Primary aldosteronism: adrenalectomy could save more lives

Area of Science:

• Endocrinology
• Cardiovascular Medicine
• Surgical Oncology

Background:

• Primary aldosteronism (PA) is a major, underdiagnosed cause of secondary hypertension, leading to substantial preventable cardiovascular morbidity and mortality.
• PA affects 4.5-20% of hypertensive patients, increasing risks of heart failure, stroke, atrial fibrillation, and renal damage, with higher mortality than essential hypertension.

Purpose of the Study:

• To highlight the severe burden of PA and advocate for improved screening, diagnosis, and surgical access.
• To compare the efficacy of adrenalectomy for unilateral PA with major cardiovascular surgeries.
• To examine international variations in surgical rates and identify barriers to optimal treatment.

Main Methods:

• Literature review and analysis of international surgical caseload data for adrenalectomy in PA.
• Comparison of mortality reduction and quality of life improvements between adrenalectomy and medical therapy.
• Examination of diagnostic pathways and surgical access disparities.

Main Results:

• Adrenalectomy for unilateral PA provides superior outcomes to medical therapy, with significant reductions in all-cause mortality and improvements in hypertension and quality of life.
• Current adrenalectomy rates are critically low (<4% of optimal), indicating a massive unmet need and potential for life-saving interventions.
• Diagnostic barriers and limited access to high-volume surgeons contribute to low surgical rates globally.

Conclusions:

• Optimizing adrenalectomy rates requires a 25-170-fold increase in surgical capacity, potentially saving thousands of lives annually.
• Enhanced PA screening, streamlined diagnostic workflows, and expanded access to specialized surgical care are crucial to address this silent epidemic.