Case detection, diagnosis, and treatment of patients with primary aldosteronism

An endocrine society clinical practice guideline

John W. Funder, Robert M. Carey, Carlos Fardella, Celso E. Gomez-Sanchez, Franco Mantero, Michael Stowasser, William Francis Young, Victor Manuel Montori, Heather Edwards

Research output: Contribution to journalArticle

1120 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)3266-3281
Number of pages16
JournalJournal of Clinical Endocrinology and Metabolism
Volume93
Issue number9
DOIs
StatePublished - Sep 2008

Fingerprint

Hyperaldosteronism
Advisory Committees
Practice Guidelines
Guidelines
Mineralocorticoid Receptor Antagonists
Teleconferencing
Consensus
Remuneration
Adrenocortical Carcinoma
Aldosterone
Renin
Surgery
Group Processes
Tomography
Hypokalemia
Websites
Adrenalectomy
Postal Service
Therapeutics
Sampling

ASJC Scopus subject areas

  • Biochemistry
  • Endocrinology, Diabetes and Metabolism

Cite this

Case detection, diagnosis, and treatment of patients with primary aldosteronism : An endocrine society clinical practice guideline. / Funder, John W.; Carey, Robert M.; Fardella, Carlos; Gomez-Sanchez, Celso E.; Mantero, Franco; Stowasser, Michael; Young, William Francis; Montori, Victor Manuel; Edwards, Heather.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 93, No. 9, 09.2008, p. 3266-3281.

Research output: Contribution to journalArticle

Funder, John W. ; Carey, Robert M. ; Fardella, Carlos ; Gomez-Sanchez, Celso E. ; Mantero, Franco ; Stowasser, Michael ; Young, William Francis ; Montori, Victor Manuel ; Edwards, Heather. / Case detection, diagnosis, and treatment of patients with primary aldosteronism : An endocrine society clinical practice guideline. In: Journal of Clinical Endocrinology and Metabolism. 2008 ; Vol. 93, No. 9. pp. 3266-3281.
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