A simple new method based on the results of two studies from Christofer Juhlin's research group can make it easier to identify the underlying cause of a common form of high blood pressure and help predict who will benefit most from surgery. The approach has now moved from research into routine patient care at Karolinska University Hospital.
Primary aldosteronism is a common but often underdiagnosed cause of high blood pressure. It occurs when the adrenal glands produce too much aldosterone, a hormone that helps regulate salt balance and blood pressure. For some patients, removing the affected adrenal gland can cure or substantially improve the condition.
After surgery, the adrenal tissue can be examined using an antibody against CYP11B2, the enzyme responsible for producing aldosterone. This staining allows pathologists to see which cells and nodules are actually producing aldosterone and helps determine what caused the disease.
However, the interpretation is not always straightforward. Several aldosterone-producing nodules can be present in the same adrenal gland, making it difficult to determine whether one nodule is driving the disease or whether aldosterone production is more widely distributed.
"In two recent studies, our group has addressed this challenge using the B2 ratio, a simple measurement comparing the two largest CYP11B2-positive nodules. We show that this approach can improve disease classification and is associated with patient outcomes after surgery. I love it when our research can turn an idea into reality and improve care for our patients - not ten years from now, but tomorrow.", says Christofer Juhlin , professor at the Department of Oncology-Pathology and last author of the two studies.
Based on the results of these studies, the B2 ratio has now been implemented in routine clinical diagnostics at Karolinska University Hospital, bringing the method from research into everyday patient care.
Together, the studies demonstrate how a simple quantitative approach can improve and standardize the diagnosis of primary aldosteronism and translate directly into clinical practice.
Publications
Improving diagnosis in primary aldosteronism using HISTALDO and nodule size metrics.
Solhusløkk Höse K, Stenman A, Falhammar H, Volpe C, Larsson C, Zedenius J, Juhlin CC
Eur J Endocrinol 2025 Jul;193(2):278-288
Stenman A, Nilsson T, Falhammar H, Juhlin CC
Histopathology 2026 Aug;():
