The Endocrine Society just released updated clinical practice guidelines, Primary Aldosteronism: An Endocrine Society Clinical Practice Guideline. This release serves as a complete update to their 2016 guidelines on primary aldosteronism (PA) to improve diagnosis rates, encouraging targeted treatment, and better assisting clinicians as they navigate key questions related to PA.

These guidelines are divided into 10 key recommendations, each accompanied by technical remarks that provide support and additional insight. The recommendations encompass topics related to hypertension, pre-surgery considerations, medical therapy considerations, and additional considerations.

For your convenience, we’ve highlighted the key recommendations below. 

Ten Key Recommendations from the Guidelines:
  1. In all individuals with hypertension, we suggest screening for PA.
  2. In individuals with hypertension and PA, we suggest PA-specific therapy (medical or surgical).
  3. In individuals with hypertension, we suggest PA screening with serum/plasma aldosterone concentration and plasma renin (concentration or activity).
  4. In individuals who screen positive for PA, we suggest aldosterone-suppression testing in situations when screening results suggest an intermediate probability for lateralizing PA and individualized decision making confirms a desire to pursue eligibility for surgical therapy.
  5. In individuals with PA, we suggest medical therapy or surgical therapy with the choice of therapy based on lateralization of aldosterone hypersecretion and candidacy for surgery.
  6. In individuals with PA considering surgery, we suggest adrenal lateralization with CT scanning and AVS prior to deciding the treatment approach (medical or surgical).
  7. In individuals with PA receiving PA-specific medical therapy whose hypertension is not controlled and renin is suppressed, we suggest increasing PA-specific medical therapy to raise renin.
  8. In individuals with PA and adrenal adenoma, we suggest a dexamethasone-suppression test.
  9. In individuals with PA receiving PA-specific medical therapy, we suggest spironolactone over other MRAs due to its low cost and widespread availability.
  10. For individuals with PA receiving PA-specific medical therapy, we suggest using MRAs rather than ENaC inhibitors (amiloride, triamterene).

These guidelines are set to be reviewed annually to assess existing recommendations and updated evidence. If warranted, updates will then be made.

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