broader screening strategies are urgently needed to improve its detection rate and allow early diagnosis and targeted treatment. For patients with un...
Article
Context The search for somatic mutations in adrenals resected from primary aldosteronism (PA) patients is being performed by Sanger sequencing, often implemented with immunohistochemistry (IHC)-guidance focused on aldosterone-producing (CYP11B2-positive) areas. Objective To investigate the impact of double IHC for CYP11B1 and CYP11B2 on Sanger and...
Article
The exclusion of causes of hypertension is not systematically exploited in clinical practice. Therefore, essential hypertension is consistently presented as the most prevalent ‘cause’. The paradox of a condition with unknown causes being described as a common cause of hypertension translates into a diagnosis of essential hypertension in most patien...
Article
Objective Current guidelines and consensus documents recommend withdrawal of mineralocorticoid receptor antagonists (MRA) before primary aldosteronism (PA) subtyping by adrenal venous sampling (AVS), but this practice can cause severe hypokalemia and/or uncontrolled high blood pressure (BP) values in PA patients. The aim of the study was to investi...
Article
Objective Primary aldosteronism (PA), the most common cause of secondary hypertension, is associated with excess cardiovascular damage and, when unilateral, is amenable to surgical cure. Our objective was to determine whether the chorioretinal microvasculature is also affected. Design and method Ocular CT-scan (OCT) and angio-OCT images of the sup...
Article
Full-text available
BACKGROUND Current guidelines and consensus documents recommend withdrawal of mineralocorticoid receptor antagonists (MRAs) before primary aldosteronism (PA) subtyping by adrenal vein sampling (AVS), but this practice can cause severe hypokalemia and uncontrolled high blood pressure. Our aim was to investigate if unilateral PA can be identified by...
Article
Full-text available
Background Congestion predicts a poor prognosis, but its assessment is challenging in clinical practice and requires a multiparametric approach. We investigated if the coronary sinus (CS) diameter can predict mortality in a human model of rapid fluid unloading. Methods We measured by echocardiography the CS, and the inferior vena cava (IVC) for co...
Article
Full-text available
Even though SARS-CoV-2 was declared by WHO as constituting no longer a public health emergency, the development of effective treatments against SARS-CoV-2 infection remains a critical issue to prevent complications, particularly in fragile patients. The protease inhibitor nafamostat, currently used in Japan and Korea for pancreatitis, owing to its...
Article
Full-text available
Disclosure: G. Rossi: None. D. Bagordo: None. L. Amar: None. M. Azizi: None. A. Riester: None. M. Reincke: None. C. Degenhart: None. J. Widimský: None. M. Naruse: None. J. Deinum: None. T. Kocjan: None. A. Negro: None. E. Rossi: None. G. Kline: None. A. Tanabe: None. F. Satoh: None. L. Rump: None. O. Vonend: None. H.S. Willenberg: None. P.J. Fuller...
Article
Full-text available
Disclosure: B. Caroccia: None. T.M. Seccia: None. G. Pallafacchina: None. M. Piazza: None. I. Caputo: None. R. Rizzuto: None. G. Rossi: None. A large environmental contamination of drinking water by perfluoroalkyl substances (PFAS) markedly increased by 8-fold the plasma levels of pentadecafluorooctanoic acid (PFOA) and perfluorooctanesulfonic acid...
Article
Full-text available
Disclosure: R. Scarpa: None. M. Piazza: None. B. Caroccia: None. S. Carraro: None. F. Vianello: None. F. Cinetto: None. C. Agostini: None. T.M. Seccia: None. G. Rossi: None. Compelling evidence suggested a role of acquired immunity in hypertension and hypertension-mediated organ damage (HMOD), but the pathogenic role of this acquired immunity is st...
Article
Full-text available
Recurring and rapidly developing (flash) pulmonary edema is the hallmark of Pickering syndrome, affecting patients with hypertension and atherosclerotic renal artery stenosis (either bilateral or unilateral) in a solitary functioning kidney, and impaired renal function. We herein report on a series of consecutive patients with recurrent hospital ad...
Article
Background: Maladaptive left ventricular hypertrophy (LVH) in hypertension is generally regarded as a result of myocardial fibrosis. However, salt loading induces a systemic and isotonic expansion of the extracellular (EC) volume in tissues, which could affect myocardial structure independent of fibrosis. Methods: Cardiac MRI, including cine-images...
Article
Background: Adrenal venous sampling is recommended for the identification of unilateral surgically curable primary aldosteronism but is often clinically useless, owing to failed bilateral adrenal vein cannulation. Objectives: To investigate if only unilaterally selective adrenal vein sampling studies can allow the identification of the responsib...
Article
Objective Compelling evidence suggested a role of acquired immunity in hypertension and hypertension-mediated organ damage (HMOD), but its pathogenic role is still unknown. Primary Aldosteronism (PA), the paradigm of salt-dependent hypertension, is characterised by a more prominent HMOD than primary hypertension and by high titer of autoantibodies...
Article
Objective Adrenal venous sampling (AVS) is recommended for the identification of unilateral surgically curable primary aldosteronism (PA) but, owing to failed bilateral adrenal vein cannulation, is often clinically useless. Design and method We investigated if only unilaterally selective AVS studies can allow identification of the responsible adre...
Article
Objective Posterior reversible encephalopathy syndrome (PRES) is a reversible subcortical vasogenic cerebral oedema involving parieto-occipital regions in patients with acute neurological symptoms. The aim of this study is to analyse an interesting case of PRES after heart transplant. Design and method A heart transplant was performed in a 53-year...
Article
Full-text available
The large environmental contamination of drinking water by perfluoroalkyl substances (PFAS) markedly increased the plasma levels of pentadecafluorooctanoic acid (PFOA) and perfluorooctanesulfonic acid (PFOS) in a Northern Italy population with a high prevalence of arterial hypertension and cardiovascular disease. As the link between PFAS and arteri...
Article
Drug-resistant arterial hypertension (RH) is a major risk factor for cardiovascular disease, often due to overlooked underlying causes. Identification of such causes poses significant clinical challenges. In this setting, primary aldosteronism (PA) is a frequent cause of RH and its prevalence in RH patients is likely higher than 20%. The pathophysi...
Article
Endothelial cell function is mediated by different mechanisms in different vascular beds. Moreover, in humans, endothelial cell dysfunction triggers and accelerates the progression of cardiovascular and chronic kidney diseases. Progression of such diseases can be in part mitigated by the control of cardiovascular risk factors and drugs targeting di...
Article
Full-text available
Patients with an aldosterone-producing adenoma (APA) carry a higher risk of cardiovascular disease and commonly have high levels of autoantibodies (AT1AA) that may activate the angiotensin II type 1 receptor (AT1R). AT1R activation is linked to an increase of the glucose metabolite methylglyoxal (MGO), a potential precursor of advanced glycation en...
Article
Importance Determining the diagnostic accuracy of “exclusion” tests for primary aldosteronism (PA) compared to the aldosterone-to-renin ratio (ARR) is fundamental to avoid invasive subtyping in false-positive patients at screening. Objective To assess the accuracy of exclusion tests for PA using the diagnosis of unilateral PA as reference. Data S...
Article
Primary aldosteronism (PA) in pregnancy (PAP) can be a serious condition and is challenging to diagnose. This study was conceived to help in the diagnosis of PAP and provide suggestions on management of PAP based on evidence retrieved using a Population, Intervention, Comparison, and Outcome search strategy. Based on the changes of aldosterone and...
Article
Full-text available
Blockers of the renin-angiotensin system (RAS) have been reported to increase the angiotensin converting enzyme (ACE)2, the cellular receptor of SARS-CoV-2, and thus the risk and course of COVID-19. Therefore, we investigated if angiotensin (Ang) II and RAS blockers affected ACE2 expression and SARS-CoV-2 infectivity in human epithelial bronchial C...
Article
An altered secretion of adrenocortical and adrenomedullary hormones plays a role in the clinical syndromes of primary aldosteronism (PA), Cushing’s and pheochromocytoma. Moreover, an altered production of adrenocortical hormones and/or an abnormal release of factors by the adrenal medulla are involved in several other diseases, including high blood...
Article
Acute increases of blood pressure values are common causes of patients’ presentation to emergency departments, and their management represents a clinical challenge. They are usually described as ‘hypertensive crises’, ‘hypertensive urgencies’, terms that should be abandoned because they are misleading and inappropriate according to a recent task fo...
Article
Full-text available
Many of the patients with primary aldosteronism (PA) are denied curative adrenalectomy because of limited availability or failure of adrenal vein sampling. It has been suggested that adrenal vein sampling can be omitted in young patients with a unilateral adrenal nodule, who show a florid biochemical PA phenotype. As this suggestion was based on a...
Article
Full-text available
Purpose Familial hyperaldosteronism type 1 (FH-1) is a rare autosomal dominant form of primary aldosteronism, which features a marked phenotypic heterogeneity, ranging from mild to severe forms of arterial hypertension that can be complicated by stroke and cardiovascular events at a young age. As affected patients usually reach the fertile age, tra...
Article
Context: Adrenal glands imaging is recommended by the current guidelines for the work-up of primary aldosteronism (PA). However, its diagnostic performance has not been established in large multi-ethnic cohorts of patients submitted to adrenal vein sampling (AVS) and adrenalectomy. Objective: To assess the diagnostic accuracy of cross-sectional...
Article
Full-text available
The adrenal cortex plays a key role in the regulation of metabolism, salt and water homeostasis and sex differentiation by synthesizing glucocorticoid, mineralocorticoid and androgen hormones. Evidence exists that angiotensin II regulates adrenocortical function and it has been contended that angiotensin peptides of the non-canonical branch of the...
Article
Background: Acute increases of high blood pressure values, usually described as ‘hypertensive crises’, ‘hypertensive urgencies’ or ‘hypertensive emergencies’, are common causes of patients’ presentation to emergency departments. Owing to the lack of ad hoc randomized clinical trials, current recommendations/suggestions for treatment of these patien...
Article
Objective A blood pressure (BP)-independent catabolic shift upon high sodium (Na+) diet, ultimately favouring body fluid preservation, has recently been described in pre-clinical controlled settings. This study sought to investigate the real-life impact of high Na+ intake on measures of renal Na+/water handling and metabolic signatures in patients...
Article
Objective Considering the amount of novel knowledge generated in the last five years, a team of experienced hypertensiologists was assembled to furnish updated clinical practice guidelines for the management of primary aldosteronism (PA). Design and method They were asked to undertake a systematic review of the literature in international database...
Article
Objective The angiotensin converting enzyme 2 (ACE2) and its product angiotensin-(1–7) (Ang-(1–7)) were suggested to play cardiovascular protective effects via angiotensin type 2 (AT2R), MasR and alamandine receptors. Whether this involves blunting of aldosterone biosynthesis in humans remains unknown. Design and method We quantified ACE2 mRNA in...
Poster
Objective Angiotensin converting enzyme 2 (ACE-2) has regained widespread attention as the cellular receptor of SARS-CoV-2 virus that caused the COVID-19 pandemic. It was contended that ACE inhibitors (ACEis) and angiotensin type 1 receptor (AT1R) antagonists (ARBs) increase ACE2 expression in lung cells and their administration in Covid-19 patient...
Article
Aims We aimed at determining the rate of drug-resistant arterial hypertension in patients with an unambiguous diagnosis of primary aldosteronism (PA). Moreover, we sought for investigating the diagnostic performance of adrenal vein sampling (AVS), and the effect of adrenalectomy on blood pressure (BP) and prior treatment resistance in PA patients s...
Article
Vasoactive molecules, such as vascular endothelial growth factor (VEGF) and endothelins, share cytokine-like activities and regulate endothelial cell (EC) growth, migration and inflammation. Some endothelial mediators and their receptors are targets for currently approved angiogenesis inhibitors, drugs that are either monoclonal antibodies raised t...
Article
Objective: The branch of the renin--angiotensin system constituting angiotensin-(1-7) [Ang-(1-7)], the Ang II type 2 receptor, the Mas receptors and the Ang-(1-7)-forming enzyme ACE-2, by counteracting the Ang II type 1 receptor (AT1R)-mediated effects, are held to be cardiovascular protective in several conditions. However, whether Ang-(1-7) and...
Chapter
In this chapter, a paradigmatic case of primary aldosteronism presenting with arterial hypertension and hypokalaemia is illustrated. However, such presentation is not common, and this explains why many cases of primary aldosteronism remain undiagnosed, leaving the patients to high risk of developing organ damage and cardiovascular events. To avoid...
Article
Purpose Familial hyperaldosteronism type 1 (FH-1) is an autosomal dominant form of primary aldosteronism (PA), featuring a marked phenotypic heterogeneity, ranging from mild forms of PA and arterial hypertension (HT) to severe forms complicated by stroke at a young age. Affected patients usually reach the fertile age; hence, transmission of the dis...
Article
Full-text available
The vast majority of hypertensive patients are never sought for a cause of their high blood pressure, i.e. for a ‘secondary’ form of arterial hypertension. This under detection explains why only a tiny percentage of hypertensive patients are ultimately diagnosed with a secondary form of arterial hypertension. The prevalence of these forms is, there...
Article
Primary aldosteronism (PA) is common, but usually overlooked in the elderly, old, and very old patients in whom the already high absolute risk of cardiovascular events, particularly atrial fibrillation, can be further increased by PA. Although in the last two decades there has been an explosion of studies devoted to diagnosis, subtyping, and treatm...
Article
Full-text available
Aims A blood pressure-independent metabolic shift toward a catabolic state upon high sodium (Na+) diet, ultimately favouring body fluid preservation, has recently been described in pre-clinical controlled settings. We sought to investigate the real-life impact of high Na+ intake on measures of renal Na+/water handling and metabolic signatures, as s...
Article
: Autonomous aldosterone overproduction represents the underlying condition of 5-10% of patients with arterial hypertension and carries a significant burden of mortality and morbidity. The diagnostic algorithm for primary aldosteronism is sequentially based on hormonal tests (screening and confirmation tests), followed by lateralization studies (ad...
Article
Full-text available
The key role of arterial hypertension in chonic kidney disease (CKD) progression is widely recognized, but its contribution to tubulointerstitial damage (TID) in glomerulonephritis (GN) remains uncertain. Hence, the objective of this study is to clarify whether TID is associated with glomerular damage, and whether the damage at the tubulointerstiti...
Article
Full-text available
Drug-resistant hypertension (RH) is a very high-risk condition involving many hypertensive patients, in whom primary aldosteronism (PA) is commonly overlooked. Hence, we aimed at determining if (1) adrenal vein sampling (AVS) can identify PA in RH patients, who are challenging because of receiving multiple interfering drugs; (2) AVS-guided adrenale...
Article
Full-text available
Rho-associated, coiled-coil containing kinases (ROCK) were originally identified as effectors of the RhoA small GTPase and found to belong to the AGC family of serine/threonine kinases. They were shown to be downstream effectors of RhoA and RhoC activation. They signal via phosphorylation of proteins such as MYPT-1, thereby regulating many key cell...
Article
Full-text available
Background and aim Considering the amount of novel knowledge generated in the last five years, a team of experienced hypertensionlogists was assembled to furnish updated clinical practice guidelines for the management of primary aldosteronism. Methods To identify the most relevant studies, the authors utilized a systematic literature review in int...
Article
Primary aldosteronism (PA) is a highly prevalent cause of arterial hypertension featuring excess cardiovascular events. A timely diagnosis and treatment of PA cures hyperaldosteronism and can provide resolution or improvement of arterial hypertension, even when the latter is resistant to drug treatment. Accordingly, strategies to screen early and w...
Article
Context The withdrawal of mineralocorticoid-receptor antagonist (MRA) and renin-angiotensin system blockers recommended in current guidelines for case detection of primary aldosteronism (PA) can worsen hypokalemia and control of high blood pressure (BP) values. Objective To investigate if aldosterone/renin ratio (ARR) values were affected by the M...
Article
Primary aldosteronism (PA), the most common form of secondary hypertension, has been considered for decades as a "benign" form of hypertension, but evidences progressively built up to show that patients with PA had an excess rate of cardiovascular damage as compared to blood pressure-matched essential hypertensive patients. This review provides an...
Article
Full-text available
Background: Despite hyperaldosteronism being suggested as predisposing to arrhythmias, the relationship between atrial fibrillation and primary aldosteronism remains uncertain. Therefore, we tested the hypothesis that atrial fibrillation is a presentation of primary aldosteronism in hypertensive patients with unexplained atrial fibrillation. Desi...
Article
Full-text available
Purpose Atrial fibrillation is the most common sustained arrhythmia, with a prevalence of 1–2% in the general population and over 15% in people older than 80 years. Due to aging of the population it imposes an increasing burden on the healthcare system because of the need for life-long pharmacological treatment and the associated increased risk of...
Article
AT1AA (Angiotensin II type-1 receptor autoantibodies) were first detected in patients with primary aldosteronism (PA) because of aldosterone-producing adenoma (APA) with an in-house developed assay, but it remained unclear if they can be ascertained also with commercially available assays and if they have a functional role. Aims of our study were t...
Article
Background: A metabolic shift in energy expenditure toward a catabolic state upon high sodium (Na ⁺ ) diet, ultimately favouring endogenous water accrual and body fluid preservation, has recently been described in a rodent model. Objective: To investigate the impact of high Na ⁺ intake on renal Na ⁺ /water handling and metabolic signatures in a lar...
Article
Blood pressure is lower in premenopausal women than in age-matched men; after menopause blood pressure values and the prevalence of hypertension show opposite trends indicating that estrogens contribute to maintaining normal blood pressure values in women. In experimental studies menopause increases aldosterone levels, an effect alleviated by estro...
Article
Full-text available
Accumulating evidence indicates that epithelial-to-mesenchymal transition (EMT), originally described as a key process for organ development and metastasis budding in cancer, plays a key role in the development of renal fibrosis in several diseases, including hypertensive nephroangiosclerosis. We herein reviewed the concept of EMT and its role in r...
Article
Context The G protein-coupled estrogen receptor (GPER) mediates an aldosterone secretagogue effect of 17β-estradiol in human HAC15 adrenocortical cells after estrogen receptor β blockade. As GPER mediates mineralocorticoid receptor-independent aldosterone effects in other cell types, we hypothesized that aldosterone could modulate its own synthesis...
Article
Full-text available
Context Accumulating evidences suggest a link between adrenocortical zona glomerulosa and parathyroid gland through mechanisms that remain unexplored. Objectives To test the hypothesis that in vivo Angiotensin (Ang) II blockade affects parathyroid hormone (PTH) secretion in hypertensive patients and that aldosterone and Ang II directly stimulate P...
Article
Full-text available
Background: Arterial hypertension is associated with obstructive sleep apnoea, poor quality and duration of sleep, which might contribute to hypertension-mediated organ damage. Methods: We investigated the presence of insomnia, restless legs syndrome, and obstructive sleep apnoea using validated questionnaires (Insomnia Severity Index, Restless Leg...
Article
Full-text available
Current guidelines recommend withdrawal of treatments that affect the aldosterone/renin ratio (ARR) when screening for primary aldosteronism (PA). However, abandonment of mineralocorticoid-receptor antagonist (MRA) and/or blockers of the renin–angiotensin system can deteriorate control of blood pressure (BP) and hypokalemia. Thus, in consecutive pa...
Article
The identification of several germline and somatic ion channel mutations in aldosterone-producing adenomas (APA) and detection of cell clusters that can be responsible for excess aldosterone production, as well as the isolation of autoantibodies activating the angiotensin II type 1 receptor, have rapidly advanced the understanding of the biology of...
Article
The angiotensin II type 2 receptor (AT2R) and the angiotensin-(1-7) receptor (MasR) play a cardiovascular protective role by counter-regulating angiotensin II type 1 receptor (AT1R)-mediated effects, but whether this involves blunting of adrenocortical hormone secretion is unknown. We investigated the presence of AT1R, AT2R and MasR in aldosterone-...
Article
Background: Cosyntropin and metoclopramide can affect the subtyping of primary aldosteronism when used with adrenal vein sampling by exerting hormone- and side-specific effects on cortisol and aldosterone secretion. We investigated how these stimuli affect the selectivity index, the relative aldosterone secretion index, and the lateralization inde...
Article
: Kidney damage is a common consequence of arterial hypertension, but is also a cause of atherogenesis. Dysfunction and/or harm of the endothelium in glomeruli and tubular interstitium damage the function of these structures and translates into dynamic changes of filtration fraction, with progressive reduction in glomerular filtration rate, expansi...