Funder John W
Hudson Institute of Medical Research and Monash University, Clayton, Australia.
Horm Metab Res. 2017 Dec;49(12):977-983. doi: 10.1055/s-0043-119802. Epub 2017 Oct 24.
The management of primary aldosteronism is widely varied within various published guidelines, with very little in the way of data supporting the choice of one variation over others. Current estimates of prevalence are probably accurate for aldosterone producing adenoma, but fall very short of that for bilateral adrenal hyperplasia. Discovery at the level of basic science has proven illuminating over the past 6 years in terms of unilateral disease and both somatic and germline mutations, with much less focus on the much more common bilateral disease; Attempts at harmonization have begun - for example, criteria for complete/partial/absent cure after adrenalectomy for unilateral disease; again focus on bilateral disease is muted. A number of possibilities are suggested as agenda for active consideration and change, across a wide range of areas - referral patterns, screening, confirmation and lateralization, what will be needed is discussion and agreement, to fill the lacunae within the current guidelines. Those involved will want to change to make such an agenda possible.
在各种已发表的指南中，原发性醛固酮增多症的管理方法差异很大，几乎没有数据支持选择一种方法而不选其他方法。目前对醛固酮瘤患病率的估计可能是准确的，但对于双侧肾上腺增生的估计则远远不足。在过去6年里，基础科学层面的发现为单侧疾病以及体细胞和种系突变带来了启示，而对更为常见的双侧疾病的关注则少得多；已经开始尝试进行协调统一——例如，制定单侧疾病肾上腺切除术后完全/部分治愈/未治愈的标准；同样，对双侧疾病的关注依然较少。有人提出了一些可能性，作为广泛领域积极考虑和变革的议程——转诊模式、筛查、确诊和定位，需要进行讨论并达成一致，以填补当前指南中的空白。相关人员会希望做出改变，以使这样的议程成为可能。
