TY - JOUR
T1 - Japan Endocrine Society clinical practice guideline for the diagnosis and management of primary aldosteronism 2021
AU - Naruse, Mitsuhide
AU - Katabami, Takuyuki
AU - Shibata, Hirotaka
AU - Sone, Masakatsu
AU - Takahashi, Katsutoshi
AU - Tanabe, Akiyo
AU - Izawa, Shoichiro
AU - Ichijo, Takamasa
AU - Otsuki, Michio
AU - Omura, Masao
AU - Ogawa, Yoshihiro
AU - Oki, Yutaka
AU - Kurihara, Isao
AU - Kobayashi, Hiroki
AU - Sakamoto, Ryuichi
AU - Satoh, Fumitoshi
AU - Takeda, Yoshiyu
AU - Tanaka, Tomoaki
AU - Tamura, Kouichi
AU - Tsuiki, Mika
AU - Hashimoto, Shigeatsu
AU - Hasegawa, Tomonobu
AU - Yoshimoto, Takanobu
AU - Yoneda, Takashi
AU - Yamamoto, Koichi
AU - Rakugi, Hiromi
AU - Wada, Norio
AU - Saiki, Aya
AU - Ohno, Youichi
AU - Haze, Tatsuya
N1 - Funding Information:
Development of this guideline was supported in part by the Japan Endocrine Society and by grants-in-aid for the study of PA in Japan (JPAS) and the study of intrac-E table adrenal diseases (JRAS) from the Practical Research Project for Rare/Intractable Diseases of Japan AMED (JP17ek0109122 and JP20ek0109352); for the Study on Disorders of Adrenal Hormone, Research Program on Rare and Intractable Diseases from the Ministry of Health, Labor, and Welfare, Japan; and for the Study of Advancing Care and Pathogenesis of Intractable Adrenal Diseases in Japan (ACPA-J) from the National Center for Global Health and Medicine, Japan (27-1402 and 30-1008), the Clinical Research Institute, National Hospital Organization Kyoto Medical Center, and the Clinical Research Center, Ijinkai Takeda General Hospital, Kyoto, Japan. The task force received no fund-E ing or remuneration from commercial sources or other entities for this guideline.
Publisher Copyright:
© 2022, Japan Endocrine Society. All rights reserved.
PY - 2022
Y1 - 2022
N2 - Primary aldosteronism (PA) is associated with higher cardiovascular morbidity and mortality rates than essential hypertension. The Japan Endocrine Society (JES) has developed an updated guideline for PA, based on the evidence, especially from Japan. We should preferentially screen hypertensive patients with a high prevalence of PA with aldosterone to renin ratio ≥200 and plasma aldosterone concentrations (PAC) ≥60 pg/mL as a cut-off of positive results. While we should confirm excess aldosterone secretion by one positive confirmatory test, we could bypass patients with typical PA findings. Since PAC became lower due to a change in assay methods from radioimmunoassay to chemiluminescent enzyme immunoassay, borderline ranges were set for screening and confirmatory tests and provisionally designated as positive. We recommend individualized medicine for those in the borderline range for the next step. We recommend evaluating cortisol co-secretion in patients with adrenal macroadenomas. Although we recommend adrenal venous sampling for lateralization before adrenalectomy, we should carefully select patients rather than all patients, and we suggest bypassing in young patients with typical PA findings. A selectivity index ≥5 and a lateralization index >4 after adrenocorticotropic hormone stimulation defines successful catheterization and unilateral subtype diagnosis. We recommend adrenalectomy for unilateral PA and mineralocorticoid receptor antagonists for bilateral PA. Systematic as well as individualized clinical practice is always warranted. This JES guideline 2021 provides updated rational evidence and recommendations for the clinical practice of PA, leading to improved quality of the clinical practice of hypertension.
AB - Primary aldosteronism (PA) is associated with higher cardiovascular morbidity and mortality rates than essential hypertension. The Japan Endocrine Society (JES) has developed an updated guideline for PA, based on the evidence, especially from Japan. We should preferentially screen hypertensive patients with a high prevalence of PA with aldosterone to renin ratio ≥200 and plasma aldosterone concentrations (PAC) ≥60 pg/mL as a cut-off of positive results. While we should confirm excess aldosterone secretion by one positive confirmatory test, we could bypass patients with typical PA findings. Since PAC became lower due to a change in assay methods from radioimmunoassay to chemiluminescent enzyme immunoassay, borderline ranges were set for screening and confirmatory tests and provisionally designated as positive. We recommend individualized medicine for those in the borderline range for the next step. We recommend evaluating cortisol co-secretion in patients with adrenal macroadenomas. Although we recommend adrenal venous sampling for lateralization before adrenalectomy, we should carefully select patients rather than all patients, and we suggest bypassing in young patients with typical PA findings. A selectivity index ≥5 and a lateralization index >4 after adrenocorticotropic hormone stimulation defines successful catheterization and unilateral subtype diagnosis. We recommend adrenalectomy for unilateral PA and mineralocorticoid receptor antagonists for bilateral PA. Systematic as well as individualized clinical practice is always warranted. This JES guideline 2021 provides updated rational evidence and recommendations for the clinical practice of PA, leading to improved quality of the clinical practice of hypertension.
KW - Adrenal venous sampling
KW - Confirmatory test
KW - Guideline
KW - Primary aldosteronism
KW - Screening
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U2 - 10.1507/endocrj.EJ21-0508
DO - 10.1507/endocrj.EJ21-0508
M3 - Article
C2 - 35418526
AN - SCOPUS:85129758109
SN - 0918-8959
VL - 69
SP - 327
EP - 359
JO - Endocrine journal
JF - Endocrine journal
IS - 4
ER -
