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Pilz, S; Schmitt, L; Kraus, DA; Theiler-Schwetz, V; Trummer, C; Riedmann, U.
Primary hyperaldosteronism-2025 Endocrine Society Guideline Summary, discussion, and implementation in clinical routine
J ENDOKRINOL DIAB ST. 2025; Doi: 10.1007/s41969-025-00291-5
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Leading authors Med Uni Graz: Pilz Stefan; Riedmann Uwe
Co-authors Med Uni Graz: Kraus Daniel Arian; Schmitt Lisa Maria; Theiler-Schwetz Verena; Trummer Christian
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Abstract:: In July 2025, the Endocrine Society published a new guideline on primary aldosteronism (PA), which is summarized and discussed in this article along with pragmatic guidance for its implementation in clinical routine. This guideline suggests screening for PA in all (!) patients with arterial hypertension. The determination of aldosterone and renin, as well as the aldosterone to renin ratio (ARR), remains the recommended screening test for PA. These laboratory measurements can be performed with any ongoing medication as part of a no medication withdrawal strategy to facilitate a wide screening to reduce the enormous underdiagnosis of PA. Confirmatory tests such as the saline infusion test are rarely required. The further management of patients with a positive screening test is guided by individual patient characteristics, but at any stage of PA diagnostics, medical PA therapy with a mineralocorticoid receptor antagonist (MRA), preferentially spironolactone, can be initiated. Beyond improvements of blood pressure and potassium, an increase in renin from baseline is now also a therapeutic target for MRA therapy. In addition to computed tomography (CT), adrenal venous sampling (AVS) is still highly recommended for subtype classification, though there is also evidence supporting a solely CT-based procedure. The dichotomous subtype classification into unilateral versus bilateral aldosterone secretion, that is, PHA types with preferentially surgical versus medical therapy, has recently been questioned by histopathologic, genetic, and clinical data. Various drugs such as nonsteroidal MRA and aldosterone synthase inhibitors, positive data on successful treatment of PA with radiofrequency ablation, and nuclear imaging methods (e.g,. 11C-Metomidate PET-CT and 68Ga-Pentixafor PET-CT) that perform as least as good as AVS, are currently emerging options for the care of PA patients.
Find related publications in this database (Keywords): Endocrine hypertension; Aldosterone to renin ratio; Adrenal gland; Adrenalectomy; Endocrine hypertension; Aldosterone to renin ratio; Adrenal gland; Adrenalectomy