Dr.Cheng HsuanTsai Taiwan

• Do We Still Need Confirmatory Testing?
  Mitsuhide NaruseJapan Speaker Update in Primary AldosteronismPrimary aldosteronism (PA) is linked to significantly greater cardiovascular morbidity and mortality than essential hypertension, yet it offers a more favorable prognosis when appropriately treated. Early detection and targeted therapy are therefore essential for achieving optimal long-term outcomes and preserving quality of life. Since the release of the Endocrine Society’s guidelines in 2010, several countries—including Japan—have developed national recommendations (e.g., Endocrine Journal, 2021). This reflects growing awareness and research momentum, with over 3,500 publications in the past decade. In Japan, we have established a national PA registry and conducted multicenter studies under the Japan Primary Aldosteronism Study (JPAS), supported by AMED, resulting in more than 40 publications as Japan-originated evidence. Diagnostic protocols have become increasingly standardized, encompassing initial screening, confirmatory testing, subtype classification via adrenal venous sampling (AVS), and tailored treatment—mineralocorticoid receptor (MR) antagonists for bilateral PA and adrenalectomy for unilateral PA. The integration of PA screening into routine hypertension care, alongside the standardization of diagnostic methods, has led to substantial improvements in clinical practice. However, key challenges remain. These include variability in assay methods (e.g., PRA vs. ARC for renin; CLEIA vs. RIA for aldosterone), which affects diagnostic thresholds; uncertainty regarding optimal cutoffs for screening and confirmatory tests; lack of consensus on AVS protocols (with or without cosyntropin); and ongoing debates over the role of non-invasive imaging and advanced surgical approaches (laparoscopic vs. robot-assisted adrenalectomy). These unresolved issues warrant evaluation through a cost-effectiveness lens. As PA diagnostics become increasingly integrated into hypertension management, a fundamental question emerges: How far should we go in diagnosing PA? This presentation will provide an updated overview of clinical practice and address these critical challenges in PA management.Do We Still Need Confirmatory Testing?
• Skipping Confirmatory Tests: Modern Simplified Pathways
  Ada E. D. TeoSingapore Speaker Skipping Confirmatory Tests: Modern Simplified Pathways
• From ARR to Subtyping: Practical Strategies for Streamlining Testing, Imaging, and AVS in Daily Practice
  Wasita Warachit ParksookThailand Speaker From ARR to Subtyping: Practical Strategies for Streamlining Testing, Imaging, and AVS in Daily Practice
• Medical vs Surgical Treatment in 2026: Optimizing MRA Therapy, ENaC Strategies, and Surgical Decision-Making
  Cheng Hsuan TsaiTaiwan Speaker Medical vs Surgical Treatment in 2026: Optimizing MRA Therapy, ENaC Strategies, and Surgical Decision-Making
• Discussion