The Joint Annual Scientific Meetings of the Endocrine Society of Australia and the Society for Reproductive Biology 2018

Current pattern of primary aldosteronism diagnosis: delayed and complicated (#287)

Yin Yu Lim 1 , Jimmy Shen 1 2 , Peter J Fuller 1 2 , Jun Yang 1 2 3
  1. Endocrinology, Monash Health, Clayton, Victoria, Australia
  2. Endocrine Hypertension Group, Hudson Institute of Medical Research, Clayton, VIC, Australia
  3. Department of Medicine, Monash University, Clayton, VIC, Australia

Background:

Primary aldosteronism (PA), also known as Conn’s syndrome, is the most common specifically treatable and potentially curable cause of hypertension. It has a prevalence of 3.2% to 12.7% in primary care and up to 30% in referral centres based on mostly overseas studies. There is limited data regarding the epidemiology and diagnosis of PA in Australia.

Objectives:

To analyse the referral pattern and disease characteristics of hypertensive patients referred to the Endocrine Hypertension Service (EHS) at Monash Health.

Methods:

Clinical data of 87 patients who attended the EHS from May 2016 to May 2017 was collected prospectively. Each patient completed a questionnaire covering socio-demographic, medication and comorbidity information. Referral sources and management outcomes were obtained from hospital medical records.

Results:

The majority of referrals (77%) were derived from tertiary centres, with only 23% from primary care. Only 3% of referrals to the EHS were made at first presentation of hypertension, while 61% had already had hypertension for over 10 years. Amongst the 62 patients diagnosed with PA by the EHS, 55% were on at least 3 antihypertensive medications, and 42% had associated end-organ damage. Adrenalectomy in 14 patients with aldosterone-producing adrenal adenomas led to 100% biochemical cure while targeted medical treatment in 37 patients led to significantly improved blood pressure control with fewer antihypertensive medications.

Conclusion:

The current diagnosis of PA is suboptimal – its delayed diagnosis results in end-organ damage which requires complex management and complicates the evaluation process of PA. Given that appropriate management of PA produced significant clinical and biochemical improvement, we postulate that there is a need to increase awareness of PA in primary and tertiary care so that an earlier diagnosis can be made to achieve optimal patient outcomes.