Endocrine Abstracts

Background: Primary aldosteronism (PA) is a common cause of hypertension, with a 5% - 22% prevalence and is associated with a higher incidence of co-morbidities. Unilateral PA can be curable, and treatment improves quality of life. Yet, < 1% of PA are diagnosed. Subtyping PA with adrenal vein sampling (AVS) is time-consuming. The AVS waiting time for our DGH was nearly 2 years following the Tertiary Endocrinology service referral pathway. The direct AVS requesting access reduced our waiting time to 7 weeks.

Aim: We aimed to investigate the waiting time from referral to completion of adrenal vein sampling. As a secondary objective, we analysed the correlation of AVS (unilateral or bilateral) to age, sex, ethnicity and BMI.

Methods: Retrospective analysis of 25 patients referred directly for AVS between December 2022 and June 2024.

Results: The mean waiting time for AVS was 7 weeks (n = 23, 2 withdrawn), with a reduction in waiting time ~ 98 weeks. Results showed 14 bilateral disease, 6 unilateral. 2 bilateral with a unilateral predominance, and 1 sampling error. 3/6 unilateral PA were offered adrenal ablation (WAVE trial), 2 received ablation,1 declined. In total, 5/8 unilateral or bilateral with predominance underwent adrenalectomy, and 1 opted for medical treatment. There was no significant correlation between unilateral (U) or bilateral (B) disease and age (mean B = 47.7, mean U = 45.6, P = 0.66), BMI (Mean B = 32.1; U = 30.6, P = 0.53), or ethnicity (black U = 4/8, white U = 4/14, P = 0.31) but significant sex difference (Men U = 8/14, women 0/8, P = 0.0074).

Discussion: We have shown that direct access to AVS has significantly reduced the waiting time. We did not find any association between age, ethnicity, BMI, and subtype of PA. In our cohort females had more bilateral PA. However, our cohort was too small for statistical confidence.