New guidelines for PA-sound familiar?

June 27, 2008

Everyone can go to this at pubmeb and get complete guidelines. I

have not even read them in detail yet but they sound like what we

have been saying here for some time.

Someone should also upload a copy to our files. The online pub is

not a pretty as the final one will be I suspect.

You should also take to your Drs-but my evolution article is clearer

I think.

Will be interested in what others think.

CEG

3: J Clin Endocrinol Metab. 2008 Jun 13. [Epub ahead of print]

Case Detection, Diagnosis, and Treatment of Patients with Primary

Aldosteronism:

An Endocrine Society Clinical Practice Guideline.

Funder JW, Carey RM, Fardella C, Gomez- CE, Mantero F,

Stowasser M, Young

WF Jr, Montori VM.

Prince Henry's Institute of Medical Research (J.W.F.), Clayton,

Australia;

University of Virginia Health System (R.M.C.), Charlottesville,

Virginia;

Facultad de Medicina Pontificia Universidad Católica de Chile (C.F.),

Santiago,

Chile; G.V. (Sonny) Montgomery VA Medical Center (C.E.G-S.), ,

Mississippi; University of Padova (F.M.), Padua, Italy; University of

Queensland

(M.S.), Brisbane, Australia; Mayo Clinic (W.F.Y.), Rochester,

Minnesota; and Mayo

Clinic (V.M.M.), Rochester, Minnesota.

Objective: To develop clinical practice guidelines for the diagnosis and

treatment of patients with primary aldosteronism. Participants: The

Task Force

comprised a chair, selected by the Clinical Guidelines Subcommittee

(CGS) of The

Endocrine Society, six additional experts, one methodologist, and a

medical

writer. The Task Force received no corporate funding or remuneration.

Evidence:

Systematic reviews of available evidence were used to formulate the

key treatment

and prevention recommendations. We used the Grading of Recommendations,

Assessment, Development, and Evaluation (GRADE) 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: Consensus was guided by systematic reviews of evidence and

discussions

during one group meeting, several conference calls, and multiple e-mail

communications. The drafts prepared by the task force with the help

of a medical

writer were reviewed successively by The Endocrine Society's CGS,

Clinical

Affairs Committee (CAC), and Council. The version approved by the CGS

and CAC was

placed on The Endocrine Society's Web site for comments by members.

At each stage

of review, the Task Force received written comments and incorporated

needed

changes. Conclusions: We recommend case detection of primary

aldosteronism be

sought in higher risk groups of hypertensive patients and those with

hypokalemia

by determining the aldosterone-renin ratio under standard conditions,

and that

the condition be confirmed/excluded by one of four commonly used

confirmatory

tests. We recommend that all patients with primary aldosteronism

undergo adrenal

computed tomography (CT) as the initial study in subtype testing and

to exclude

adrenocortical carcinoma. We recommend the presence of a unilateral

form of

primary aldosteronism should be established/excluded by bilateral

adrenal venous

sampling by an experienced radiologist and, where present, optimally

treated by

laparoscopic adrenalectomy. We recommend that patients with bilateral

adrenal

hyperplasia, or those unsuitable for surgery, optimally be treated

medically by

mineralocorticoid receptor antagonists.

June 27, 2008

I put this in the Files for those who come by in the future. Not only is

there no mention of low renin HTN, there is no mention of the use of spiro

as a confirmatory test for PA.

rxlist.com says:

" Aldactone (spironolactone) is indicated in the management of:

Primary hyperaldosteronism for:

Establishing the diagnosis of primary hyperaldosteronism by therapeutic

trial.

Short-term preoperative treatment of patients with primary

hyperaldosteronism.

Long-term maintenance therapy for patients with discrete

aldosterone-producing adrenal adenomas who are judged to be poor operative

risks or who decline surgery. "

http://www.rxlist.com/cgi/generic/spiron_ids.htm

Val

From: hyperaldosteronism

[mailto:hyperaldosteronism ] On Behalf Of jwwright

Available full text in pdf

http://jcem.endojournals.org/cgi/rapidpdf/jc.2008-0104v1

These can be saved to your PC.

No instance of low renin essential HTN.

June 27, 2008

Well they are only Endocrinologists!

On Jun 28, 2008, at 12:05 AM, jwwright wrote:

> No instance of low renin essential HTN.

June 27, 2008

We will collect your comments and respond to them by writing a letter

to J it is published in.

One reason for the lack of using spiro is that it works very well

even in those who do not have PA but it depends on how you define

PA. Which stage. My guess is that they do not mention stages.

On Jun 27, 2008, at 10:24 PM, Valarie wrote:

> I put this in the Files for those who come by in the future. Not

> only is

> there no mention of low renin HTN, there is no mention of the use

> of spiro

> as a confirmatory test for PA.

>

> rxlist.com says:

>

> " Aldactone (spironolactone) is indicated in the management of:

>

> Primary hyperaldosteronism for:

>

> Establishing the diagnosis of primary hyperaldosteronism by

> therapeutic

> trial.

> Short-term preoperative treatment of patients with primary

> hyperaldosteronism.

> Long-term maintenance therapy for patients with discrete

> aldosterone-producing adrenal adenomas who are judged to be poor

> operative

> risks or who decline surgery. "

>

> http://www.rxlist.com/cgi/generic/spiron_ids.htm

>

> Val

>

> From: hyperaldosteronism

> [mailto:hyperaldosteronism ] On Behalf Of jwwright

>

> Available full text in pdf

> http://jcem.endojournals.org/cgi/rapidpdf/jc.2008-0104v1

>

> These can be saved to your PC.

>

> No instance of low renin essential HTN.

>

June 27, 2008

Available full text in pdf