Guidelines for the diagnosis and treatment of primary aldosteronism -The Japan Endocrine Society 2009-

Abstract

Abstract. The Japan Endocrine Society (JES) attempted to develop guidelines for the diagnosis and treatment of primary aldosteronism (PA). The Task Force Committee (TFC) was composed of a chair, selected by the JES, and additional experts. Systematic reviews of available evidence for Japanese patients were used to recommend the key treatment and prevention. We have evaluated the methods of screening, confirmatory tests and imaging, plus adrenal vein sampling (AVS). Consensus was guided by systematic review of evidence and discussion during each annual meeting of the JES, plus its related meetings, and by e-mail communication. The drafts prepared by TFC were reviewed successively by the members of Research on Intractable Diseases provided by the Japanese Ministry of Health, Labour and Welfare, and in comments from the JES's councilors. At each stage of review, TFC received written comments and incorporated suggested changes. In conclusion, all patients with hypertension should be screened for PA, because of the high prevalence of cardiovascular disease and the current low case-detection rate in Japan. Case detection can be performed in hypertensive patients and those with hypokalemia by determining the aldosterone/renin ratio, and the diagnosis of PA can be confirmed by two of three confirmatory tests. The presence of a unilateral aldosterone-producing adenoma should be established/ excluded by AVS by an experienced radiologist, optimally followed by laparoscopic adrenalectomy. In contrast, patients with bilateral adrenal hyperplasia, or those unsuitable for surgery, are optimally treated medically with mineralocorticoid receptor antagonists.

Eplerenone improves carotid intima-media thickness (IMT) in patients with primary aldosteronism

“…PA was diagnosed according to the clinical guidelines of the Japan Endocrine Society [18], based on the ratio of plasma aldosterone concentration (PAC; pg/ mL) to plasma renin activity (PRA; ng/mL/hr) measured simultaneously in patients with hypertension and/or adrenal lesions. Patients found to have a PAC/ PRA ratio (ARR) >200 underwent confirmatory tests for PA, including captopril-challenge, upright furosemide-loading, and saline-loading tests.…”

Comparison of eplerenone and spironolactone for the treatment of primary aldosteronism

“…Fifty-four hypertensive patients (24 men and 30 women; aged 56 ± 10 years) were diagnosed with PA according to The Japanese Society of Endocrinology Guidelines for the Management of PA [14] in the Kanazawa University Hospital and two municipal hospitals. Thirty-nine patients underwent adrenal venous sampling (AVS); 9 subjects had unilateral aldosterone hypersecretion (4 patients in the SPL group and 5 patients in the EPL group), and 30 subjects had bilateral production of aldosterone (17 patients in the SPL group and 13 patients in the EPL group).…”

Increasing Incidence of Primary Aldosteronism in Patients Investigated for Resistant Hypertension: An Observational Study from a Nephrology Unit

“…However, today the uselfuness of ARR is still debated because there are some doubts on its reliability, in terms of reproducibility, sensitivity and specificity. Moreover, several factors could influence ARR, like the posture, the time of the day of blood sampling and the possibile use of antihypertensive drugs [1,[31][32][33]. Also, there is a lack of consensus on the types of patients' populations in which the ARR should be used as screening test for PA and on clear cut-off values to adopt.…”