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Role of KCNJ5 in familial and sporadic primary aldosteronism

Nature Reviews Endocrinology volume 9, pages 104–112 (2013)Cite this article

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Abstract

Primary aldosteronism is characterised by the dysregulation of aldosterone production and comprises both sporadic forms, caused by an aldosterone-producing adenoma or bilateral adrenal hyperplasia, and familial forms (familial hyperaldosteronism types I, II and III). The two principal physiological regulators of aldosterone synthesis are angiotensin II and serum K+, which reverse the high resting K+ conductance and hyperpolarized membrane potential of adrenal glomerulosa cells. The resulting membrane depolarization causes the opening of voltage-gated Ca2+ channels and an increase in intracellular Ca2+ that stimulates aldosterone biosynthesis. Point mutations in the KCNJ5 gene, which encodes the G-protein-activated inward rectifier K+ channel 4 (GIRK4), have been implicated in the pathogenesis of both sporadic and familial forms of primary aldosteronism. These mutations interfere with the selectivity filter of GIRK4 causing Na+ entry, cell depolarization and Ca2+ channel opening, resulting in constitutive aldosterone production. Seven families with familial hyperaldosteronism caused by KCNJ5 germline mutations have so far been described, and multicentre studies have reported KCNJ5 mutations in approximately 40% of sporadic aldosterone-producing adenomas. Herein, we review the role of GIRK4 in adrenal pathophysiology and provide an overview of the clinical and biochemical phenotypes resulting from KCNJ5 mutations in patients with sporadic and familial primary aldosteronism.

Key Points

  • Primary aldosteronism is the most frequent cause of secondary hypertension

  • Mutations in KCNJ5, which encodes the G-protein-activated inward rectifier K+ channel 4 GIRK4, cause familial hyperaldosteronism type III and around 40% of sporadic aldosterone-producing adenomas

  • KCNJ5 mutations alter the channel selectivity filter of the encoded K+ channel, which results in a calcium-mediated increase in aldosterone secretion

  • Most families with familial hyperaldosteronism type III display severe hyperaldosteronism with marked hypokalaemia from childhood and often require bilateral adrenalectomy

  • Patients with aldosterone-producing adenomas carrying KCNJ5 somatic mutations are more frequently female than those with wild-type KCNJ5

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Figure 1: Effect of KCNJ5 mutations on adrenal glomerulosa cells.

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Change history

  • 18 December 2012

    In the version of this article initially published online there was a mistake in Figure 1: Na+ was incorrectly labelled as Na2+. The error has been corrected for the HTML and PDF versions of the article.

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Authors and Affiliations

  1. Department of Medical Sciences, Division of Internal Medicine and Hypertension, University of Torino, Via Genova 3, Torino, 10126, Italy

    Paolo Mulatero, Silvia Monticone, Franco Veglio & Tracy Ann Williams

  2. Department of Molecular and Integrative Physiology, University of Michigan Medical School, 1301 E. Catherine Street, Ann Arbor, 48109, MI, USA

    William E. Rainey

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  1. Paolo Mulatero
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Contributions

P. Mulatero and S. Monticone contributed equally to writing the article as joint first authors, and also researched data for the article and provided a substantial contribution to discussion of the content. W. Rainey and F. Veglio provided a substantial contribution to discussion of the content and reviewed and/or edited the manuscript before submission. T. A. Williams researched data for the article, provided a substantial contribution to discussion of the content and contributed to writing the article.

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Correspondence to William E. Rainey.

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Mulatero, P., Monticone, S., Rainey, W. et al. Role of KCNJ5 in familial and sporadic primary aldosteronism. Nat Rev Endocrinol 9, 104–112 (2013). https://doi.org/10.1038/nrendo.2012.230

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