Background: Primary aldosteronism (PA) is a prevalent yet underdiagnosed cause of secondary hypertension, associated with increased cardiovascular, renal and metabolic risk. Limited awareness, resources and expertise contribute to delays in diagnosis and treatment. A dedicated Endocrine Hypertension Service previously improved PA screening and increased primary care referrals in the first three years of operation (2016 – 2019).
Aims: To evaluate the sustained impact of the Endocrine Hypertension Service on PA diagnosis and management over a subsequent three-year period.
Methods: We conducted a retrospective analysis of consecutive new patients seen at a tertiary Endocrine Hypertension Service in Victoria, Australia, from 1 July 2019 to 30 June 2022, a period that included significant COVID-19 related healthcare disruptions. Clinical data were extracted and analysed by referral year (Y1: July 2019 – June 2020, Y2: July 2020 – June 2021, Y3: July 2021 – June 2022) to assess changes over time.
Results: A total of 457 new patients were assessed, with annual referrals increasing over time (Y1: 115; Y2:156; Y3:186). Most referrals originated from primary care (50%), followed by cardiology (23%). At presentation, 20% were treatment-naïve, the median hypertension duration was four years, and 22% had end-organ damage. PA was confirmed in 213 patients (47%), excluded in 171 (37%), and undetermined in 73 (16%) due to incomplete work-up. Among 171 patients treated medically, 78% achieved complete biochemical response and 46% complete clinical response on MRA monotherapy. Among 34 patients who underwent unilateral adrenalectomy, 86% achieved complete biochemical response and 39% complete clinical response.
Conclusion: Growth in referrals, earlier disease detection, and high treatment response rates highlight the sustained effectiveness of a dedicated, structured pathway for timely PA diagnosis and management, even despite COVID-19 disruptions.
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