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SFE/SFHTA/AFCE primary aldosteronism consensus: Introduction and handbook.
Laurence Amar1, Jean Philippe Baguet2, Stéphane Bardet3
1Université Paris Descartes, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Unité D'hypertension Artérielle, 75098 Paris Cedex 15, France.
Annales D'Endocrinologie
|June 19, 2016
Summary
New guidelines recommend managing primary aldosteronism (PA) by suspecting hypertension with specific signs. Diagnosis uses aldosterone/renin ratio (ARR) under standardized conditions, with specific thresholds for confirmation or rejection.
Area of Science:
- Endocrinology
- Cardiology
- Nephrology
Background:
- Primary aldosteronism (PA) is a significant cause of secondary hypertension.
- PA diagnosis is often delayed, leading to increased cardiovascular and renal complications.
- Current management strategies require updated, evidence-based recommendations.
Framework:
- Recommendations developed by the French Endocrinology Society (SFE), French Hypertension Society (SFHTA), and Francophone Endocrine Surgery Association (AFCE).
- Based on a comprehensive literature analysis by 27 experts across 7 workgroups.
- Establishes clear criteria for suspecting PA, including resistant hypertension, hypokalemia, and adrenal incidentalomas.
Implementation:
- Diagnosis relies on aldosterone/renin ratio (ARR) under standardized conditions, with defined thresholds.
- Specific diagnostic criteria are provided for confirmed, rejected, and intermediate cases.
- Genetic screening for PA is recommended in younger patients and those with a family history.
- Lateralization is assessed via adrenal vein sampling (AVS), with exceptions for specific patient groups.
Implications:
- Informed patient consent regarding medical and surgical treatment outcomes is crucial before lateralization testing.
- Treatment options include unilateral adrenalectomy for lateralized PA or medical management with spironolactone/amiloride for non-lateralized cases.
- These guidelines aim to improve early detection and optimize management of primary aldosteronism, reducing associated comorbidities.
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