Endocrine Abstracts

Background: Primary aldosteronism (PA) is a treatable cause of secondary hypertension, associated with significant cardiovascular morbidity. Whilst up to 25% of patients with hypertension have underlying PA, it remains underdiagnosed. Management approaches comprise medical (mineralocorticoid receptor antagonists, (MRA)) and/or surgical (adrenalectomy). Our study aimed to evaluate medical and surgical outcomes of treated PA in patients with adrenal incidentalomas (AI) in a UK cohort using established criteria.

Methods: Retrospective data were collected from unselected patients with AI assessed for possible PA between August 2018 and March 2023. Data included demographics, biochemistry, radiological characteristics and management. Further outcomes such as post-treatment blood pressure, biochemistry and relevant medications were also collected. Outcomes were assessed using the PA medical (PAMO) and surgical outcome (PASO) scoring criteria at 3- and 12-months following treatment for both biochemical and clinical outcomes.

Results: Of 833 patients (46.1% male) with incidentalomas, 42 patients (5.0%) were diagnosed with PA. Of these, 37 (88.1%) received MRAs and 20 (47.6%) underwent unilateral adrenalectomy. Of available outcomes, 10 (91%) achieved partial or complete clinical success and 11 (85%) biochemical success at 12 months post-adrenalectomy as per PASO. After 12 months of medication only, 21 (87.5%) and 17 (77.2%) achieved partial or complete clinical and biochemical success, respectively. Higher proportions of both cohorts had partial or complete clinical and biochemical success at 12 months compared to outcomes at 3 months though these were not statistically significant.

Conclusions: Our results demonstrate that most patients had partial or complete clinical and biochemical success following treatment. More patients achieved successful outcomes when managed with surgery, compared to medication alone, with preferable outcomes at 12 versus 3 months in both groups. PASO and PAMO criteria are useful standardised tools for assessing PA-related outcomes and should facilitate better post-intervention follow-up to help identify patients potentially requiring further intervention.