オオツキ　ミチオ   Michio Otsuki   大月　道夫    所属   医学部 医学科（東京女子医科大学病院）    職種   教授・基幹分野長
論文種別	総説
言語種別	日本語
査読の有無	査読あり
表題	Japan Endocrine Society clinical practice guideline for the diagnosis and management of primary aldosteronism 2021.
掲載誌名	正式名：Endocrine journal 略　 称：Endocr J ISSNコード：13484540/09188959
掲載区分	国内
巻・号・頁	69(4),327-359頁
著者・共著者	Naruse Mitsuhide, Katabami Takuyuki, Shibata Hirotaka, Sone Masakatsu, Takahashi Katsutoshi, Tanabe Akiyo, Izawa Shoichiro, Ichijo Takamasa, Otsuki Michio, Omura Masao, Ogawa Yoshihiro, Oki Yutaka, Kurihara Isao, Kobayashi Hiroki, Sakamoto Ryuichi, Satoh Fumitoshi, Takeda Yoshiyu, Tanaka Tomoaki, Tamura Kouichi, Tsuiki Mika, Hashimoto Shigeatsu, Hasegawa Tomonobu, Yoshimoto Takanobu, Yoneda Takashi, Yamamoto Koichi, Rakugi Hiromi, Wada Norio, Saiki Aya, Ohno Youichi, Haze Tatsuya
発行年月	2022/04
概要	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.
DOI	10.1507/endocrj.EJ21-0508
PMID	35418526