Abstract
Background: Several guidelines and expert consensuses have been developed for management of primary aldosteronism (PA). It is important to understand the detailed recommendations and quality of these guidelines to help physicians make informed and reliable decision.Methods: PubMed, EMBASE, and three websites were searched for practice guidelines or consensuses of PA from inception to January 24, 2019. We summarized the major recommendations on the management of PA from these guidelines and consensuses. The Appraisal of Guidelines for Research and Evaluation II was used to assess quality of the included guidelines and consensuses.Results: We identified three clinical practice guidelines and three consensus statements. Most of the recommendations on the diagnosis and treatment of PA from these guidelines and consensuses were consistent. Some minor conflicts were recorded for patient's screen and confirmation test. All included guideline documents have a good quality (score, >70%) on the scope and purpose (mean score, 81.02%) and clarity of presentation of the recommendations (mean score, 86.88%). However, the reporting for the stakeholder involvement (mean score, 54.32%) and applicability (mean score, 47.92%) were insufficient. There was an insufficient rigorousness in most of the guideline documents (mean score, 45.56%) on the development process. The Endocrine Society practice guideline 2016 ranked highest in quality (score, 81.13%).Conclusions: Existing guideline documents provided valuable recommendations on the management of PA, but further efforts are needed to improve the methodological quality. The Endocrine Society practice guideline 2016 was recommended for use.
Highlights
Primary aldosteronism (PA) is a group of disorders caused by the autonomous excessive production aldosterone which escapes regulation from angiotensin or plasma potassium concentrations [1]
In order to help physicians to make informed and reliable decisions, in this article, we studied the major recommendations and potential discrepancies of current PA guidelines and consensuses; we conducted a critical appraisal of their quality
We considered both expert consensus and clinical practice guidelines for the management of PA
Summary
Primary aldosteronism (PA) is a group of disorders caused by the autonomous excessive production aldosterone which escapes regulation from angiotensin or plasma potassium concentrations [1]. Patients who suffer from PA may have a higher risk of cardiovascular and cerebrovascular events than those with essential hypertension [3,4,5]. This excess risk may be mitigated by proper treatment, for example, adrenalectomy for unilateral aldosterone-producing adenomas [6]. Clinical practice guidelines are developed to provide implemental basis for physicians and/or patients for the entire spectrum of clinical decision-making process, from prevention, screening, diagnosis, treatment, to rehabilitation, as an effort to improve the healthcare [8]. It is important to understand the detailed recommendations and quality of these guidelines to help physicians make informed and reliable decision
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