New Recommendations Intend to Increase Screening for Primary Aldosteronism
The new guidelines make suggestions for the management of primary aldosteronism based on scientific and societal evidence.
(HealthDay News) — The Endocrine Society has issued new guidelines intended to increase screening for primary aldosteronism. The Clinical Practice Guideline was published in The Journal of Clinical Endocrinology & Metabolism.
John W. Funder, MD, PhD, from the Hudson Institute of Medical Research in Australia, and colleagues searched for systematic reviews and primary studies to formulate key treatment and prevention recommendations for primary aldosteronism. The quality of evidence and strength of recommendations were described.
The researchers recommend case detection of primary aldosteronism by determining the aldosterone-renin ratio for high-risk groups of patients with hypertension and those with hypokalemia; the condition should be confirmed/excluded using a confirmatory test. All patients with primary aldosteronism are recommended to undergo adrenal computed tomography as the initial study in testing for subtypes and to exclude adrenocortical carcinoma. Using bilateral adrenal venous sampling, an experienced radiologist should establish/exclude unilateral primary aldosteronism; if confirmed, this should be treated by laparoscopic adrenalectomy. Treatment with a mineralocorticoid receptor antagonist is recommended for patients with bilateral adrenal hyperplasia or those unsuitable for surgery.
"The revised guidelines make recommendations and suggestions for the management of primary aldosteronism on the evidence, both scientific and societal," the authors write. "Over the next five years, management should have further evolved."
Several authors disclosed financial ties to the pharmaceutical industry.
- Funder JW, Carey RM, Mantero F, et al. The management of primary aldosteronism: case detection, diagnosis, and treatment: an endocrine society clinical practice guideline. J Clin Endorin Metab. 2016. doi: 10.1210/jc.2015-4061.