{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T10:49:07Z","timestamp":1785322147238,"version":"3.55.0"},"reference-count":56,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2020,7,17]],"date-time":"2020-07-17T00:00:00Z","timestamp":1594944000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Cardiomyopathies are myocardial disorders in which heart muscle is structurally and\/or functionally abnormal. Previously, structural cardiomyocyte disorders due to adrenal diseases, such as hyperaldosteronism, hypercortisolism, and hypercatecholaminism, were misunderstood, and endomyocardial biopsy (EMB) was not performed because was considered dangerous and too invasive. Recent data confirm that, if performed in experienced centers, EMB is a safe technique and gives precious information about physiopathological processes implied in clinical abnormalities in patients with different systemic disturbances. In this review, we illustrate the most important features in patients affected by primary aldosteronism (PA), Cushing\u2019s syndrome (CS), and pheochromocytoma (PHEO). Then, we critically describe microscopic and ultrastructural aspects that have emerged from the newest EMB studies. In PA, the autonomous hypersecretion of aldosterone induces the alteration of ion and water homeostasis, intracellular vacuolization, and swelling; interstitial oedema could be a peculiar feature of myocardial toxicity. In CS, cardiomyocyte hypertrophy and myofibrillolysis could be related to higher expression of atrogin-1. Finally, in PHEO, the hypercontraction of myofilaments with the formation of contraction bands and occasional cellular necrosis has been observed. We expect to clear the role of EMB in patients with cardiomyopathies and adrenal disease, and we believe EMB is a valid tool to implement new management and therapies.<\/jats:p>","DOI":"10.3390\/ijms21145047","type":"journal-article","created":{"date-parts":[[2020,7,17]],"date-time":"2020-07-17T10:22:02Z","timestamp":1594981322000},"page":"5047","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Cardiomyopathies and Adrenal Diseases"],"prefix":"10.3390","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4463-4956","authenticated-orcid":false,"given":"Luigi","family":"Petramala","sequence":"first","affiliation":[{"name":"Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Concistr\u00e8","sequence":"additional","affiliation":[{"name":"Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Olmati","sequence":"additional","affiliation":[{"name":"Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenza","family":"Saracino","sequence":"additional","affiliation":[{"name":"Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Chimenti","sequence":"additional","affiliation":[{"name":"Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, 00185 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Frustaci","sequence":"additional","affiliation":[{"name":"Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, 00185 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo A.","family":"Russo","sequence":"additional","affiliation":[{"name":"MEBIC Consortium, San Raffaele Open University, and IRCCS San Raffaele Pisana, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4397-0624","authenticated-orcid":false,"given":"Claudio","family":"Letizia","sequence":"additional","affiliation":[{"name":"Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,7,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1807","DOI":"10.1161\/CIRCULATIONAHA.106.174287","article-title":"Contemporary definitions and classification of the cardiomyopathies: An American Heart Association Scientific Statement from the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention","volume":"113","author":"Maron","year":"2006","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1914","DOI":"10.1016\/j.jacc.2007.09.008","article-title":"The role of endomyocardial biopsy in the management of cardiovascular disease: A scientific statement from the American Heart Association, the American College of Cardiology, and the European Society of Cardiology. Endorsed by the Heart Failure Society of America and the Heart Failure Association of the European Society of Cardiology","volume":"50","author":"Cooper","year":"2007","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1531","DOI":"10.1161\/CIRCULATIONAHA.13.001414","article-title":"Contribution and Risks of Left Ventricular Endomyocardial Biopsy in Patients with Cardiomyopathies","volume":"128","author":"Chimenti","year":"2013","journal-title":"Circulation"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1889","DOI":"10.1210\/jc.2015-4061","article-title":"The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline","volume":"101","author":"Funder","year":"2016","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2293","DOI":"10.1016\/j.jacc.2006.07.059","article-title":"A Prospective Study of the Prevalence of Primary Aldosteronism in 1,125 Hypertensive Patients","volume":"48","author":"Rossi","year":"2006","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1007\/s10557-010-6256-6","article-title":"Aldosterone Inhibition and Cardiovascular Protection: More Important Than it Once Appeared","volume":"24","author":"Martinez","year":"2010","journal-title":"Cardiovasc. Drugs Ther."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1007\/s11906-000-0017-z","article-title":"Aldosterone and vascular damage","volume":"2","author":"Daniel","year":"2000","journal-title":"Curr. Hypertens. Rep."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1300","DOI":"10.1006\/bbrc.2001.4275","article-title":"Mineralocorticoid Receptor-Mediated Signaling Regulates the Ion Gated Sodium Channel in Vascular Endothelial Cells and Requires an Intact Cytoskeleton","volume":"280","author":"Golestaneh","year":"2001","journal-title":"Biochem. Biophys. Res. Commun."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/j.1523-1755.2004.00701.x","article-title":"Aldosterone in the development and progression of renal injury","volume":"66","author":"Hollenberg","year":"2004","journal-title":"Kidney Int."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2022","DOI":"10.1097\/HJH.0000000000000284","article-title":"Oxidative stress in patients affected by primary aldosteronism","volume":"32","author":"Petramala","year":"2014","journal-title":"J. Hypertens."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/S2213-8587(17)30319-4","article-title":"Cardiovascular events and target organ damage in primary aldosteronism compared with essential hypertension: A systematic review and meta-analysis","volume":"6","author":"Monticone","year":"2018","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1400","DOI":"10.1046\/j.1523-1755.1999.00674.x","article-title":"Aldosterone activates Na\u00fe\/H\u00feexchange in vascular smooth muscle cells by nongenomic and genomic mechanisms","volume":"56","author":"Ebata","year":"1999","journal-title":"Kidney Int."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1465","DOI":"10.1097\/00004872-200208000-00002","article-title":"Mineralocorticoid receptors and pathophysiological roles for aldosterone in the cardiovascular system","volume":"20","author":"Young","year":"2002","journal-title":"J. Hypertens."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2391","DOI":"10.1210\/jc.2009-2204","article-title":"Adipokines and Cardiometabolic Profile in Primary Hyperaldosteronism","volume":"95","author":"Iacobellis","year":"2010","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1055\/s-0035-1559769","article-title":"Epicardial Fat Thickness and Primary Aldosteronism","volume":"48","author":"Iacobellis","year":"2016","journal-title":"Horm. Metab. Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1291\/hypres.28.447","article-title":"Excess aldosterone under normal salt diet induces cardiac hypertrophy and infiltration via oxidative stress","volume":"28","author":"Yoshida","year":"2005","journal-title":"Hypertens. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1016\/j.cardfail.2004.03.002","article-title":"Aldosterone directly stimulates cardiac myocyte hypertrophy","volume":"10","author":"Okoshi","year":"2004","journal-title":"J. Card. Fail."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.amjhyper.2005.05.013","article-title":"Role of Aldosterone in Left Ventricular Hypertrophy in Hypertension","volume":"19","author":"Matsumura","year":"2006","journal-title":"Am. J. Hypertens."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1007\/BF03346529","article-title":"Cardiac remodeling in patients with primary aldosteronism","volume":"32","author":"Galetta","year":"2009","journal-title":"J. Endocrinol. Investig."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1161\/01.HYP.27.5.1039","article-title":"Changes in Left Ventrcular Anatomy and Function in Hypertension and Primary Aldosteronism","volume":"27","author":"Rossi","year":"1996","journal-title":"Hypertension"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e004815","DOI":"10.1161\/CIRCIMAGING.116.004815","article-title":"Cardiac Remodeling in Patients with Primary and Secondary Aldosteronism","volume":"9","author":"Cesari","year":"2016","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"740","DOI":"10.1161\/CIRCIMAGING.112.974576","article-title":"Demonstration of BP-independent noninfarct myocardial fibrosis in primary aldosteronism: A cardiac magnetic resonance imaging study","volume":"5","author":"Freel","year":"2012","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.ijcard.2019.06.055","article-title":"Primary aldosteronism-associated cardiomyopathy: Clinical-pathologic impact of aldosterone normalization","volume":"292","author":"Frustaci","year":"2019","journal-title":"Int. J. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1056\/NEJM199909023411001","article-title":"The Effect of Spironolactone on Morbidity and Mortality in Patients with Severe Heart Failure","volume":"341","author":"Pitt","year":"1999","journal-title":"N. Engl. J. Med."},{"key":"ref_25","first-page":"1309","article-title":"Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction","volume":"348","author":"Pitt","year":"2003","journal-title":"ACC Curr. J. Rev."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1067\/mhj.2001.111258","article-title":"Aldosterone inhibition limits collagen synthesis and progressive left ventricular enlargement after anterior myocardial infarction","volume":"141","author":"Modena","year":"2001","journal-title":"Am. Heart J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1227","DOI":"10.1161\/hy1101.099484","article-title":"Treatment of congestive heart failure: Interfering the aldosterone-cardiac extracellular matrix relationship","volume":"38","author":"Zannad","year":"2001","journal-title":"Hypertension"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1093\/eurheartj\/ehn543","article-title":"Aldosterone blockade and left ventricular dysfunction: A systematic review of randomized clinical trials","volume":"30","author":"Ezekowitz","year":"2008","journal-title":"Eur. Heart J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1161\/HYPERTENSIONAHA.107.095448","article-title":"Long-Term Cardiac Effects of Adrenalectomy or Mineralocorticoid Antagonists in Patients With Primary Aldosteronism","volume":"50","author":"Catena","year":"2007","journal-title":"Hypertension"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1606","DOI":"10.1097\/HJH.0b013e3283550f93","article-title":"Adrenalectomy reverses myocardial fibrosis in patients with primary aldosteronism","volume":"30","author":"Lin","year":"2012","journal-title":"J. Hypertens."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2527","DOI":"10.1210\/jc.2002-021558","article-title":"Cardiovascular Risk Factors and Common Carotid Artery Caliber and Stiffness in Patients with Cushing\u2019s Disease during Active Disease and 1 Year after Disease Remission","volume":"88","author":"Faggiano","year":"2003","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"291","DOI":"10.2147\/vhrm.2005.1.4.291","article-title":"Cardiovascular Consequences of Cortisol Excess","volume":"1","author":"Williamson","year":"2005","journal-title":"Vasc. Health Risk Manag."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1210\/er.2002-0010","article-title":"Insulin Resistance and Chronic Cardiovascular Inflammatory Syndrome","volume":"24","year":"2003","journal-title":"Endocr. Rev."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2275","DOI":"10.1016\/S0735-1097(03)00493-5","article-title":"Left ventricular structural and functional characteristics in Cushing\u2019s syndrome","volume":"41","author":"Muiesan","year":"2003","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1097\/MAJ.0b013e3181a927e0","article-title":"Dilated Cardiomyopathy as the Predominant Feature of Cushing\u2019s Syndrome","volume":"338","author":"Peppa","year":"2009","journal-title":"Am. J. Med. Sci."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Frustaci, A., Letizia, C., Verardo, R., Grande, C., Petramala, L., Russo, M.A., and Chimenti, C. (2016). Cushing Syndrome Cardiomyopathy. Circ. Cardiovasc. Imaging, 9.","DOI":"10.1161\/CIRCIMAGING.116.004569"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1002\/jcp.25485","article-title":"Atrogin-1 Increases Smooth Muscle Contractility through Myocardin Degradation","volume":"232","author":"Singh","year":"2016","journal-title":"J. Cell. Physiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1016\/S0092-8674(04)00400-3","article-title":"Foxo Transcription Factors Induce the Atrophy-Related Ubiquitin Ligase Atrogin-1 and Cause Skeletal Muscle Atrophy","volume":"117","author":"Sandri","year":"2004","journal-title":"Cell"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.jacc.2015.10.040","article-title":"Atrogin-1 Pathway Activation in Cushing Syndrome Cardiomyopathy","volume":"67","author":"Frustaci","year":"2016","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1007\/s12020-017-1344-z","article-title":"Morphlogic and molecular pathway of cushing syndrome cardiomyopathy","volume":"60","author":"Frustaci","year":"2018","journal-title":"Endocrine"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1530\/EJE-09-0621","article-title":"Cardiac dysfunction is reversed upon successful treatment of Cushing\u2019s syndrome","volume":"162","author":"Pereira","year":"2010","journal-title":"Eur. J. Endocrinol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1016\/j.beem.2006.07.006","article-title":"Hypertension in Cushing\u2019s syndrome","volume":"20","author":"Magiakou","year":"2006","journal-title":"Best Pract. Res. Clin. Endocrinol. Metab."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1186\/1750-1172-1-49","article-title":"Pheochromocytomas and secreting paragangliomas","volume":"1","author":"Plouin","year":"2006","journal-title":"Orphanet J. Rare Dis."},{"key":"ref_44","first-page":"543","article-title":"Phaeochromocytoma","volume":"9","author":"Sever","year":"1980","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"183","DOI":"10.2165\/11530430-000000000-00000","article-title":"Clinical Experience with Pheochromocytoma in a Single Centre Over 16 Years","volume":"16","author":"Cotesta","year":"2009","journal-title":"High Blood Press. Cardiovasc. Prev."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/j.ijcard.2017.07.014","article-title":"Pheochromocytoma as a reversible cause of cardiomyopathy: Analysis and review of the literature","volume":"249","author":"Zhang","year":"2017","journal-title":"Int. J. Cardiol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1139\/Y09-042","article-title":"Role of the excessive amounts of circulating catecholamines and glucocorticoids in stress-induced heart disease","volume":"87","author":"Adameova","year":"2009","journal-title":"Can. J. Physiol. Pharmacol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e2198","DOI":"10.1097\/MD.0000000000002198","article-title":"Acute and Chronic Pheochromocytoma-Induced Cardiomyopathies","volume":"94","author":"Pereira","year":"2015","journal-title":"Medicine"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1536\/ihj.15-311","article-title":"Left ventricular non compaction combined with epinephrine-secreted pheochromocytoma inducing heart failure","volume":"57","author":"Han","year":"2016","journal-title":"Int. Heart J."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1102","DOI":"10.1056\/NEJM196605192742002","article-title":"Focal Myocarditis Associated with Pheochromocytoma","volume":"274","author":"Burchell","year":"1966","journal-title":"N. Engl. J. Med."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1007\/s10741-014-9418-y","article-title":"Pathophysiological mechanisms of catecholamine and cocaine-mediated cardiotoxicity","volume":"19","author":"Liaudet","year":"2014","journal-title":"Heart Fail. Rev."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1348","DOI":"10.1161\/CIRCULATIONAHA.113.002762","article-title":"Catecholamine-Induced Myocarditis in Pheochromocytoma","volume":"129","author":"Arias","year":"2014","journal-title":"Circulation"},{"key":"ref_53","first-page":"22","article-title":"Stress (Takotsubo) cardiomyopathy\u2014A novel pathophysiological hypothesis to explain catecholamine-induced acute myocardial stunning","volume":"5","author":"Lyon","year":"2008","journal-title":"Nat. Clin. Pract. Neurol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"e138","DOI":"10.1016\/j.ijcard.2008.03.012","article-title":"Pheochromocytoma crisis presenting with shock and tako-tsubo-like cardiomyopathy","volume":"134","author":"Lassnig","year":"2009","journal-title":"Int. J. Cardiol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"e13369","DOI":"10.1097\/MD.0000000000013369","article-title":"A rare case report of hypertrophic cardiomyopathy induced by catecholamine-producing tumor","volume":"97","author":"Olmati","year":"2018","journal-title":"Medicine"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1038\/jhh.2009.115","article-title":"Pheochromocytoma-related \u2018classic\u2019 takotsubo cardiomyopathy","volume":"24","author":"Klisiewicz","year":"2010","journal-title":"J. Hum. Hypertens."}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/21\/14\/5047\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:49:25Z","timestamp":1760176165000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/21\/14\/5047"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,7,17]]},"references-count":56,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2020,7]]}},"alternative-id":["ijms21145047"],"URL":"https:\/\/doi.org\/10.3390\/ijms21145047","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,7,17]]}}}