Japan Endocrine Society clinical practice guideline for the diagnosis and management of primary aldosteronism 2021

Mitsuhide Naruse, Takuyuki Katabami, Hirotaka Shibata, Masakatsu Sone, Katsutoshi Takahashi, Akiyo Tanabe, Shoichiro Izawa, Takamasa Ichijo, Michio Otsuki, Masao Omura, Yoshihiro Ogawa, Yutaka Oki, Isao Kurihara, Hiroki Kobayashi, Ryuichi Sakamoto, Fumitoshi Satoh, Yoshiyu Takeda, Tomoaki Tanaka, Kouichi Tamura, Mika TsuikiShigeatsu Hashimoto, Tomonobu Hasegawa, Takanobu Yoshimoto, Takashi Yoneda, Koichi Yamamoto, Hiromi Rakugi, Norio Wada, Aya Saiki, Youichi Ohno, Tatsuya Haze

研究成果: Article査読

4 被引用数 (Scopus)

抄録

Primary aldosteronism (PA) is associated with higher cardiovascular morbidity and mortality rates than essential hypertension. The Japan Endocrine Society (JES) has developed an updated guideline for PA, based on the evidence, especially from Japan. We should preferentially screen hypertensive patients with a high prevalence of PA with aldosterone to renin ratio ≥200 and plasma aldosterone concentrations (PAC) ≥60 pg/mL as a cut-off of positive results. While we should confirm excess aldosterone secretion by one positive confirmatory test, we could bypass patients with typical PA findings. Since PAC became lower due to a change in assay methods from radioimmunoassay to chemiluminescent enzyme immunoassay, borderline ranges were set for screening and confirmatory tests and provisionally designated as positive. We recommend individualized medicine for those in the borderline range for the next step. We recommend evaluating cortisol co-secretion in patients with adrenal macroadenomas. Although we recommend adrenal venous sampling for lateralization before adrenalectomy, we should carefully select patients rather than all patients, and we suggest bypassing in young patients with typical PA findings. A selectivity index ≥5 and a lateralization index >4 after adrenocorticotropic hormone stimulation defines successful catheterization and unilateral subtype diagnosis. We recommend adrenalectomy for unilateral PA and mineralocorticoid receptor antagonists for bilateral PA. Systematic as well as individualized clinical practice is always warranted. This JES guideline 2021 provides updated rational evidence and recommendations for the clinical practice of PA, leading to improved quality of the clinical practice of hypertension.

本文言語English
ページ(範囲)327-359
ページ数33
ジャーナルEndocrine journal
69
4
DOI
出版ステータスPublished - 2022

ASJC Scopus subject areas

  • 内分泌学、糖尿病および代謝内科学
  • 内分泌学

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