Japan Endocrine Society clinical practice guideline for the diagnosis and management of primary aldosteronism 2021

  • Naruse Mitsuhide
    Endocrine Center and Clinical Research Center, Ijinkai Takeda General Hospital, Kyoto 601-1495, Japan Clinical Research Institute of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan
  • Katabami Takuyuki
    Division of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University, Yokohama City Seibu Hospital, Yokohama 241-0811, Japan
  • Shibata Hirotaka
    Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Yufu 879-5593, Japan
  • Sone Masakatsu
    Division of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University, Kawasaki 216-8511, Japan
  • Takahashi Katsutoshi
    Division of Metabolism, Showa General Hospital, Kodaira, 187-8510 Japan
  • Tanabe Akiyo
    Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
  • Izawa Shoichiro
    Division of Endocrinology and Metabolism, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
  • Ichijo Takamasa
    Department of Diabetes and Endocrinology, Saiseikai Yokohamashi Tobu Hospital, Yokohama 230-0012, Japan
  • Otsuki Michio
    Department of Endocrinology, Tokyo Women’s Medical University, Tokyo 162-8666, Japan
  • Omura Masao
    Minato Mirai Medical Square, Yokohama, 220-0012 Japan
  • Ogawa Yoshihiro
    Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan Department of Endocrine and Metabolic Diseases/Diabetes Mellitus, Kyushu University Hospital, Fukuoka 812-8582, Japan
  • Oki Yutaka
    Department of Metabolism and Endocrinology, Hamamatsu Kita Hospital, Hamamatsu 431-3113, Japan
  • Kurihara Isao
    Department of Medical Education, National Defense Medical College, Tokorozawa 359-8513, Japan Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Tokyo 160-8582, Japan
  • Kobayashi Hiroki
    Division of Nephrology, Hypertension and Endocrinology, Nihon University School of Medicine, Tokyo 173-8610, Japan
  • Sakamoto Ryuichi
    Department of Endocrine and Metabolic Diseases/Diabetes Mellitus, Kyushu University Hospital, Fukuoka 812-8582, Japan
  • Satoh Fumitoshi
    Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
  • Takeda Yoshiyu
    Department of Endocrinology and Metabolism, Kanazawa University Hospital, Kanazawa 920-8641, Japan
  • Tanaka Tomoaki
    Department of Molecular Diagnosis, Chiba University, Chiba 260-8677, Japan
  • Tamura Kouichi
    Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan
  • Tsuiki Mika
    Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan
  • Hashimoto Shigeatsu
    Department of Endocrinology, Metabolism, Diabetology and Nephrology, Fukushima Medical University Aizu Medical Center, Aizu 969-3492, Japan
  • Hasegawa Tomonobu
    Department of Pediatrics, Keio University School of Medicine, Tokyo 160-0016, Japan
  • Yoshimoto Takanobu
    Department of Diabetes and Endocrinology, Tokyo Metropolitan Hiroo Hospital, Tokyo 150-0013, Japan
  • Yoneda Takashi
    Department of Health Promotion and Medicine of the Future, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
  • Yamamoto Koichi
    Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
  • Rakugi Hiromi
    Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
  • Wada Norio
    Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo 060-8604, Japan
  • Saiki Aya
    Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
  • Ohno Youichi
    Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
  • Haze Tatsuya
    Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan Department of Nephrology and Hypertension, Yokohama City University Medical Center, Yokohama 232-0024, Japan

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Abstract

<p>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.</p>

Journal

  • Endocrine Journal

    Endocrine Journal 69 (4), 327-359, 2022

    The Japan Endocrine Society

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