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.