Background:
Primary aldosteronism (PA) is the most common endocrine cause of hypertension, affecting 5 – 10 % of hypertensive patients and up to 30% of those with resistant hypertension. Early diagnosis is crucial as it is potentially curable. Unfortunately very few centres have established protocols or expertise in its diagnosis and management.
Objectives:
Building on our expertise in aldosterone research, our aim was to develop centre-specific guidelines for the diagnosis and management of PA with an evidence-based pathway of care.
Methods:
An extensive literature review of PA was performed. The information was collated into a centre-specific protocol after consultation with all stakeholders involved in the pathway of care, including endocrinologists, radiologists, chemical pathologists and endocrine surgeons. The PA protocol was introduced in January 2010 and education sessions were delivered to both tertiary and primary care sectors. Outcomes were audited in 2018 to evaluate the impact of the protocol on clinical practice.
Results:
The number of cases of PA diagnosed at Monash Health, Victoria’s largest health service, increased from 2 per year in 2011-12 to 31 in 2016. The increased demand led to the establishment of the Endocrine Hypertension Service which reviewed 87 patients in its first year of operation from May 2016 and diagnosed 62 cases of PA. Of these, 14 were surgically cured and 37 experienced clinical improvement on targeted PA therapy. The engagement of a dedicated interventional radiologist to perform all of the adrenal vein sampling led to an increase in procedural success from 30 – 40% pre-2011 to almost 100% in 2018.
Conclusion:
An evidence-based center-specific protocol developed from PA research has been successfully implemented in clinical practice, leading to increased diagnoses and improved patient care. Further research to evaluate local PA community prevalence and improvements in diagnosis can now be embedded into the Endocrine Hypertension Service.