DELAYED DIAGNOSIS OF PRIMARY ALDOSTERONISM IN PATIENTS WITH HYPOKALEMIA: CLINICAL COURSE AND ASSOCIATED FACTORS

Abstract

Objective: PA is a common and curable cause of hypertension. However, diagnosis is often delayed, leading to poorer clinical outcomes. Presence of hypokalemia, with hypertension, is characteristic of PA, and is an indication for screening. We evaluated if patients with PA had prolonged hypokalaemia before PA screening, the subsequent clinical course, and factors associated with delayed diagnosis. Design and method: Our retrospective study included all PA patients with hypokalemia diagnosed between 2001 to 2022. Delayed diagnosis was defined as duration of hypokalemia of >1 year from first occurrence, to first evaluation by a PA specialist. Patients who underwent unilateral adrenalectomy were assessed using the Primary Aldosteronism Surgery Outcomes criteria. We performed multivariable analysis to assess for factors associated with delayed diagnosis. Results: Of 240 newly diagnosed PA patients with hypokalemia, 122 (51%) patients had prolonged hypokalemia, with a median duration 4.5 (2.3 – 7.5) years. Patients with delayed diagnosis were older, had longer duration of hypertension, poorer renal function and more frequent cardiovascular disease. A lower proportion of patients with delayed diagnosis underwent adrenal vein sampling (58% vs 73%), P<0.05, adrenalectomy (32% vs 51%), P<0.05, and eventually achieved partial/complete clinical success post-adrenalectomy (21% vs 37%), P<0.05, compared to those with early diagnosis. Factors associated with delayed diagnosis included older age, presence of hyperlipidemia, and less severe hypokalemia (serum potassium >3mmol/L). Conclusions: Despite manifestation of hypokalaemia, many patients with PA fail to be promptly screened. Greater emphasis in hypertension guidelines, and efforts to improve awareness amongst primary care physicians are urgently needed.