Adrenalectomy for Primary Aldosteronism: Significant Variability in Work‐Up Strategies and Low Guideline Adherence in Worldwide Daily Clinical Practice

Abstract

Background

Various diagnostic tests are available to establish the primary aldosteronism (PA) diagnosis and to determine the disease laterality. Combined with the controversies in the literature, unawareness of guidelines and technical demands and high costs of some of these diagnostics, this could lead to significant differences in work‐up strategies worldwide. Therefore, we investigated the work‐up before surgery for PA in daily clinical practice within a multicenter study.

Methods

Patients who underwent unilateral adrenalectomy for PA within 16 centers in Europe, Canada, Australia and the USA between 2010 and 2016 were included. We did not exclude patients based on the performed diagnostic tests during work‐up to make our data representative for current clinical practice. Adherence to the Endocrine Society Guideline and variables associated with not performing adrenal venous sampling (AVS) were analyzed.

Results

In total, 435 patients were eligible. An aldosterone‐to‐renin ratio, confirmatory test, computed tomography (CT), magnetic resonance imaging and AVS were performed in 82.9%, 32.9%, 86.9%, 17.0% and 65.3% of patients, respectively. A complete work‐up, as recommended by the guideline, was performed in 13.1% of patients. Bilateral disease or normal adrenal anatomy on CT (OR 16.19; CI 3.50–74.99), smaller tumor size on CT (OR 0.06; CI 0.04–0.08) and presence of hypokalemia (OR 2.00; CI 1.19–3.32) were independently associated with performing AVS.

Conclusions

This study is the first to examine the daily clinical practice work‐up of PA within a worldwide cohort of surgical patients. The results demonstrate significant variability in work‐up strategies and low adherence to The Endocrine Society guideline.

Overview publication

TitleAdrenalectomy for Primary Aldosteronism: Significant Variability in Work‐Up Strategies and Low Guideline Adherence in Worldwide Daily Clinical Practice
DateJune 1st, 2020
Issue nameWorld Journal of Surgery
Issue numberv44.6 p1905-1915
DOI10.1007/s00268-020-05408-2
AuthorsVorselaars WMCM, van Beek D, Suurd DPD, Postma E, Spiering W, Borel Rinkes IHM, Valk GD, Vriens MR, Zarnegar R, Fahey TJ, Drake FT, Duh QY, Talutis SD, McAneny DB, McManus C, Lee JA, Grant SB, Grogan RH, Romero Arenas MA, Perrier ND, Sturgeon C, Castelino T, Mitmaker EJ, Parente DN, Pasternak JD, Sidhu SB, Sywak M, D'Amato G, Raffaelli M, Schuermans V, Bouvy ND, Eker HH, Jaap Bonjer H, Engelsman AF, Nieveen van Dijkum EJM, Kerstens MN & Kruijff S
InfoInternational CONNsortium*
MTGsMTG1
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