A Systematic Review Supporting the Endocrine Society Clinical Practice Guideline on Management of Primary Aldosteronism
Authors' conclusion
This systematic review addresses various aspects of managing PA and will support the development of the Endocrine Society guidelines.
Study context
- Population
- Patients with primary aldosteronism (PA); studies supporting the Endocrine Society Clinical Practice Guideline on managing PA95 studies (7 RCTs, 88 observational)
Methodological detailsMEDLINE, Embase, Scopus and others searched on October 4, 2024, Selection, extraction and appraisal by pairs of independent reviewers
- MEDLINE, Embase, Scopus and others searched on October 4, 2024
- Selection, extraction and appraisal by pairs of independent reviewers
Pooled result
As reported in the abstract
- No trials identified that evaluated outcomes of PA screening
- One observational study: screening associated with higher use of PA-specific medical therapies and better BP control
- Adrenal venous sampling (vs CT alone) may give better post-adrenalectomy biochemical cure rate, with increased risk of adrenal hemorrhage
- Two small observational studies: PA-specific medical or surgical therapy likely associated with better BP control than nonspecific therapy
- Small RCTs: surgical therapy may be associated with better BP control than medical therapy, with lower number and dosage of antihypertensive medications
- Spironolactone vs eplerenone: may be associated with better control of hypokalemia and lower number and dosage of antihypertensive agents
- Unsuppressed plasma renin activity associated with better hypokalemia control; suppression associated with higher risk of mortality, AF and stroke
- Very low certainty (renin activity findings)
Safety
- Increased risk of adrenal hemorrhage with adrenal venous sampling vs CT alone
Original publication
A Systematic Review Supporting the Endocrine Society Clinical Practice Guideline on Management of Primary Aldosteronism. J Clin Endocrinol Metab. Published 14 July 2025. doi:10.
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