Abstract：
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.
摘要：
原发性醛固酮增多症（PA）的心血管发病率和死亡率高于原发性高血压。日本内分泌学会（JES）为PA制定了更新的指南，根据证据,尤其是来自日本。我们应优先筛查PA患病率高的高血压患者，醛固酮与肾素之比≥200，血浆醛固酮浓度（PAC）≥60pg/mL作为阳性结果的界限。虽然我们应该通过一个阳性确证试验确认过量的醛固酮分泌，我们可以绕过典型PA发现的患者。由于从放射免疫分析法到化学发光酶免疫测定法的改变，PAC变得更低，设定了筛查和验证性试验的临界范围,并暂时指定为阳性.我们建议为处于下一步边界范围内的患者提供个性化药物。我们建议评估肾上腺大腺瘤患者的皮质醇分泌。尽管我们建议在肾上腺切除术前进行肾上腺静脉采样，我们应该仔细选择患者，而不是所有患者，我们建议在有典型PA发现的年轻患者中进行旁路。促肾上腺皮质激素刺激后的选择性指数≥5和侧化指数>4表示成功的导管插入和单侧亚型诊断。我们建议单侧PA的肾上腺切除术和双侧PA的盐皮质激素受体拮抗剂。系统的和个性化的临床实践始终是必要的。本JES指南2021为PA的临床实践提供了最新的合理证据和建议。提高高血压的临床实践质量。
