Endocrine Abstracts

Primary aldosteronism (PA) accounts for up to 15% of cases of hypertension, and associates with increased cardiovascular morbidity. Specific treatment options include mineralocorticoid antagonists or adrenalectomy; the latter offers cure although reported rates vary between 20–60%. The role of adrenal vein sampling (AVS) in diagnosing PA remains controversial. By reviewing casenotes of PA patients treated surgically and comparing with matched medically managed PA patients, we aimed to determine influence of AVS on treatment strategy and compare outcomes between the groups. 31 PA patients underwent adrenalectomy and 28 were treated medically. 25 patients had AVS. Adrenal imaging and AVS outcome disagreed in 9 cases; treatment was guided by AVS in 6 of these. 18 months after surgery, 24% of patients were on no anti-hypertensives and 48% were on fewer agents. 9 (34%) patients treated medically required fewer anti-hypertensives at 18 months. Comparisons of key outcomes are shown in table 1. Based on our results, AVS remains an important presurgical investigation; omitting AVS could have led to inappropriate surgery in 6/25 patients (24%). Adrenalectomy and medical therapy appear equally effective treatments although surgery offers reduced drug requirements. Therefore, medical therapy may offer a satisfactory alternative to adrenalectomy in selected cases.

Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.

Key Outcomes