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Primary Aldosteronism: A Clinical Practice Guideli ...
Guideline: Primary Aldosteronism
Guideline: Primary Aldosteronism
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The "Primary Aldosteronism: An Endocrine Society Clinical Practice Guideline" outlines comprehensive strategies for diagnosing and managing primary aldosteronism (PA), a common cause of hypertension due to excessive aldosterone production by the adrenal glands. The guideline emphasizes the need for improved screenings, as PA is often underdiagnosed and undertreated despite its association with greater cardiovascular risks compared to primary hypertension.<br /><br />Key Recommendations:<br />1. Screening: All hypertensive individuals should be screened for PA using serum/plasma aldosterone and renin levels, alongside calculating the aldosterone to renin ratio (ARR). This approach is favored over relying solely on detecting hypokalemia, as many PA cases exhibit normal potassium levels.<br />2. Specific Therapy: Individuals with diagnosed PA should receive PA-specific treatments, such as MRAs or unilateral adrenalectomy in cases of lateralizing disease, instead of nonspecific antihypertensive drugs, to reduce cardiovascular and renal risks.<br />3. Confirmation and Lateralization Tests: When screening results suggest PA, aldosterone suppression testing may aid in determining the probability of lateralizing PA. AVS in conjunction with CT is recommended to accurately distinguish between unilateral and bilateral adrenal aldosterone production before surgical decisions.<br />4. Medical vs. Surgical Options: For lateralizing PA, surgical removal of the adrenal gland is preferred if feasible, while bilateral PA is typically managed with MRAs.<br />5. Monitoring: In those receiving MRA therapy, monitoring renin levels is recommended for optimal dosing to manage blood pressure effectively and reduce complications.<br />6. Spironolactone vs. Other MRAs: Spironolactone is suggested due to its cost-effectiveness and availability; however, other MRAs may be considered to minimize side effects.<br /><br />The guideline emphasizes the practical nature of these strategies, offering context-sensitive approaches based on available resources and healthcare infrastructure, thus aiming to improve diagnosis and management, enhancing outcomes while addressing current knowledge gaps and suggesting areas for future research.
Keywords
Primary Aldosteronism
Endocrine Society
Hypertension
Aldosterone
Screening
Adrenal Glands
Cardiovascular Risks
MRAs
Unilateral Adrenalectomy
Aldosterone to Renin Ratio
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