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SFE/SFHTA/AFCE primary aldosteronism consensus: Introduction and handbook

Laurence Amar 1 Jean Philippe Baguet 2 Stéphane Bardet 3 Philippe Chaffanjon 4 Bernard Chamontin 5 Claire Douillard 6 Pierre Durieux 1 Xaxier Girerd 7 Philippe Gosse 8 Anne Hernigou 1 Daniel Herpin 9 Pascal Houillier 1 Xavier Jeunemaitre 1 Francis Joffre 10 Jean-Louis Kraimps 11 Hervé Lefebvre 12, 13 Fabrice Menegaux 14 Claire Mounier-Vehier 15 Juerg Nussberger 16 Jean-Yves Pagny 1 Antoinette Pechère 17 Pierre-François Plouin 1 Yves Reznik 18 Olivier Steichen 1 Antoine Tabarin 19 Maria-Christina Zennaro 20, 1 Franck Zinzindohoue 1 Olivier Chabre 1, 21
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 work-groups. 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.
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Submitted on : Thursday, December 19, 2019 - 5:35:04 PM
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Laurence Amar, Jean Philippe Baguet, Stéphane Bardet, Philippe Chaffanjon, Bernard Chamontin, et al.. SFE/SFHTA/AFCE primary aldosteronism consensus: Introduction and handbook. Annales d'Endocrinologie, Elsevier Masson, 2016, 77 (3), pp.179-186. ⟨10.1016/j.ando.2016.05.001⟩. ⟨hal-02420232⟩

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