RCP Excellence in Patient Care Awards 2016 winner – The Lancet research award
Professor Morris Brown was the winner of The Lancet research award category at the RCP Excellence in Patient Care Awards 2016 for his discovery of a common subtype of Conn’s adenoma and development of a PET-CT scan for its detection.
The winner's work
My award recognises the discovery of a common subtype of Conn’s adenoma, and development of a PET-CT scan for its detection. Aldosterone-producing adenomas of the adrenal cause 5–10% of hypertension cases. However, the tumours are easy to miss, and the adrenal CT often appears normal. A specific PET-CT was therefore developed using 11C-metomidate, which targets the aldosterone synthase enzyme in the tumours. An intense signal in one adrenal confirms their presence, allowing the patient to proceed to adrenalectomy.
The clue as to how such microadenomas cause severe hypertension came with the discovery that they have specific, somatic mutations (in genes encoding Na+/K+-ATPase or the L-type Ca2+ channel, CaV1.3). Extensive molecular and immunohistochemical analyses proved that smaller tumours arise from the compact, aldosterone-producing cells of the adrenal cortex, whereas classical Conn’s tumours arise from the larger, cortisol-secreting cells.
The tumours are the most common cause of hypertension, and potentially curable providing only one adrenal is affected. However, the diagnostic challenges have discouraged routine screening for the underlying condition of primary aldosteronism (Conn’s syndrome). At first, it seemed counterintuitive that small tumours could have such potent clinical impact, but their molecular characterisation provided proof of their existence, and an explanation for their size.
Clinical research is an uphill struggle these days, but the potential has never been higher for learning from experiments of nature and translating discoveries into patient benefit.
I was delighted with the award, and for my close team of PhD students and clinical colleagues in PET-CT and endocrinology. Clinical research is an uphill struggle these days, but the potential has never been higher for learning from experiments of nature and translating discoveries into patient benefit.
I recently moved to London to be at the centre of several exciting developments and opportunities:
- With colleagues at QMUL [Queen Mary University of London] and Barts, we seek a molecular test to predict which patients are cured completely from hypertension by adrenalectomy, and are developing aldosterone-suppressing drugs for the remaining patients.
- At UCL [University College London], endoscopic radiofrequency ablation of the adrenal adenomas may permit an alternative to surgery.
- At UCL and King’s College London, alternatives to 11C-metomidate are being developed with longer half-lives. Primary aldosteronism appears particularly common among African-Caribbeans in London with difficult hypertension, who may benefit hugely from developments.
Meet other Excellence in Patient Care Awards 2016 winners
- Dr Alexander Wilkinson – Doctor in specialty training category
- Dr Anu Jacob – Consultant category
- Atrial fibrillation stroke prevention team, Royal Stoke Hospital – Team category.