What are the French recommendations on the management of primary aldosteronism?

Updated: Mar 24, 2020
  • Author: Gabriel I Uwaifo, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

A series of recommendations on the management of primary aldosteronism were developed by the French Endocrinology Society (SFE), the French Hypertension Society (SFHTA), and the Francophone Endocrine Surgery Association (AFCE). [54, 55, 56, 57, 58, 59, 60, 61] They include a recommendation to screen for primary aldosteronism in patients with any of the following:

  • Severe hypertension (systolic blood pressure of 180 mm Hg or greater or diastolic blood pressure of 110 mm Hg or greater)
  • Resistant hypertension (systolic blood pressure of 140 mm Hg or greater or diastolic blood pressure of 90 mm Hg or above, even after the use of at least three antihypertensive agents, including a thiazide diuretic)
  • Hypokalemia-associated hypertension (either spontaneous or diuretic associated)
  • Hypertension or hypokalemia related to an adrenal incidentaloma

Regarding surgery, the recommendations state that laparoscopic adrenalectomy should be used for patients with lateralized primary aldosteronism who are candidates for surgery. In terms of medical treatment, the use of amiloride is recommended for patients with spironolactone intolerance, while eplerenone is suggested as another alternative in cases of spironolactone intolerance or if amiloride does not sufficiently control hypertension.


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