The Endocrine Society has released a new clinical practice guideline for the detection, diagnosis, and treatment of patients with primary aldosteronism. The guidelines appear in the September issue of the Journal of Clinical Endocrinology & Metabolism (JCEM), a publication of The Endocrine Society.
Primary aldosteronism (PA) refers to conditions in which production of aldosterone, a steroid hormone produced in the adrenal gland, is inappropriately high. Such inappropriate production of aldosteronism causes cardiovascular damage, hypertension, sodium retention, and potassium excretion that, if prolonged and severe, may lead to significant potassium deficiency. PA is commonly caused by benign tumors of the adrenal gland, over-activity of steroid producing cells in the adrenal cortex, or in rare cases by hereditary conditions or adrenal cancer.
"Studies show primary aldosteronism may be more prevalent than previously thought, affecting more than ten percent of hypertensive patients," said Dr. John Funder of Prince Henry's Institute of Medical Research in Clayton, Australia and chair of the task force that developed these guidelines. "The new guideline uses the best available research to help physicians diagnose primary aldosteronism and employ specific treatments that can alleviate the impact of this condition."
The guideline recommends that case detection of PA be sought in higher risk groups of hypertensive patients and those with potassium deficiency by determining the ratio of aldosterone to renin, an enzyme that regulates blood pressure. If this ratio is elevated, diagnosis should then be confirmed or excluded by commonly-used confirmatory tests.
If PA is confirmed, the guideline recommends that patients undergo adrenal computed tomography (CT) to exclude adrenocorticol carcinoma, followed by radiographic lateralization to determine whether PA is due to unilateral or bilateral oversecretion.
Lateralization is important because if only one of the two adrenal glands is responsible for oversecretion PA is best treated by laparoscopic surgery to remove the overproducing adrenal gland. For the bilateral form, medical therapy is the treatment of choice. When medical therapy is needed, the guideline recommends patients be treated with mineralocorticoid receptor antagonists, drugs which inhibit the action of aldosterone.
The new guideline was developed by a task force chaired by Dr. Funder. Other members of the task force included Robert M. Carey of the University of Virginia Health System in Charlottesville, Va.; Carlos Fardella of Facultad de Medicina Pontificia Universidad Catolica de Chile in Santiago, Chile; Celso Gomez-Sanchez of Montgomery VA Medical Center in Jackson, Miss.; Franco Mantero of the University of Padova in Padua, Italy; Michael Stowasser of the University of Queensland in Brisbane, Australia; and William Young, Jr. and Victor Montori of the Mayo Clinic in Rochester, Minn.
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