Evaluation of screening practices for primary hyperaldosteronism by specialists and general practitioners: an observational, cross-sectional study

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ABSTRACT

Objective:

Despite its recognized importance, primary hyperaldosteronism (PHA) remains an underdiagnosed condition in clinical practice. The objective of the present study was to evaluate PHA screening practices by general practitioners and specialists in endocrinology and cardiology. Subjects and methods: This cross-sectional, observational study invited physicians to respond voluntarily to an online survey. The survey collected the respondents’ sociodemographic data and answers to five hypothetical clinical cases meeting Endocrine Society criteria for PHA screening.

Results:

In all, 126 physicians responded to the online survey. Endocrinologists were the specialists who most often chose PHA screening, although the screening rates were overall low, ranging from 36.5% to 92.9%, depending on the case and the respondents’ specialty. The survey also assessed the reasons for not choosing PHA screening, which included limited availability of tests within the public health services, interference of antihypertensive medications on hormone levels, and failure to identify the screening indication. Being an endocrinologist was an independent predictor for choosing PHA screening for the patients in Cases #1 and #5 (p = 0.001 and p = 0.002, respectively).

Conclusion:

Endocrinologists were the specialists who most often chose PHA screening, although the screening rates were overall low among all specialists. These findings highlight a need for continuing medical education programs addressing PHA screening and making the diagnosis of PHA more present in the daily clinical practice of physicians treating patients with hypertension.

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Most cited references 24

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The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline.

John Funder, Robert Carey, Franco Mantero … (2016)

To develop clinical practice guidelines for the management of patients with primary aldosteronism.

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A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients.

Gian Paolo Rossi, Giampaolo Bernini, Chiara Caliumi … (2006)

We prospectively investigated the prevalence of curable forms of primary aldosteronism (PA) in newly diagnosed hypertensive patients. The prevalence of curable forms of PA is currently unknown, although retrospective data suggest that it is not as low as commonly perceived. Consecutive hypertensive patients referred to 14 hypertension centers underwent a diagnostic protocol composed of measurement of Na+ and K+ in serum and 24-h urine, sitting plasma renin activity, and aldosterone at baseline and after 50 mg captopril. The patients with an aldosterone/renin ratio >40 at baseline, and/or >30 after captopril, and/or a probability of PA (by a logistic discriminant function) > or =50% underwent imaging tests and adrenal vein sampling (AVS) or adrenocortical scintigraphy to identify the underlying adrenal pathology. An aldosterone-producing adenoma (APA) was diagnosed in patients who in addition to excess autonomous aldosterone secretion showed: 1) lateralized aldosterone secretion at AVS or adrenocortical scintigraphy, 2) adenoma at surgery and pathology, and 3) a blood pressure decrease after adrenalectomy. Evidence of excess autonomous aldosterone secretion without such criteria led to a diagnosis of idiopathic hyperaldosteronism (IHA). A total of 1,180 patients (age 46 +/- 12 years) were enrolled; a conclusive diagnosis was attained in 1,125 (95.3%). Of these, 54 (4.8%) had an APA and 72 (6.4%) had an IHA. There were more APA (62.5%) and fewer IHA cases (37.5%) at centers where AVS was available (p = 0.002); the opposite occurred where AVS was unavailable. In newly diagnosed hypertensive patients referred to hypertension centers, the prevalence of APA is high (4.8%). The availability of AVS is essential for an accurate identification of the adrenocortical pathologies underlying PA.

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Cardiovascular events and target organ damage in primary aldosteronism compared with essential hypertension: a systematic review and meta-analysis.

Silvia Monticone, Fabrizio D'Ascenzo, Claudio Moretti … (2018)

There is conflicting evidence, relying on heterogeneous studies, as to whether aldosterone excess is responsible for an increased risk of cardiovascular and cerebrovascular complications in patients with primary aldosteronism. We aimed to assess the association between primary aldosteronism and adverse cardiac and cerebrovascular events, target organ damage, diabetes, and metabolic syndrome, compared with the association of essential hypertension and these cardiovascular and end organ events, by integrating results of previous studies.

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Author and article information

Journal

Journal ID (nlm-ta): Arch Endocrinol Metab

Journal ID (iso-abbrev): Arch Endocrinol Metab

Journal ID (publisher-id): aem

Title: Archives of Endocrinology and Metabolism

Publisher: Sociedade Brasileira de Endocrinologia e Metabologia

ISSN (Print): 2359-3997

ISSN (Electronic): 2359-4292

Publication date (Electronic): 21 March 2024

Publication date Collection: 2024

Volume: 68

Electronic Location Identifier: e230211

Affiliations

[1 ] orgnameUniversidade Federal Fluminense orgdiv1Departamento de Clínica Médica orgdiv2Hospital Universitário Antônio Niterói RJ Brasil originalUniversidade Federal Fluminense, Departamento de Clínica Médica, Hospital Universitário Antônio Pedro, Niterói, RJ, Brasil

[2 ] orgnameUniversidade Estácio de Sá/IDOMED orgdiv1Disciplina de Clínica Médica Rio de Janeiro RJ Brasil originalDisciplina de Clínica Médica, Universidade Estácio de Sá/IDOMED, Rio de Janeiro, RJ, Brasil

[3 ] orgnameUniversidade Federal do Rio de Janeiro orgdiv1Departamento de Clínica Médica orgdiv2Hospital Universitário Clementino Fraga Filho Rio de Janeiro RJ Brasil originalUniversidade Federal do Rio de Janeiro, Departamento de Clínica Médica, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, RJ, Brasil

Author notes

Correspondence to: Giselle Fernandes Taboada Universidade Federal Fluminense, Departamento de Clínica Médica, Hospital Universitário Antônio Pedro Rua Marquês do Paraná, 303 24033-900 – Niterói, RJ, Brasil giselletaboada@ 123456id.uff.br

Disclosure: no potential conflict of interest relevant to this article was reported.

Author information

Giselle Fernandes Taboada https://orcid.org/0000-0002-7177-0446

Aline Barbosa Moraes https://orcid.org/0000-0001-7533-7458

Leonardo Vieira Neto https://orcid.org/0000-0002-1595-3985

Article

Other ID: 00325

DOI: 10.20945/2359-4292-2023-0211

PMC ID: 11081042

PubMed ID: 38530960

SO-VID: 02feb75e-272a-4e4e-b792-167129b8856f

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 28 May 2023

Date accepted : 17 July 2023

Page count

Figures: 3, Tables: 3, Equations: 0, References: 21