Endocrine Abstracts

Hyperaldosteronism is a significant cause of secondary hypertension, but there are often delays in obtaining the diagnosis. The recent BES publication of Guidelines for the investigation and management of this condition represent a move to standardise the work-up of these patients.

We present an audit of cases, dating back to 2000, with confirmed biochemical hyperaldosteronism (on the basis of plasma aldosterone/renin activity ratio or lack of aldosterone suppression on salt loading testing). All patients went on to have bilateral adrenal vein sampling (AVS) and CT/MRI adrenal imaging.

Data was collected for 45 patients. The average age of the cohort was 47.6 years and 51% were female. Imaging identified potential causative adrenal lesions in 73% of patients, with AVS results indicating significant lateralisation in 78% of patients. There was concordance between imaging and AVS results in 68.8% of cases, which agrees well with previously published data. Interesting and informative examples will be highlighted from the cohort. On the basis of investigation results, patients were selected for either surgical or medical management of their hyperaldosteronism. Age and gender were equally distributed between both groups. Although blood pressure reduction and potassium levels were comparable, patients who underwent surgery were able to reduce their number of antihypertensives, from a mean of 2.7 to 1.2. In comparison, after optimisation of antihypertensive therapy in the Endocrine clinic, there was no reduction in the number taken by the medically-managed group. Long-term follow up data regarding cardiovascular morbidity (up to 9 years) will also be presented.

Our results reinforce the potential dangers of basing treatment decisions on imaging alone in primary hyperaldosteronism. Management in a tertiary referral centre, alongside expertise in AVS procedure, is important. In view of reductions in medication burden, surgical management is the best option in cases where unilateral secretion has been confirmed.