{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T04:40:08Z","timestamp":1790138408128,"version":"4.0.1"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T00:00:00Z","timestamp":1753747200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002794","name":"Swedish Cancer Society","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002794","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004359","name":"Swedish Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003514","name":"Stockholm City Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003514","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004047","name":"Karolinska Institutet","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004047","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,31]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Primary aldosteronism (PA) is the leading cause of secondary hypertension. The 2022 WHO classification introduced the HISTALDO system, separating solitary aldosterone-producing adenomas\/nodules (APA\/APN; classical histology) from multiple nodules\/micronodules (MAPN\/MAPM; non-classical histology). Surgery often cures classical cases, while non-classical cases frequently recur. HISTALDO uses CYP11B2 immunohistochemistry, but interpretation is challenged by background nodules. A \u201cB2 ratio\u201d (size ratio of the largest to second-largest CYP11B2-positive nodule) has been proposed to aid diagnosis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To assess whether standardized tissue sampling and the B2 ratio improve PA diagnosis and correlate with outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A prospective study of 75 unilateral PA patients undergoing adrenalectomy (2017-2022) at Karolinska University Hospital. CYP11B2 immunohistochemistry was performed using a standardized protocol, and the B2 ratio was calculated in cases with multiple CYP11B2-positive nodules (HISTALDO B2R). Outcomes were assessed using Primary Aldosteronism Surgical Outcome criteria.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>HISTALDO classified 20 cases as classical and 55 as non-classical (median B2 ratio 9). Using a B2 ratio cut-off \u22658.1, 29\/55 non-classical cases were reclassified, yielding 49 classical and 26 non-classical cases under HISTALDO B2R. Higher B2 ratios correlated with complete clinical response (P = .0038) and fewer antihypertensive medications postoperatively (R = \u22120.4, P = .0022). A trend for B2 ratio as an independent predictor of complete response was observed (OR = 1.07, P = .058).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>HISTALDO may over-report non-classical histology. Adding the B2 ratio improves diagnostic accuracy, distinguishing APA with background zona glomerulosa activity from true multinodular disease, facilitating patient management and follow-up.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejendo\/lvaf157","type":"journal-article","created":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T11:30:14Z","timestamp":1753788614000},"page":"278-288","source":"Crossref","is-referenced-by-count":8,"title":["Improving diagnosis in primary aldosteronism using HISTALDO and nodule size metrics"],"prefix":"10.1093","volume":"193","author":[{"given":"Karolina","family":"Solhusl\u00f8kk H\u00f6se","sequence":"first","affiliation":[{"name":"Department of Oncology-Pathology, Karolinska Institutet , 171 77 Stockholm 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