CLINICAL COURSE FOR PATIENTS WITH PRIMARY ALDOSTERONISM

A SINGLE CENTRE EXPERIENCE

Abstract

INTRODUCTION
Timely diagnosis and appropriate treatment of primary aldosteronism (PA) are crucial to prevent detrimental cardiovascular and renal outcomes. Our study aimed to evaluate the clinical characteristics of patients with PA and compare the treatment outcomes of surgical versus pharmacologic therapy.

METHODOLOGY
We conducted a retrospective review of patients with PA followed up at our Endocrine Clinic from March 2010 until December 2022. Clinical data were collected from September 2022 until January 2023.

RESULTS
A total of fifty-one patients were analyzed. They were diagnosed with hypertension at 40.8 ± 11.8 years of age. A duration of 6.5 ± 5.7 years was delayed before confirmation of PA. The majority (92.2%) underwent screening because of spontaneous hypokalemia and hypertension with mean blood pressure (BP) of 175/103 ± 20/15 mmHg and potassium level of 2.8 ± 0.5 mmol/L. Most patients (92.1%) required at least two anti-hypertensive medications with significant comorbidities including chronic kidney disease (35.3%), left ventricular hypertrophy (30.8%), and stroke (5.9%). Forty-eight patients underwent adrenal-directed computed tomography with the following findings: 37.5% had unilateral nodules, 20.8% had a micronodular lesion (<1 cm) and 41.7% had no focal lesion. Sixteen patients underwent adrenal venous sampling (AVS) with a success rate of 56.2%. Forty-two patients (82.4%) were treated pharmacologically. Two patients were cured after surgery. One patient failed to achieve normokalaemia after surgery whereas eight patients in the pharmacologic group were dependent on potassium replacement. During the follow-up period, there was no significant difference in the mean BP for both treatment groups however surgical group required a lesser number of anti-hypertensive medications (1.33 ± 0.86) as compared to the pharmacologic group (2.95 ± 0.73) (p <0.001).

CONCLUSION
Diagnosis of PA remains suboptimal leading to a high burden of aldosterone-specific end-organ damage. The majority of confirmed PAs received medical therapy either due to individual preference or lack of AVS-guided treatment. Patients who underwent surgery attained greater biochemical improvement and reduced medication burden in the long term.