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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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ejendo\/lvaf117","type":"journal-article","created":{"date-parts":[[2025,6,5]],"date-time":"2025-06-05T07:50:05Z","timestamp":1749109805000},"page":"85-96","source":"Crossref","is-referenced-by-count":28,"title":["Expert Consensus on the Primary Aldosteronism Severity Classification and its strategic application in indicating adrenal venous sampling"],"prefix":"10.1093","volume":"193","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5541-3502","authenticated-orcid":false,"given":"Masanori","family":"Murakami","sequence":"first","affiliation":[{"name":"Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo , Tokyo 113-8510 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8977-4090","authenticated-orcid":false,"given":"Mitsuhide","family":"Naruse","sequence":"additional","affiliation":[{"name":"Endocrine Center, Ijinkai Takeda General Hospital , Kyoto 601-1495 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9674-0374","authenticated-orcid":false,"given":"Hiroki","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Hypertension, and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine , Tokyo 173-8610 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6930-7073","authenticated-orcid":false,"given":"Mirko","family":"Parasiliti-Caprino","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin , Turin 10126 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7550-7023","authenticated-orcid":false,"given":"Fabio","family":"Bioletto","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin , Turin 10126 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denise","family":"Br\u00fcdgam","sequence":"additional","affiliation":[{"name":"Department of Medicine IV, University Hospital, Ludwig Maximilian University Munich , Munich 80336 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel","family":"St\u00fcfchen","sequence":"additional","affiliation":[{"name":"Department of Medicine IV, University Hospital, Ludwig Maximilian University Munich , Munich 80336 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9817-9875","authenticated-orcid":false,"given":"Martin","family":"Reincke","sequence":"additional","affiliation":[{"name":"Department of Medicine IV, University Hospital, Ludwig Maximilian University Munich , Munich 80336 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9791-2118","authenticated-orcid":false,"given":"Matthieu","family":"St-Jean","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Department of Medicine, Centre int\u00e9gr\u00e9 universitaire de sant\u00e9 et de services sociaux de l\u2019Estrie - 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