Taiwan mini-frontier of primary aldosteronism: Updating detection and diagnosis
Background: To update information about the internationally accepted standards and clinical recommendations for the detection and diagnosis of primary aldosteronism (PA). Methods: The Taiwan Society of Aldosteronism (TSA) Task Force reviewed the latest literature and reached a consensus after group...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2021-01-01
|
| Series: | Journal of the Formosan Medical Association |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S0929664620303557 |
| _version_ | 1818715737721667584 |
|---|---|
| author | Chin-Chen Chang Ying-Ying Chen Tai-Shuan Lai Yi-Hong Zeng Chung-Kuang Chen Kun-Hua Tu Ching-Chu Lu Vin-Cent Wu Leay Kiaw Er |
| author_facet | Chin-Chen Chang Ying-Ying Chen Tai-Shuan Lai Yi-Hong Zeng Chung-Kuang Chen Kun-Hua Tu Ching-Chu Lu Vin-Cent Wu Leay Kiaw Er |
| author_sort | Chin-Chen Chang |
| collection | DOAJ |
| description | Background: To update information about the internationally accepted standards and clinical recommendations for the detection and diagnosis of primary aldosteronism (PA). Methods: The Taiwan Society of Aldosteronism (TSA) Task Force reviewed the latest literature and reached a consensus after group meetings. The nine critical issues were recognized to provide updated information and internationally acceptable protocols. Results: When screening for PA by using the plasma aldosterone concentration (PAC) to plasma renin activity (PRA) ratio (ARR), withdrawal or adjustment of antihypertensive medication is not always necessary on the first patient visit. Hypokalemia should be corrected before ARR screening. In spontaneous hypokalemia, plasma renin below detection levels, and PAC higher than 20 ng/dL (550 pmol/L), further confirmatory testing is unnecessary for PA diagnosis. Direct renin concentration (DRC) could be used for PA diagnosis if PRA is unavailable. Although additional confirmatory tests are suggested, the result of a single test is still reliable. For patient safety, discontinuation or adjustment of antihypertensive medications is indicated before adrenal venous sampling (AVS). ACTH could be beneficial for successful adrenal vein cannulation but is not necessary for determining lateralization in AVS. Simultaneous technique is preferred for AVS. Adrenal NP-59 scintigraphy integrated with SPECT/CT could guide PA management. Conclusion: With introduction of these new concepts to the clinicians, we expect better identification, management and treatment of PA patients. |
| first_indexed | 2024-12-17T19:08:07Z |
| format | Article |
| id | doaj.art-1f70f8138ca94aef874e1636543f1e2f |
| institution | Directory Open Access Journal |
| issn | 0929-6646 |
| language | English |
| last_indexed | 2024-12-17T19:08:07Z |
| publishDate | 2021-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the Formosan Medical Association |
| spelling | doaj.art-1f70f8138ca94aef874e1636543f1e2f2022-12-21T21:35:55ZengElsevierJournal of the Formosan Medical Association0929-66462021-01-011201121129Taiwan mini-frontier of primary aldosteronism: Updating detection and diagnosisChin-Chen Chang0Ying-Ying Chen1Tai-Shuan Lai2Yi-Hong Zeng3Chung-Kuang Chen4Kun-Hua Tu5Ching-Chu Lu6Vin-Cent Wu7Leay Kiaw Er8Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department and Graduate Institute of Forensic Medicine, National Taiwan University College of Medicine, Taipei, TaiwanDivision of Nephrology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, TaiwanDivision of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, TaiwanDivision of Endocrinology and Metabolism, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, TaiwanDepartment of Clinical Pathology and Laboratory Medicine, ZhongXiao Branch, Taipei City Hospital, Taipei, TaiwanKidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taoyuan City, TaiwanDepartment of Nuclear Medicine, National Taiwan University Hospital, Taipei, TaiwanDepartment of Internal Medicine, National Taiwan University Hospital, Taipei, TaiwanDivision of Endocrinology, Department of Internal Medicine, Taipei Tzu-Chi Hospital, Buddhist Tzu-Chi Medical Foundation, New Taipei City, Taiwan; School of Medicine, Tzu-Chi University, Hualien, Taiwan; Corresponding author. No 289, Jian Kuo Road, Xindian district, New Taipei City, 23142, Taiwan.Background: To update information about the internationally accepted standards and clinical recommendations for the detection and diagnosis of primary aldosteronism (PA). Methods: The Taiwan Society of Aldosteronism (TSA) Task Force reviewed the latest literature and reached a consensus after group meetings. The nine critical issues were recognized to provide updated information and internationally acceptable protocols. Results: When screening for PA by using the plasma aldosterone concentration (PAC) to plasma renin activity (PRA) ratio (ARR), withdrawal or adjustment of antihypertensive medication is not always necessary on the first patient visit. Hypokalemia should be corrected before ARR screening. In spontaneous hypokalemia, plasma renin below detection levels, and PAC higher than 20 ng/dL (550 pmol/L), further confirmatory testing is unnecessary for PA diagnosis. Direct renin concentration (DRC) could be used for PA diagnosis if PRA is unavailable. Although additional confirmatory tests are suggested, the result of a single test is still reliable. For patient safety, discontinuation or adjustment of antihypertensive medications is indicated before adrenal venous sampling (AVS). ACTH could be beneficial for successful adrenal vein cannulation but is not necessary for determining lateralization in AVS. Simultaneous technique is preferred for AVS. Adrenal NP-59 scintigraphy integrated with SPECT/CT could guide PA management. Conclusion: With introduction of these new concepts to the clinicians, we expect better identification, management and treatment of PA patients.http://www.sciencedirect.com/science/article/pii/S0929664620303557Adrenal venous samplingPlasma renin activityPrimary aldosteronism |
| spellingShingle | Chin-Chen Chang Ying-Ying Chen Tai-Shuan Lai Yi-Hong Zeng Chung-Kuang Chen Kun-Hua Tu Ching-Chu Lu Vin-Cent Wu Leay Kiaw Er Taiwan mini-frontier of primary aldosteronism: Updating detection and diagnosis Journal of the Formosan Medical Association Adrenal venous sampling Plasma renin activity Primary aldosteronism |
| title | Taiwan mini-frontier of primary aldosteronism: Updating detection and diagnosis |
| title_full | Taiwan mini-frontier of primary aldosteronism: Updating detection and diagnosis |
| title_fullStr | Taiwan mini-frontier of primary aldosteronism: Updating detection and diagnosis |
| title_full_unstemmed | Taiwan mini-frontier of primary aldosteronism: Updating detection and diagnosis |
| title_short | Taiwan mini-frontier of primary aldosteronism: Updating detection and diagnosis |
| title_sort | taiwan mini frontier of primary aldosteronism updating detection and diagnosis |
| topic | Adrenal venous sampling Plasma renin activity Primary aldosteronism |
| url | http://www.sciencedirect.com/science/article/pii/S0929664620303557 |
| work_keys_str_mv | AT chinchenchang taiwanminifrontierofprimaryaldosteronismupdatingdetectionanddiagnosis AT yingyingchen taiwanminifrontierofprimaryaldosteronismupdatingdetectionanddiagnosis AT taishuanlai taiwanminifrontierofprimaryaldosteronismupdatingdetectionanddiagnosis AT yihongzeng taiwanminifrontierofprimaryaldosteronismupdatingdetectionanddiagnosis AT chungkuangchen taiwanminifrontierofprimaryaldosteronismupdatingdetectionanddiagnosis AT kunhuatu taiwanminifrontierofprimaryaldosteronismupdatingdetectionanddiagnosis AT chingchulu taiwanminifrontierofprimaryaldosteronismupdatingdetectionanddiagnosis AT vincentwu taiwanminifrontierofprimaryaldosteronismupdatingdetectionanddiagnosis AT leaykiawer taiwanminifrontierofprimaryaldosteronismupdatingdetectionanddiagnosis |