ICEECE2012 Poster Presentations Adrenal cortex (113 abstracts)
Applicability of the guideline for the diagnosis of primary hyperaldosteronism in patients with hypertension in Japan (PHAS-J2): Prospective multi-center study of national hospital organization
M. Naruse 1 , Y. Miyazaki 1, , T. Tanaka 3 , M. Shimizu 4 , S. Otani 1, , S. Hata 6 , A. Ogo 1, , K. Yonezawa 8 , K. Yoshida 9 , M. Sawamura 10 , R. Araki 1, , M. Tanabe 1, , M. Tsuiki 1 , T. Suzuki 1, & T. Shimbo 13
1NHO Kyoto Medical Center, Kyoto, Japan; 2Misato Kenwa Hospital, Misato, Japan; 3NHO Mie Chuou Medical Center, Tsu, Japan; 4NHO Kobe Medical Center, Kobe, Japan; 5Saitama National Hospital, Wako, Japan; 6Nagasaki Goto Chuoh Hospital, Goto, Japan; 7NHO Kyushu Medical Center, Fukuoka, Japan; 8NHO Hakodate Hospital, Hakodate, Japan; 9NHO Nagasaki Kawatana Medical Center, Nagasaki, Japan; 10Nishigunma National Hospital, Shibukawa, Japan; 11National Mie Hospital, Tsu, Japan; 12NHO Kokura Medical Center, Kitakyushu, Japan; 13National Center for Global Health and Medicine, Tokyo, Japan.
Primary aldosteronism (PA) is the most major cause of secondary hypertension, with its prevalence ranging from 3 to 20% of the hypertensive patients. Although guideline for diagnosis of PA has been established by the Endocrine Society, details of its applicability remain to be elucidated. In this study, we investigated the applicability of each step of the guideline in hypertensive patients by the multi-center collaborative study of National Hospital Organization (NHO) in Japan (PHAS-J2). Total 25 NHO hospitals participated into the study. The study was performed in accordance with the Guidelines for Human Research of Japanese Government and approved by the institutional ethical committee. Written informed consent was obtained from each patient. Patients with hypertension ranging from 20 to 75 yrs were enrolled. Plasma aldosterone to renin activity ratio (ARR) with a cutoff of 20 was used for case detection and captopril test was used as a confirmatory testing. Captopril-positive patients were subjected to subtype testing with adrenal CT, 131I-adosterol scintigraphy, and adrenal venous sampling (AVS). Total 1237 patients were enrolled to the study. Case detection was positive in 21% of the patients and captopril test was positive in 58% of the screening-positive patients. Collectively, prevalence of PA was 12.2% of the total patients with hypertension. Adrenal tumor was visualized in 32% on CT. Applicability of each step was 85% in confirmatory testing, 93% in adrenal CT, 14.9% in adrenal scintigraphy, and 39% in AVS. Subtype diagnosis was achieved in 46% in those patients subjected to adrenal scintigraphy and/or AVS. These results suggest that applicability of the PA guideline in its subtype testing is not high enough to make definite diagnosis. Given the high prevalence of PA in hypertension, modification of the PA guideline as well as further advances in subtype testing are mandatory.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This work was supported, however funding details unavailable.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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