Primary aldosteronism: comparison between guidelines of the Japanese and the US Endocrine Society

The US and Japanese Endocrine Societies recently both developed a therapeutic guideline for primary aldosteronism (PA). These guidelines indicate that differential diagnosis between PA caused by aldosterone-producing adenoma (APA) and bilateral adrenal hyperplasia (or idiopathic hyperaldosteronism [IHA]) is important and critical for treatment choice, while they show some inconsistency due to different frequencies of disorders and medical circumstances in respective countries. Japanese Endocrine Society guidelines have a unique description on the adrenal vein sampling (AVS) against microAPA, detection of which is difficult with current imaging tools and thus is frequently misdiagnosed as IHA. We reported that AVS performed in combination with adrenocorticotropic hormone stimulation was useful for diagnosing laterality of PA lesions, and APA underlay 74% of our cases with significant reduction of IHA compared with those previously reported. Laterality of PA should be precisely evaluated with AVS and imaging studies, as the results strongly influence the choice of therapeutic strategies.