SFEBES2026 Poster Presentations Late Breaking (54 abstracts)
Single centre experience of managing primary hyperaldosteronism
Win Lai Khine 1 , Neetha Joseph 1 , Kelvin Tan 1 , Emma Miller 1 , Janak Saada 1 , Allison Chipchase 1 , Mark Rochester 1 , Melanie Maxwell 1 & Khin Swe Myint 1,2
1Norfolk and Norwich University Hospital, Norwich, United Kingdom; 2University of East Anglia, Norwich, United Kingdom
Background: Primary aldosteronism (PA) is a leading cause of secondary hypertension but remains underdiagnosed in routine practice. Diagnostic delays often occur due to the complex influence of antihypertensive therapy and hypokalaemia on the renin–angiotensin–aldosterone system. Adrenal vein sampling (AVS) is the gold standard for identifying unilateral disease suitable for adrenalectomy.
Methods: We retrospectively reviewed all patients with confirmed PA who underwent AVS between 2009 and 2025. Clinical history, biochemical data, imaging, and management outcomes were extracted from case notes. Lateralization was assessed using the Lateralization Index (LI), calculated as the aldosterone-to-cortisol ratio of the dominant adrenal divided by the non-dominant adrenal vein (LI ≥2 indicating unilateral disease).
Results: Thirty-eight patients were identified (mean age 57 years, range 28–76; 15 female). Baseline blood pressure averaged 153/87 mmHg on 2.3 antihypertensive agents; 58% were hypokalaemic. Mean aldosterone-to-renin ratio (ARR) was ≥176, with aldosterone levels averaging 1029 pmol/l. CT revealed adrenal nodules in 76% (10 >10 mm). AVS demonstrated unilateral disease in 28 patients; 23 underwent adrenalectomy (18 left, 5 right), with one declining surgery and three awaiting intervention. Eight had bilateral secretion, though three showed marked asymmetry. Three AVS procedures failed to cannulate the right adrenal vein. Postoperatively, ARR normalized in 37/38 surgical patients; 14 discontinued all antihypertensives, and overall medication burden fell from 3.18 to 0.41 agents. Mean BP improved from 154/86 to 127/79 mmHg. Younger patients (mean age 53.4) with higher ARR (245.7) were more likely to achieve complete medication withdrawal compared to conservatively managed patients (mean age 57.4, ARR 85.4). Non-surgical patients also showed BP improvement (147/87 to 129/81 mmHg).
Conclusion: AVS reliably stratifies PA, enabling targeted adrenalectomy with high cure rates in appropriately selected patients. Younger age and higher ARR predict surgical success, reinforcing AVS as an essential tool in PA management
Volume 117
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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