The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline
The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline
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DOI：
10.1210/jc.2015-4061
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发表时间：
2016-05-01
影响因子：
5.8
通讯作者：
Young, William F., Jr.
中科院分区：
文献类型：
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作者：
Funder, John W.;Carey, Robert M.;Young, William F., Jr.
目的：制定原发性醛固酮增多症患者治疗的临床实践指南。参与者：工作组包括一名由内分泌学会临床指南小组委员会选出的主席、另外六名专家、一名方法学家和一名医学撰稿人。该指南由美国心脏协会、美国内分泌外科医生协会、欧洲内分泌学会、欧洲高血压学会、国际内分泌外科医生协会、国际内分泌学会、国际高血压学会、日本内分泌学会和日本高血压学会共同发起。该工作组没有收到任何公司资助或报酬。证据：我们寻找系统评价和初步研究来制定关键的治疗和预防建议。我们使用建议分级、评估、制定和评估组标准来描述证据的质量和建议的强度。对于强推荐，我们使用“推荐”，对于弱推荐，我们使用“建议”。 共识过程：我们通过收集最佳可用证据并进行一次小组会议、多次电话会议和多次电子邮件通信来达成共识。在医学撰稿人的帮助下，内分泌学会临床指南小组委员会、临床事务核心委员会和理事会成功审查了工作组编写的草案。我们将临床指南分委会和临床事务核心委员会批准的版本放在内分泌学会网站上征求会员意见。在每个审查阶段，工作组都收到了书面意见并进行了必要的修改。结论：对于高血压患者和低钾血症患者的高危人群，我们建议通过在标准条件下测定醛固酮-肾素比值来检测原发性醛固酮增多症，并建议采用常用的确诊试验来确认/排除该病症。我们建议所有原发性醛固酮增多症患者均接受肾上腺计算机断层扫描作为亚型检测的初始研究并排除肾上腺皮质癌。我们建议经验丰富的放射科医生应使用双侧肾上腺静脉采样来确定/排除单侧原发性醛固酮增多症，如果得到证实，最好通过腹腔镜肾上腺切除术进行治疗。我们建议双侧肾上腺增生或不适合手术的患者主要使用盐皮质激素受体拮抗剂治疗。
Objective: To develop clinical practice guidelines for the management of patients with primary aldosteronism.Participants: The Task Force included a chair, selected by the Clinical Guidelines Subcommittee of the Endocrine Society, six additional experts, a methodologist, and a medical writer. The guideline was cosponsored by American Heart Association, American Association of Endocrine Surgeons, European Society of Endocrinology, European Society of Hypertension, International Association of Endocrine Surgeons, International Society of Endocrinology, International Society of Hypertension, Japan Endocri ne Soci ety, and The Japanese Society of Hypertension. The Task Force received no corporate funding or remuneration.Evidence: We searched for systematic reviews and primary studies to formulate the key treatment and prevention recommendations. We used the Gradi ng of Recommendations, Assessment, Development, and Evaluation group criteria to describe both the quality of evidence and the strength of recommendations. We used "recommend" for strong recommendations and "suggest" for weak recommendations.Consensus Process: We achieved consensus by collecting the best available evidence and conducting one group meeting, several conference calls, and multiple e-mail communications. With the help of a medical writer, the Endocrine Society's Clinical Guidelines Subcommittee, Clinical Affairs Core Committee, and Council successfully reviewed the drafts prepared by the Task Force. We placed the version approved by the Clinical Guidelines Subcommittee and Clinical Affairs Core Committee on the Endocrine Society's website for comments by members. At each stage of review, the Task Force received written comments and incorporated necessary changes.Conclusions: For high -risk groups of hypertensive patients and those with hypokalemi a, we recommend case detection of primary aldosteronism by determining the aldosterone-renin ratio under standard conditions and recommend that a commonly used confi rmatory test should confirm/exclude the condition. We recommend that all patients with primary aldosteronism undergo adrenal computed tomography as the initial study in subtype testing and to exclude adrenocortical carcinoma. We recommend that an experienced radiologist should establish/exclude unilateral primary aldosteronism using bilateral adrenal venous sampling, and if confirmed, this should optimally be treated by laparoscopic adrenalectomy. We recommend that patients with bilateral adrenal hyperplasia or those unsuitable for surgery should be treated primarily with a mineralocorticoid receptor antagonist.