Abstract
BackgroundVarious diagnostic tests are available to establish the primary aldosteronism (PA) diagnosis and to determine the disease laterality. Combined with the controversies in the literature, unawareness of guidelines and technical demands and high costs of some of these diagnostics, this could lead to significant differences in work-up strategies worldwide. Therefore, we investigated the work-up before surgery for PA in daily clinical practice within a multicenter study.MethodsPatients who underwent unilateral adrenalectomy for PA within 16 centers in Europe, Canada, Australia and the USA between 2010 and 2016 were included. We did not exclude patients based on the performed diagnostic tests during work-up to make our data representative for current clinical practice. Adherence to the Endocrine Society Guideline and variables associated with not performing adrenal venous sampling (AVS) were analyzed.ResultsIn total, 435 patients were eligible. An aldosterone-to-renin ratio, confirmatory test, computed tomography (CT), magnetic resonance imaging and AVS were performed in 82.9%, 32.9%, 86.9%, 17.0% and 65.3% of patients, respectively. A complete work-up, as recommended by the guideline, was performed in 13.1% of patients. Bilateral disease or normal adrenal anatomy on CT (OR 16.19; CI 3.50–74.99), smaller tumor size on CT (OR 0.06; CI 0.04–0.08) and presence of hypokalemia (OR 2.00; CI 1.19–3.32) were independently associated with performing AVS.ConclusionsThis study is the first to examine the daily clinical practice work-up of PA within a worldwide cohort of surgical patients. The results demonstrate significant variability in work-up strategies and low adherence to The Endocrine Society guideline.
Highlights
Primary aldosteronism (PA) is the most common surgically treatable cause of secondary hypertension with an estimated prevalence of 5–20% within the hypertensive population [1,2,3,4,5,6,7]
The results demonstrate significant variability in work-up strategies and low adherence to The Endocrine Society guideline
While bilateral hyperplasia is generally treated with a mineralocorticoid receptor agonist, adrenalectomy is the preferred treatment for patients with aldosterone-producing adenoma (APA) [8, 9]
Summary
Primary aldosteronism (PA) is the most common surgically treatable cause of secondary hypertension with an estimated prevalence of 5–20% within the hypertensive population [1,2,3,4,5,6,7]. In the vast majority of cases, PA is either caused by bilateral adrenal hyperplasia or by a unilateral aldosterone-producing adenoma (APA). In 2008, The Endocrine Society published a clinical practice guideline on PA with the goal of improving screening, work-up and treatment of PA worldwide [8]. In 2016, an update of the Endocrine Society Guideline was published [9] This revised guideline suggested that a specific subgroup of patients potentially do not have to undergo confirmatory testing or AVS. These recommendations were based on a relatively low level of evidence [9]. We investigated the work-up before surgery for PA in daily clinical practice within a multicenter study
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