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