VIDEO: Screening a key part of treatment for primary hyperaldosteronism
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In this video exclusive, Jonathan D. Leffert, MD, talks with Richard J. Auchus, MD, PhD, FACE, about how to define primary hyperaldosteronism, the importance of screening and tips for treating the disease.
Leffert is managing partner at North Texas Endocrine Center, a past president of the American Association of Clinical Endocrinology and an Endocrine Today Editorial Board Member. Auchus is professor of pharmacology and internal medicine at the University of Michigan and chief of the endocrinology and metabolism section at the Ann Arbor VA Medical Center.
One of the biggest issues surrounding primary hyperaldosteronism is a lack of screening. Auchus said people who are screened for primary hyperaldosteronism have 33% odds of receiving directed therapy for the disease compared with 5% to 10% odds for people who are not screened.
“One of the things that we are learning is that we are not screening broadly enough,” Auchus said. “There was a study done in the VA system where I work that only about 2% to 4% of people that meet criteria are being screened for this disease. The targeted population that we’re mainly missing is people with resistant hypertension.”
If a provider finds that aldosterone is contributing to a person’s hypertension, Auchus said, providers should assess the likelihood that the patient has a single tumor causing the disease and whether it would be beneficial to remove the tumor.
“Usually, based on studies that have been done in Germany and other places, it’s the people who are younger, the people who are on more blood pressure medications, the people who have higher aldosterone, the people who have hypokalemia who are going to harbor the tumors,” Auchus said. “In those people, we’re going to go the whole nine yards: CT scan, additional testing including adrenal vein sampling for localization, because you can’t tell where the aldosterone is coming from without that.”
For people who are more likely to have bilateral disease, such as those with lower aldosterone levels or older adults, Auchus said, it may be more beneficial to treat them with medications. He said clinical decision-making is needed to determine the best course of treatment.
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