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Endocrine Society issues guidelines for aldosteronism
The guidelines include recommendations and suggestions for the detection and treatment of aldosteronism.
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Patients with primary aldosteronism should undergo adrenal CT as the first step in subtype testing and to exclude adrenocortical carcinoma, according to recommendations from the Endocrine Society.
A seven-member task force, comprised by a panel of experts from the Endocrine Society, reviewed systematic analyses of aldosteronism and discussed the issues at length. As a result, they developed clinical practice guidelines for the diagnosis and treatment of the disease.
The guidelines are published in the September issue of the Journal of Clinical Endocrinology and Metabolism.
Detection and confirmation
The task force recommended evaluating the following patients for primary aldosteronism: those with Joint National Commission stage 1 (>160-179/100-109 mm Hg), stage 2 (>180/110 mm Hg) or drug-resistant hypertension; hypertension and spontaneous or diuretic-inducted hypokalemia; hypertension with adrenal incidentaloma; or hypertension and a family history of early-onset hypertension or cerebrovascular accident at <40 years of age.
To detect primary aldosteronism in these patients, the society recommended using plasma aldosterone-renin ratio. When patients test positive, any of four confirmatory tests should be conducted to confirm or exclude the diagnosis.
Classifying subtypes
As the first subtype test in patients with primary aldosteronism, the task force recommended using adrenal CT scans to exclude adrenocortical carcinoma in these patients.
Experienced radiologists should conduct adrenal venous sampling to distinguish between unilateral and bilateral adrenal disease in patients who desire surgical treatment, according to the task force.
Genetic testing for glucocorticoid-remediable aldosteronism was suggested for patients diagnosed with primary aldosteronism before age 20 years or for those with a family history of primary aldosteronism or stroke before age 40 years.
Treating aldosteronism
The task force recommended treating patients with unilateral primary aldosteronism with unilateral laparoscopic adrenalectomy. In patients who decide against surgery, mineralocorticoid receptor antagonist treatment was recommended.
Medical treatment with mineralocorticoid receptor antagonists was also recommended for patients with bilateral adrenal disease. Specifically, the task force suggested spironolactone as the primary agent and eplerenone as an alternative.
Rather than first-line treatment with a mineralocorticoid receptor antagonist for patients with glucocorticoid-remediable aldosteronism, the task force recommended the lowest dose of glucocorticoid to normalize blood pressure and serum potassium levels.
J Clin Endocrinol Metab. 2008;93:3266-3281.
Read perspective about the new guidelines on aldosteronism from an EndocrineToday.com blogger.