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Ann Endocrinol (Paris). 2016 Jul;77(3):179-86. doi: 10.1016/j.ando.2016.05.001. Epub 2016 Jun 15.

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

Author information

1
Université Paris Descartes, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Unité D'hypertension Artérielle, 75098 Paris Cedex 15, France.
2
Service de Cardiologie, centre d'excellence en hypertension, Clinique Mutualiste de Grenoble, 38028 Grenoble, France.
3
Centre François Baclesse, Service de Médecine Nucléaire, 3, Avenue du Général-Harris, 14076 Caen cedex 05, France.
4
CHU Grenoble-Alpes, Département de Chirurgie Thoracique, Vasculaire et Endocrinienne, 38700 La Tronche, France; Université Grenoble Alpes, LADAF-Laboratoire d'Anatomie Des Alpes Françaises, UFR de Médecine, 38700 La Tronche, France.
5
Centre Hospitalo-Universitaire Rangueil, Service de Médecine Interne et d'Hypertension Artérielle, 31059 Toulouse, France.
6
Service d'endocrinologie et des maladies métaboliques, Centre Hospitalier Régional Universitaire de Lille, 59037 Lille, France.
7
Santé Publique et Informatique Médicale, Hôpital Européen Georges Pompidou, 20, Rue Leblanc, 75908 Paris cedex 15, France; Centre Cochrane Français, Université Paris Descartes, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, 75098 Paris France.
8
Pôle Cœur Métabolisme, Unité de Prévention Cardiovasculaire, Groupe Hospitalier Universitaire Pitié-Salpêtrière, 83, bld de l'Hôpital, 75013 Paris, France.
9
Service de Cardiologie/Hypertension CHU Bordeaux, 33076 Bordeaux, France.
10
Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Unité d'Hypertension, 20, Rue Leblanc, 75908 Paris cedex 15, France.
11
Service de Cardiologie, Centre Hospitalier Universitaire de Poitiers, 86021 Poitiers, France.
12
Département des maladies rénales et métaboliques, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France.
13
INSERM, UMRS_970, Paris Cardiovascular Research Center, Université Paris Descartes, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Génétique, 75098 Paris, France.
14
Centre Hospitalo-Universitaire Rangueil, Département de Radiologie, 31059 Toulouse, France.
15
CHU Poitiers, Hôpital Jean Bernard, Chirurgie Générale et Endocrinienne, Université de Poitiers, Faculté de Médecine, 86000 Poitiers, France.
16
Service d'endocrinologie, Centre Hospitalier Universitaire, 76031 Rouen, France.
17
Sorbonne Universités, UPMC Univ Paris 06, Faculté de Médecine, 75006 Paris, France; AP-HP, Pitié Salpétrière, Service de Chirurgie Digestive et Viscérale, 75013 Paris, France.
18
Service de Médecine Vasculaire et Hypertension Artérielle, Centre Hospitalier Universitaire de Lille, 59037 Lille, France.
19
Service de Médecine Interne (unité vasculaire et d'hypertension), Centre Hospitalier Universitaire de Lausanne, 1011 Lausanne, Switzerland.
20
Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Département de Radiologie, 20, Rue Leblanc, 75908 Paris cedex 15, France.
21
Unité d'Hypertension, Hopital Universitaire de Genève, 1205 Geneve, Switzerland.
22
Service d'Endocrinologie et Maladies Métaboliques, CHU Côte de Nacre, 14033 Caen Cedex, France.
23
AP-HP, hôpital Tenon, Service de Médecine Interne, 75020 Paris, France.
24
Service d'Endocrinologie, Hôpital Haut Lévêque, CHU de Bordeaux, Avenue de Magellan, 33600 Pessac, France.
25
INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Génétique, 75098 Paris, France.
26
Sorbonne Paris Cité, Université Paris Descartes, Faculté de Médecine, 75006 Paris, France.
27
AP-HP, HEGP, Service de Chirurgie Digestive, Générale et Cancérologique, 75015 Paris, France; Endocrinologie, Pavillon des Ecrins, Centre Hospitalier Universitaire de Grenoble, CS 10217, 38043 Grenoble Cedex 9, France. Electronic address: OlivierChabre@chu-grenoble.fr.

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 >550pmol/L (200pg/mL) on 2 measurements, and rejected for aldosterone concentration<240pmol/L (90pg/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.

KEYWORDS:

Adrenal incidentaloma; Consensus; Hyperaldostéronisme; Hypertension résistante; Hypertension sévère; Hypokalemia; Hypokaliémie; Incidentalome surrénalien; Primary aldosteronism; Resistant hypertension; Severe hypertension

PMID:
27315757
DOI:
10.1016/j.ando.2016.05.001
[Indexed for MEDLINE]

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