ECE2016 Eposter Presentations Adrenal cortex (to include Cushing's) (85 abstracts)
Primary aldosteronism – results from the first Portuguese multicentre study
Tiago Nunes da Silva 1, , Vera Fernandes 2, , Diana Martins 2, , Diana Gonçalves 2, , Raquel Almeida 2, , Ana Margarida Monteiro 2, , Carolina Neves 2, , Helder Simões 2, , Pedro Marques 2, , Filipa Alves 2, & Maria Pereira 2,
1Hospital Garcia de Orta, Almada, Portugal; 2Grupo de Estudos Tumores da Supra-renal, Portugal; 3Hospital de Braga, Braga, Portugal; 4Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal; 5Centro Hospitalar São João, Porto, Portugal; 6Centro Hospitalar do Porto, Porto, Portugal; 7Hospital Curry Cabral, Lisboa, Portugal; 8Hospital das Forças Armadas, Lisboa, Portugal; 9Hospital de Egas Moniz, Lisboa, Portugal; 10Instituto Português de Oncologia de Lisboa, Lisboa, Portugal.
Primary Aldosteronism (PA) is the most prevalent cause of secondary hypertension. The aim of this work was to characterize the diagnostic workup, treatment and follow-up of confirmed PA.
The adrenal tumour study group of the Portuguese Society of Endocrinology undertook the first retrospective multicentre study of Portuguese PA patients. Data was gathered from nine Portuguese Endocrinology centres (three in the north, one in the centre and five in the south). The data was analysed with SPSS 21.
Sixty-three cases were selected with a mean age of diagnosis of 52.1±13.1 years; 9.9 years after the diagnosis of hypertension. At presentation 32.8% of patients had hipokalemia and 22.9% resistant hypertension (52% with ≥3 drugs). Baseline laboratory investigation showed a mean serum aldosterone of 33.4 ng/dl, plasmatic renin activity (PRA) of 0.2 ng/ml per h with a aldosterone/PRA of 97.1. Confirmatory testing was performed with saline infusion in 91.7% (aldosterone >10 ng/dl in 84.4%) and captopril in 23.7% (positive in 85.7%).
Imaging showed adenomas in 87.3% (mean size: 1.7 cm), hyperplasia in 3.2% and bilateral cases in 13.6%. Arterial venous sampling (AVS) was conclusive in 1 case (11%). Iodocholesterol scintigraphy was done in 22% with unilateral fixation in 64% and no fixation in 29% (nodule size 1.5–1.8 cm). Iodocholesterol and CT agreed in 50%.
Patients were treated with laparoscopic adrenalectomy in 58.3% and aldosterone antagonists in 41.7% (median spirolactone dose of 62.5 mg/d). The surgical treated group had a bigger tumour size (1.8 vs 1.5 cm, P=0.022), less duration of hypertension (8 vs 14 years, P=0.002) and higher prevalence of anti-hypertensive treatment at presentation (100 vs 75% P=0.009). During follow-up (median 2.5 years), there was a trend towards more hypertension cure in the surgical treated group (92.6% vs 70.6%, P=0.089).
This is the first Portuguese PA multicentre study. It shows that PA remains an under-diagnosed condition with a significant delay in diagnosis. Surgical treated patients had a more aggressive disease and showed a trend towards better hypertension control.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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