Endocrine Abstracts

Background: Primary hyperaldosteronism (PH) is a syndrome caused by excess aldosterone secretion, which leads to hypertension and hypokalemia and increased risk for target organ damage. The overproduction of aldosterone at the adrenal gland can be unilateral or bilateral. For unilateral disease the best treatment is unilateral adrenalectomy. According to international guidelines, most of the patients should have adrenal venous sampling (AVS) to distinguish between bilateral and unilateral disease. At 2018 we established a multidisciplinary team for diagnosis and management of primary hyperaldosteronism. The aim of this study was to investigate all cases of PH treated in our institute since establishment, including advantages and pitfalls of AVS procedure.

Methods: A retrospective study was performed on a cohort including all patients that were diagnosed and treated at Shaare Zedek Medical Center during 2018–2021. All patients had adrenal imaging (CT or MRI) followed by AVS as needed. Data collection included demographic, clinical and biochemical information, detailed results of AVS procedures and follow up after. AVS protocol and interpretation of the results were done according to International clinical practice guidelines.

Results: During the described period, 22 patients were diagnosed with PH. Mean age 51.6±10, 19/22 (86%) males. All patients had hypertension and 18/22 (82%) had hypokalemia. 21 of them had an AVS. All AVS procedures were done by one invasive radiology specialist. In 17/21 (81%) the AVS results were fully successful, with improvement during time, from 70% at the first ten patients to 90% at the last ten patients. In 4/21 (19%) there was difficulty to locate the right adrenal vein; even though, in 3/4 patients there was evidence for lateralization according to indirect interpretation of the results, overall 20/21 (95%) had a conclusive lateralization result. In 8/21 (38%) adrenal imaging wasn’t accurate in confirming lateralization side. No significant complications of the AVS were observed. 11/16 patients with unilateral disease had unilateral adrenalectomy, all of them became normotensive with less medications or no medical treatment for hypertension.

Conclusion: Establishment of a multidisciplinary team can improve management and treatment for patients with primary hyperaldosteronism. Learning curve for AVS can be achieved after 10 cases. With the limitation of adrenal imaging to locate the hyperaldosteronism source, AVS is a critical step in the diagnosis of primary hyperaldosteronism, and with a good implementation process it is a safe and efficient procedure.