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Expert consensus on primary aldosteronism
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Consensus d’experts de la SFE, AFCE et la Société Française d’Hypertension Artérielle (SFHTA) de la SFC
Laurence Amar, Jean Philippe Baguet, Stéphane Bardet, Philippe Chaffanjon, Bernard Chamontin, Claire Douillard, Pierre Durieux, Xaxier Girerd, Philippe Gosse, Anne Hernigou, Daniel Herpin, Pascal Houillier, Xavier Jeunemaitre, Francis Joffre, Jean-Louis Kraimps, Hervé Lefebvre, Fabrice Ménégaux, Claire Mounier-Véhier,Juerg Nussberger, Jean-Yves Pagny, Antoinette Pechère, Pierre-François Plouin, Yves Reznik, Olivier Steichen, Antoine Tabarin, Maria-Christina Zennaro, Franck Zinzindohoue, Olivier Chabre
Abstract
The French Endocrinology Society (SFE) French Hypertension Society (SFHTA) and Francophone Endocrine Surgery Association (AFCE) have drawn up recommendations for the management of primary aldosteronism (PA), based on an analysis of the literature by 27 experts in 7 workgroups. PA is suspected in case of hypertension associated with one of the following characteristics: severity, resistance, associated hypokalemia, disproportionate target organ lesions, or adrenal incidentaloma with hypertension or hypokalemia. Diagnosis is founded on aldosterone/renin ratio (ARR) measured under standardized conditions. Diagnostic thresholds are expressed according to the measurement units employed. Diagnosis is established for suprathreshold ARR associated with aldosterone concentrations > 550 pmol/L (200 pg/mL) on 2 measurements, and rejected for aldosterone concentration < 240 pmol/L (90 pg/mL) and/or subthreshold ARR. The diagnostic threshold applied is different if certain medication cannot be interrupted. In intermediate situations, dynamic testing is performed. Genetic forms of PA are screened for in young subjects and/or in case of familial history. The patient should be informed of the results expected from medical and surgical treatment of PA before exploration for lateralization is proposed. Lateralization is explored by adrenal vein sampling (AVS), except in patients under 35 years of age with unilateral adenoma on imaging. If PA proves to be lateralized, unilateral adrenalectomy may be performed, with adaptation of medical treatment pre- and postoperatively. If PA is non-lateralized or the patient refuses surgery, spironolactone is administered as first-line treatment, replaced by amiloride, eplerenone or calcium-channel blockers if insufficiently effective or poorly tolerated.
Table of contents
- Introduction
- Handbook
- Epidemiology of primary aldosteronism: who should be screened for sporadic PA?
- First diagnostic steps and confirmatory testing
- Subtype diagnosis of PA
- Genetic diagnosis of PA
- Adrenal surgery in PA
- Medical treatment of primary aldosteronism
- Perspectives
Date de mise à jour du document : 2016
© 2016 Elsevier Masson SAS. All rights reserved
Document validé par la Commission Documents de Consensus
Cette commission de la SFC a pour objectif de superviser et contrôler la préparation des documents scientifiques ou d’autres documents tels que les consensus d’experts ou prises de position.
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