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Clinical Practice Guidelines - Resource Library
Primary Aldosteronism: An Endocrine Society Clinic ...
Primary Aldosteronism: An Endocrine Society Clinical Practice Guideline (CPG02)
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Video Transcription
Video Summary
The session presented the new Endocrine Society clinical practice guidelines for primary aldosteronism (PA), a common but under-recognized cause of secondary hypertension associated with significant cardiovascular, cerebrovascular, and renal risks. The multidisciplinary guideline panel, including experts from various institutions and co-sponsored by several major societies, developed evidence-based recommendations based on systematic reviews using the GRADE methodology.<br /><br />Key points include recommending screening for PA in all hypertensive patients via serum or plasma aldosterone and renin measurements, acknowledging the challenges posed by interfering medications, and proposing pragmatic approaches to testing without necessarily withdrawing all medications. The guidelines redefine aldosterone suppression testing, previously mandatory for confirmation, now suggested primarily as a prognostic tool to assess the likelihood of unilateral disease suitable for surgery. Adrenal venous sampling (AVS) remains the gold standard for lateralization, with cross-sectional imaging as supplementary.<br /><br />Treatment emphasizes mineralocorticoid receptor antagonists (MRAs), primarily spironolactone, due to cost and availability, with shared decision-making regarding drug choice. A novel strategy involves monitoring plasma renin levels during therapy to guide MRA titration: increasing doses if renin remains suppressed and blood pressure uncontrolled, and avoiding dose escalation if renin is normalized. Surgical adrenalectomy is preferred for unilateral disease when feasible, offering superior biochemical cure and quality of life benefits.<br /><br />Limitations include low-quality evidence for many recommendations and lack of randomized controlled trials. Future directions highlight the need for improved diagnostic biomarkers, less invasive lateralization techniques, and randomized trials evaluating renin-guided therapy and novel treatments like aldosterone synthase inhibitors. Online tools and patient resources were also introduced to aid clinical implementation.
Keywords
Primary Aldosteronism
Secondary Hypertension
Endocrine Society Guidelines
Aldosterone Suppression Testing
Adrenal Venous Sampling
Mineralocorticoid Receptor Antagonists
Spironolactone
Plasma Renin Monitoring
Unilateral Disease
Adrenalectomy
GRADE Methodology
Diagnostic Biomarkers
Aldosterone Synthase Inhibitors
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