Lou Portero

Urban Health Today

<p>The Endocrine Society has released updated clinical practice guidelines for primary aldosteronism, a condition that represents a common yet significantly underdiagnosed cause of hypertension.</p>
<p>Published in <a href="https://academic.oup.com/jcem/advance-article/doi/10.1210/clinem/dgaf284/8196671?login=false">The Journal of Clinical Endocrinology &amp; Metabolism</a> by Gail Adler and her team, the detailed guidelines focus on primary aldosteronism, a condition where the adrenal glands produce too much aldosterone, leading to high blood pressure that can cause more heart problems than regular high blood pressure. The condition remains markedly underdiagnosed and undertreated, despite effective diagnostic and treatment methods being available.</p>
<p>The guidelines recommend universal screening for all individuals with hypertension through measurement of aldosterone and renin levels to determine the aldosterone-to-renin ratio. Urban communities, where environmental stressors, dietary factors, and limited healthcare access often elevate hypertension prevalence, could significantly benefit from this systematic approach. The multidisciplinary expert panel used rigorous GRADE methodology to address ten key questions about diagnosis and treatment, considering factors including cost-effectiveness, acceptability, feasibility, and potential impact on health equity.</p>
<p>For treatment, the guidelines suggest primary aldosteronism-specific therapy, either medical or surgical approaches. Medical management prioritizes mineralocorticoid receptor antagonists over epithelial sodium-channel inhibitors, with spironolactone recommended as first-line therapy due to its lower cost and greater availability. This cost consideration is particularly relevant for urban populations, where medication affordability affects treatment adherence.</p>
<p>The guidelines emphasize individualized decision-making based on screening results and patient preferences. For those with an intermediate probability of lateralizing disease, aldosterone suppression testing guides surgical eligibility. High-probability cases may proceed directly to adrenal lateralization studies using computed tomography and adrenal venous sampling.</p>
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<div class="post-references"><h3>References</h3><p>Adler GK, et al. <em>J Clin Endocrinol Metab</em>. 2025;dgaf284. doi:<a href="https://academic.oup.com/jcem/advance-article/doi/10.1210/clinem/dgaf284/8196671?login=false">10.1210/clinem/dgaf284</a></p>
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<p>The Endocrine Society has released updated clinical practice guidelines for primary aldosteronism, a condition that represents a common yet significantly underdiagnosed cause of hypertension.</p><p>Published in <a href="https://academic.oup.com/jcem/advance-article/doi/10.1210/clinem/dgaf284/8196671?login=false">The Journal of Clinical Endocrinology &amp; Metabolism</a> by Gail Adler and her team, the detailed guidelines focus on primary aldosteronism, a condition where the adrenal glands produce too much aldosterone, leading to high blood pressure that can cause more heart problems than regular high blood pressure. The condition remains markedly underdiagnosed and undertreated, despite effective diagnostic and treatment methods being available.</p><p>The guidelines recommend universal screening for all individuals with hypertension through measurement of aldosterone and renin levels to determine the aldosterone-to-renin ratio. Urban communities, where environmental stressors, dietary factors, and limited healthcare access often elevate hypertension prevalence, could significantly benefit from this systematic approach. The multidisciplinary expert panel used rigorous GRADE methodology to address ten key questions about diagnosis and treatment, considering factors including cost-effectiveness, acceptability, feasibility, and potential impact on health equity.</p><p>For treatment, the guidelines suggest primary aldosteronism-specific therapy, either medical or surgical approaches. Medical management prioritizes mineralocorticoid receptor antagonists over epithelial sodium-channel inhibitors, with spironolactone recommended as first-line therapy due to its lower cost and greater availability. This cost consideration is particularly relevant for urban populations, where medication affordability affects treatment adherence.</p><p>The guidelines emphasize individualized decision-making based on screening results and patient preferences. For those with an intermediate probability of lateralizing disease, aldosterone suppression testing guides surgical eligibility. High-probability cases may proceed directly to adrenal lateralization studies using computed tomography and adrenal venous sampling.</p><p> </p><div class="post-references"><h3>References</h3><p>Adler GK, et al. <em>J Clin Endocrinol Metab</em>. 2025;dgaf284. doi:<a href="https://academic.oup.com/jcem/advance-article/doi/10.1210/clinem/dgaf284/8196671?login=false">10.1210/clinem/dgaf284</a></p>
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guidelines focus on primary aldosteronism, a condition where the adrenal glands produce too much aldosterone, leading to high blood pressure