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Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline.
J Clin Endocrinol Metab. 2008 Sep; 93(9):3266-81.JC

Abstract

OBJECTIVE

Our objective was to develop clinical practice guidelines for the diagnosis and treatment of patients with primary aldosteronism.

PARTICIPANTS

The Task Force comprised a chair, selected by the Clinical Guidelines Subcommittee (CGS) of The Endocrine Society, six additional experts, one methodologist, and a medical writer. The Task Force received no corporate funding or remuneration.

EVIDENCE

Systematic reviews of available evidence were used to formulate the key treatment and prevention recommendations. We used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) 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

Consensus was guided by systematic reviews of evidence and discussions during one group meeting, several conference calls, and multiple e-mail communications. The drafts prepared by the task force with the help of a medical writer were reviewed successively by The Endocrine Society's CGS, Clinical Affairs Core Committee (CACC), and Council. The version approved by the CGS and CACC was placed on The Endocrine Society's Web site for comments by members. At each stage of review, the Task Force received written comments and incorporated needed changes.

CONCLUSIONS

We recommend case detection of primary aldosteronism be sought in higher risk groups of hypertensive patients and those with hypokalemia by determining the aldosterone-renin ratio under standard conditions and that the condition be confirmed/excluded by one of four commonly used confirmatory tests. 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 the presence of a unilateral form of primary aldosteronism should be established/excluded by bilateral adrenal venous sampling by an experienced radiologist and, where present, optimally treated by laparoscopic adrenalectomy. We recommend that patients with bilateral adrenal hyperplasia, or those unsuitable for surgery, optimally be treated medically by mineralocorticoid receptor antagonists.

Authors+Show Affiliations

Prince Henry's Institute of Medical Research, Clayton, VIC, Australia.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Guideline
Journal Article

Language

eng

PubMed ID

18552288

Citation

Funder, John W., et al. "Case Detection, Diagnosis, and Treatment of Patients With Primary Aldosteronism: an Endocrine Society Clinical Practice Guideline." The Journal of Clinical Endocrinology and Metabolism, vol. 93, no. 9, 2008, pp. 3266-81.
Funder JW, Carey RM, Fardella C, et al. Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2008;93(9):3266-81.
Funder, J. W., Carey, R. M., Fardella, C., Gomez-Sanchez, C. E., Mantero, F., Stowasser, M., Young, W. F., & Montori, V. M. (2008). Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline. The Journal of Clinical Endocrinology and Metabolism, 93(9), 3266-81. https://doi.org/10.1210/jc.2008-0104
Funder JW, et al. Case Detection, Diagnosis, and Treatment of Patients With Primary Aldosteronism: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2008;93(9):3266-81. PubMed PMID: 18552288.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline. AU - Funder,John W, AU - Carey,Robert M, AU - Fardella,Carlos, AU - Gomez-Sanchez,Celso E, AU - Mantero,Franco, AU - Stowasser,Michael, AU - Young,William F,Jr AU - Montori,Victor M, AU - ,, Y1 - 2008/06/13/ PY - 2008/6/17/pubmed PY - 2008/10/10/medline PY - 2008/6/17/entrez SP - 3266 EP - 81 JF - The Journal of clinical endocrinology and metabolism JO - J Clin Endocrinol Metab VL - 93 IS - 9 N2 - OBJECTIVE: Our objective was to develop clinical practice guidelines for the diagnosis and treatment of patients with primary aldosteronism. PARTICIPANTS: The Task Force comprised a chair, selected by the Clinical Guidelines Subcommittee (CGS) of The Endocrine Society, six additional experts, one methodologist, and a medical writer. The Task Force received no corporate funding or remuneration. EVIDENCE: Systematic reviews of available evidence were used to formulate the key treatment and prevention recommendations. We used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) 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: Consensus was guided by systematic reviews of evidence and discussions during one group meeting, several conference calls, and multiple e-mail communications. The drafts prepared by the task force with the help of a medical writer were reviewed successively by The Endocrine Society's CGS, Clinical Affairs Core Committee (CACC), and Council. The version approved by the CGS and CACC was placed on The Endocrine Society's Web site for comments by members. At each stage of review, the Task Force received written comments and incorporated needed changes. CONCLUSIONS: We recommend case detection of primary aldosteronism be sought in higher risk groups of hypertensive patients and those with hypokalemia by determining the aldosterone-renin ratio under standard conditions and that the condition be confirmed/excluded by one of four commonly used confirmatory tests. 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 the presence of a unilateral form of primary aldosteronism should be established/excluded by bilateral adrenal venous sampling by an experienced radiologist and, where present, optimally treated by laparoscopic adrenalectomy. We recommend that patients with bilateral adrenal hyperplasia, or those unsuitable for surgery, optimally be treated medically by mineralocorticoid receptor antagonists. SN - 0021-972X UR - https://www.unboundmedicine.com/medline/citation/18552288/Case_detection_diagnosis_and_treatment_of_patients_with_primary_aldosteronism:_an_endocrine_society_clinical_practice_guideline_ L2 - https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2008-0104 DB - PRIME DP - Unbound Medicine ER -