The management of primary aldosteronism: case detection, diagnosis, and treatment: an endocrine society clinical practice guideline

Funder, John W., Carey, Robert M., Mantero, Franco, Murad, M. Hassan, Reincke, Martin, Shibata, Hirotaka, Stowasser, Michael and Young, William F., Jr. (2016) The management of primary aldosteronism: case detection, diagnosis, and treatment: an endocrine society clinical practice guideline. Journal of Clinical Endocrinology and Metabolism, 101 5: 1889-1916. doi:10.1210/jc.2015-4061


Author Funder, John W.
Carey, Robert M.
Mantero, Franco
Murad, M. Hassan
Reincke, Martin
Shibata, Hirotaka
Stowasser, Michael
Young, William F., Jr.
Title The management of primary aldosteronism: case detection, diagnosis, and treatment: an endocrine society clinical practice guideline
Journal name Journal of Clinical Endocrinology and Metabolism   Check publisher's open access policy
ISSN 1945-7197
0021-972X
Publication date 2016-03-02
Year available 2016
Sub-type Article (original research)
DOI 10.1210/jc.2015-4061
Open Access Status DOI
Volume 101
Issue 5
Start page 1889
End page 1916
Total pages 28
Place of publication Chevy Chase, MD, United States
Publisher Endocrine Society
Collection year 2017
Language eng
Formatted abstract
Objective: To develop clinical practice guidelines for the management of patients with primary aldosteronism.

Participants: The Task Force included a chair, selected by the Clinical Guidelines Subcommittee of the Endocrine Society, six additional experts, a methodologist, and a medical writer. The guideline was cosponsored by American Heart Association, American Association of Endocrine Surgeons, European Society of Endocrinology, European Society of Hypertension, International Association of Endocrine Surgeons, International Society of Endocrinology, International Society of Hypertension, Japan Endocrine Society, and The Japanese Society of Hypertension. The Task Force received no corporate funding or remuneration.

Evidence: We searched for systematic reviews and primary studies to formulate the key treatment and prevention recommendations. We used the Grading of Recommendations, Assessment, Development, and Evaluation group criteria to describe both the quality of evidence and the strength of recommendations. We used "recommend" for strong recommendations and "suggest" for weak recommendations.

Consensus Process: We achieved consensus by collecting the best available evidence and conducting one group meeting, several conference calls, and multiple e-mail communications. With the help of a medical writer, the Endocrine Society's Clinical Guidelines Subcommittee, Clinical Affairs Core Committee, and Council successfully reviewed the drafts prepared by the Task Force. We placed the version approved by the Clinical Guidelines Subcommittee and Clinical Affairs Core Committee on the Endocrine Society's website for comments by members. At each stage of review, the Task Force received written comments and incorporated necessary changes.

Conclusions: For high-risk groups of hypertensive patients and those with hypokalemia, we recommend case detection of primary aldosteronism by determining the aldosterone-renin ratio under standard conditions and recommend that a commonly used confirmatory test should confirm/exclude the condition. We recommend that all patients with primary aldosteronism undergo adrenal computed tomography as the initial study in subtype testing and to exclude adrenocortical carcinoma. We recommend that an experienced radiologist should establish/exclude unilateral primary aldosteronism using bilateral adrenal venous sampling, and if confirmed, this should optimally be treated by laparoscopic adrenalectomy. We recommend that patients with bilateral adrenal hyperplasia or those unsuitable for surgery should be treated primarily with a mineralocorticoid receptor antagonist.
Keyword Primary aldosteronism
Treatment recommendation
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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