Expert Consensus on the Primary Aldosteronism Severity Classification and its strategic application in indicating adrenal venous sampling
European Journal of Endocrinology, vol. 193, pp. 85–96
Abstract
OBJECTIVE: Severity classifications are essential for many diseases to prioritize patient management tasks such as diagnosis, treatment, and follow-up. Primary aldosteronism (PA), a common cause of secondary hypertension, lacks a standardized severity scale despite generally requiring invasive diagnostics like adrenal venous sampling (AVS). This study aimed to develop a global expert consensus-based classification for PA severity to improve clinical decision-making. METHODS: A panel of 45 international experts from 40 centers across four continents used the Delphi method to create a consensus severity classification for PA. This classification was then applied retrospectively to 2593 PA patients from 26 centers to assess its association with the disease subtype. RESULTS: After four rounds, the Primary Aldosteronism Severity Classification (PASC), which integrates biochemical and clinical parameters including serum potassium, blood pressure, and basal plasma aldosterone concentration, was established. Primary Aldosteronism Severity Classification classifies PA into mild (3 and 4 points), moderate (5-7 points), and severe (8 and 9 points). Among the cohort from 26 centers, 13.9%, 63.0%, and 23.1% were classified as mild, moderate, and severe, respectively, aligning with lateralized subtype prevalence rates of 14.7%, 44.6%, and 72.6%. CONCLUSION: Primary Aldosteronism Severity Classification is a newly developed simplified, semi-quantitative classification of PA severity. The correlation between PASC and lateralized PA subtype supports its potential to provide graded recommendations of AVS prior to surgical indication in each patient.
Authors 50
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Masanori Murakami corresponding
Affiliation as printed
Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo , Tokyo 113-8510 ,
Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo , Tokyo ,
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Mitsuhide Naruse corresponding
Ijinkai Takeda General Hospital
Affiliation as printed
Endocrine Center, Ijinkai Takeda General Hospital , Kyoto 601-1495 ,
Endocrine Center, Ijinkai Takeda General Hospital , Kyoto ,
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Affiliation as printed
Division of Nephrology, Hypertension, and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine , Tokyo 173-8610 ,
Division of Nephrology, Hypertension, and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine , Tokyo ,
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Affiliation as printed
Division of Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin , Turin 10126 ,
Division of Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin , Turin ,
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Affiliation as printed
Division of Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin , Turin 10126 ,
Division of Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin , Turin ,
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LMU Klinikum · Ludwig-Maximilians-Universität München
Affiliation as printed
Department of Medicine IV, University Hospital, Ludwig Maximilian University Munich , Munich 80336 ,
Department of Medicine IV, University Hospital, Ludwig Maximilian University Munich , Munich ,
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LMU Klinikum · Ludwig-Maximilians-Universität München
Affiliation as printed
Department of Medicine IV, University Hospital, Ludwig Maximilian University Munich , Munich 80336 ,
Department of Medicine IV, University Hospital, Ludwig Maximilian University Munich , Munich ,
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LMU Klinikum · Ludwig-Maximilians-Universität München
Affiliation as printed
Department of Medicine IV, University Hospital, Ludwig Maximilian University Munich , Munich 80336 ,
Department of Medicine IV, University Hospital, Ludwig Maximilian University Munich , Munich ,
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Centre Hospitalier Universitaire de Sherbrooke
Affiliation as printed
Division of Endocrinology, Department of Medicine, Centre intégré universitaire de santé et de services sociaux de l’Estrie - Centre hospitalier Universitaire de Sherbrooke , Sherbrooke, Quebec, Canada J1H 5N4
Division of Endocrinology, Department of Medicine, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier Universitaire de Sherbrooke , Sherbrooke, Quebec ,
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University Hospital Centre Zagreb · University of Zagreb
Affiliation as printed
Department of Endocrinology, University Hospital Centre Zagreb , Zagreb 10 000 ,
School of Medicine, University of Zagreb , Zagreb 10 000 ,
Department of Endocrinology, University Hospital Centre Zagreb , Zagreb, Croatia
School of Medicine, University of Zagreb , Zagreb, Croatia
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University Hospital Centre Zagreb · University of Zagreb
Affiliation as printed
Department of Endocrinology, University Hospital Centre Zagreb , Zagreb 10 000 ,
School of Medicine, University of Zagreb , Zagreb 10 000 ,
Department of Endocrinology, University Hospital Centre Zagreb , Zagreb, Croatia
School of Medicine, University of Zagreb , Zagreb, Croatia
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Tampere University · Tampere University Hospital
Affiliation as printed
Endocrine Unit, Department of Internal Medicine, Tampere University Hospital, and Faculty of Medicine and Health Technology, Tampere University , Tampere 33521 ,
Endocrine Unit, Department of Internal Medicine, Tampere University Hospital, and Faculty of Medicine and Health Technology, Tampere University , Tampere, Finland
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Hospital Universitario Ramón y Cajal
Affiliation as printed
Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal , Madrid 28034 ,
Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal , Madrid ,
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University Kebangsaan Malaysia Medical Centre · National University of Malaysia
Affiliation as printed
Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center (UKMMC) , Cheras, Kuala Lumpur 56000 ,
Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, Bandar Tun Razak , Kuala Lumpur 56000 ,
Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center (UKMMC) , Kuala Lumpur ,
Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, Bandar Tun Razak , Kuala Lumpur ,
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Leiden University · Leiden University Medical Center
Affiliation as printed
Department of Internal Medicine, Division of Endocrinology and Diabetes, Leiden University Medical Center , Leiden 2333 ZA ,
Department of Internal Medicine, Division of Endocrinology and Diabetes, Leiden University Medical Center , Leiden ,
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Affiliation as printed
University Hospital of Endocrinology, Medical University , Sofia 1431 ,
University Hospital of Endocrinology, Medical University , Sofia, Bulgaria
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Sahlgrenska University Hospital · Wallenberg Centre for Molecular and Translational Medicine · University of Gothenburg
Affiliation as printed
Department of Endocrinology, Sahlgrenska University Hospital , Gothenburg 413 45 ,
Wallenberg Center for Molecular and Translational Medicine, University of Gothenburg , Gothenburg 405 30 ,
Department of Endocrinology, Sahlgrenska University Hospital , Gothenburg ,
Wallenberg Center for Molecular and Translational Medicine, University of Gothenburg , Gothenburg ,
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North-Western State Medical University named after I.I. Mechnikov
Affiliation as printed
Department of Endocrinology, North-Western State Medical University Named After I.I. Mechnikov , St. Petersburg 191015 ,
Department of Endocrinology, North-Western State Medical University named after I.I. Mechnikov , St. Petersburg ,
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University of Helsinki · Helsinki University Hospital
Affiliation as printed
Endocrinology, Abdominal Center, Helsinki University Hospital and RPU Clinical and Molecular Medicine, University of Helsinki , Helsinki 00290 ,
Endocrinology, Abdominal Center, Helsinki University Hospital and RPU Clinical and Molecular Medicine, University of Helsinki , Helsinki, Finland
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General Hospital of Athens G. Genimatas
Affiliation as printed
Endocrinology Department and Diabetes Center, ‘G. Gennimatas’ General Hospital of Athens , Athens 11527 ,
Endocrinology Department and Diabetes Center, ‘G. Gennimatas’ General Hospital of Athens , Athens ,
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General Hospital of Athens G. Genimatas
Affiliation as printed
Endocrinology Department and Diabetes Center, ‘G. Gennimatas’ General Hospital of Athens , Athens 11527 ,
Endocrinology Department and Diabetes Center, ‘G. Gennimatas’ General Hospital of Athens , Athens ,
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Affiliation as printed
Division of Endocrinology and Metabolism, Tottori University Faculty of Medicine , Yonago 683-8504 ,
Division of Endocrinology and Metabolism, Tottori University Faculty of Medicine , Yonago ,
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Affiliation as printed
Department of Metabolism and Endocrinology, St. Marianna University Yokohama Seibu Hospital , Yokohama 241-0811 ,
Department of Metabolism and Endocrinology, St. Marianna University Yokohama Seibu Hospital , Yokohama ,
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Affiliation as printed
Department of Diabetes and Endocrinology, Saiseikai Yokohamashi Tobu Hospital , Yokohama 230-8765 ,
Department of Diabetes and Endocrinology, Saiseikai Yokohamashi Tobu Hospital , Yokohama ,
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National Center for Global Health and Medicine
Affiliation as printed
Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine , Tokyo 162-8655 ,
Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine , Tokyo ,
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Affiliation as printed
Department of Endocrinology and Metabolism, NHO Kyoto Medical Center , Kyoto 612-8555 ,
Department of Endocrinology and Metabolism, NHO Kyoto Medical Center , Kyoto ,
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Affiliation as printed
Department of Diabetes, Endocrinology and Clinical Immunology, School of Medicine, Hyogo Medical University , Nishinomiya, Hyogo 663-8501 ,
Department of Diabetes, Endocrinology and Clinical Immunology, School of Medicine, Hyogo Medical University , Nishinomiya, Hyogo ,
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Affiliation as printed
Department of Diabetes and Endocrinology, Sapporo City General Hospital , Sapporo 060-8604 ,
Department of Diabetes and Endocrinology, Sapporo City General Hospital , Sapporo ,
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Affiliation as printed
Department of Endocrinology and Metabolism, Kashiwa City Hospital , Kashiwa 277-0825 ,
Department of Endocrinology and Metabolism, Kashiwa City Hospital , Kashiwa ,
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Affiliation as printed
Department of Clinical and Experimental Medicine, University of Pisa , Pisa 56126 ,
Department of Clinical and Experimental Medicine, University of Pisa , Pisa ,
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University of Zurich · LMU Klinikum · University Hospital Zurich · Ludwig-Maximilians-Universität München
Affiliation as printed
Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich (USZ) and University of Zurich (UZH) , Zurich 8091 ,
Department of Medicine IV, University Hospital, Ludwig Maximilian University Munich , Munich 80336 ,
The LOOP Zurich—Medical Research Center , Zurich 8044 ,
Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich and University of Zurich , Zurich ,
Department of Medicine IV, University Hospital, Ludwig Maximilian University Munich , Munich ,
The LOOP Zurich - Medical Research Center , Zurich ,
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Affiliation as printed
Department of Medicine, Clinica Medica 3, University of Padova , Padova 35128 ,
Department of Medicine, Clinica Medica 3, University of Padova , Padova ,
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Karolinska University Hospital · Karolinska Institutet
Affiliation as printed
Department of Endocrinology, Karolinska University Hospital , Stockholm 171 76 ,
Department of Molecular Medicine and Surgery, Karolinska Institutet , Stockholm 171 76 ,
Department of Endocrinology, Karolinska University Hospital , Stockholm ,
Department of Molecular Medicine and Surgery, Karolinska Institutet , Stockholm ,
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Affiliation as printed
Department of Medicine, Haukeland University Hospital , Bergen 5021 ,
Department of Medicine, Haukeland University Hospital , Bergen ,
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Affiliation as printed
Department of Medicine, Haukeland University Hospital , Bergen 5021 ,
Department of Medicine, Haukeland University Hospital , Bergen ,
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Universidade de São Paulo · Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
Affiliation as printed
Adrenal Unit, Laboratory of Molecular and Cellular Endocrinology LIM/25, Division of Endocrinology and Metabolism, Clinics Hospital & Cancer Institute of Sao Paulo State, University of Sao Paulo Medical School , Sao Paulo 01246-903 ,
Adrenal Unit, Laboratory of Molecular and Cellular Endocrinology LIM/25, Division of Endocrinology and Metabolism, Clinics Hospital & Cancer Institute of Sao Paulo State, University of Sao Paulo Medical School , Sao Paulo ,
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Cliniques Universitaires Saint-Luc · UCLouvain
Affiliation as printed
Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain , Brussels 1200 ,
Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain , Brussels ,
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National University of Singapore · Changi General Hospital · Duke-NUS Medical School
Affiliation as printed
Department of Endocrinology, Changi General Hospital , Singapore 529889
Medical ACP, Duke-NUS Medical School , Singapore 169857
Department of Endocrinology, Changi General Hospital ,
Medical ACP, Duke-NUS Medical School ,
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University Clinical Centre · Gdańsk Medical University
Affiliation as printed
Department of Endocrinology and Internal Medicine, Medical University of Gdańsk , Gdańsk 80214 ,
Department of Endocrinology and Internal Medicine, University Clinical Center , Gdańsk 80214 ,
Department of Endocrinology and Internal Medicine, Medical University of Gdańsk , Gdańsk, Poland
Department of Endocrinology and Internal Medicine, University Clinical Center , Gdańsk, Poland
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Affiliation as printed
Department of Clinical and Experimental Medicine, University of Pisa , Pisa 56126 ,
Department of Clinical and Experimental Medicine, University of Pisa , Pisa ,
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Centre Hospitalier de l’Université de Montréal
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Endocrine Division, Department of Medicine, Centre hospitalier de l’Université de Montréal (CHUM) , Montréal, Canada H2X 3E4
Endocrine Division, Department of Medicine, Centre hospitalier de l’Université de Montréal (CHUM) , Montréal ,
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Inserm · Université Paris Cité · La Ligue Contre le Cancer · Assistance Publique – Hôpitaux de Paris · Hôpital Européen Georges-Pompidou · Paris Cardiovascular Research Center
Affiliation as printed
Hypertension Unit, Hôpital Européen Georges Pompidou, Assistance Publique—Hôpitaux de Paris , Paris F-75015 ,
Université Paris Cité, Inserm, PARCC, Equipe Labellisée par la Ligue contre le Cancer , Paris F-75015 ,
Hypertension Unit, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris , Paris ,
Université Paris Cité, Inserm, PARCC, Equipe Labellisée par la Ligue contre le Cancer , Paris ,
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Affiliation as printed
Department of Endocrinology, University Hospital Galway , Galway H91 YR71 ,
Department of Endocrinology, University Hospital Galway , Galway ,
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Affiliation as printed
Department of Medicine, Clinica Medica 3, University of Padova , Padova 35128 ,
Department of Medicine, Clinica Medica 3, University of Padova , Padova ,
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Radboud University Nijmegen · Radboud University Medical Center
Affiliation as printed
Department of Internal Medicine, Radboud University Medical Center , Nijmegen 6525 GA ,
Department of Internal Medicine, Radboud University Medical Center , Nijmegen ,
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Affiliation as printed
Department of Endocrinology, The Royal Hallamshire Hospital , Sheffield S10 2JF ,
Department of Endocrinology, The Royal Hallamshire Hospital , Sheffield ,
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Affiliation as printed
Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo , Tokyo 113-8510 ,
Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo , Tokyo ,
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Affiliation as printed
Endocrinology in Charlottenburg , Berlin 10627 ,
Endocrinology in Charlottenburg , Berlin ,
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Centre Hospitalier de l’Université de Montréal
Affiliation as printed
Endocrine Division, Department of Medicine, Centre hospitalier de l’Université de Montréal (CHUM) , Montréal, Canada H2X 3E4
Endocrine Division, Department of Medicine, Centre hospitalier de l’Université de Montréal (CHUM) , Montréal ,
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University of Ljubljana · Ljubljana University Medical Centre
Affiliation as printed
Department of Endocrinology, Diabetes, and Metabolic Diseases, University Medical Centre Ljubljana , Ljubljana 1000 ,
Faculty of Medicine, University of Ljubljana , Ljubljana 1000 ,
Department of Endocrinology, Diabetes, and Metabolic Diseases, University Medical Centre Ljubljana , Ljubljana, Slovenia
Faculty of Medicine, University of Ljubljana , Ljubljana, Slovenia
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