Primary aldosteronism in a Malaysian Tertiary Centre: A retrospective audit of clinical characteristics, diagnostic pathways, and treatment outcomes (2018–2025)
https://doi.org/10.15605/jafes.041.S1
- Author:
Ahmad Hambal Bin Zamari
1
;
Yusniza Yusof
1
Author Information
1. Endocrine Unit, Hospital Sungai Buloh
- Publication Type:Journal Article
- MeSH:
Hyperaldosteronism;
Treatment Outcome;
Retrospective Studies
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):19-20
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Primary aldosteronism (PA) is a common yet underdiagnosed cause of secondary hypertension, associated
with increased cardiovascular and renal morbidity. Early
detection and subtype-directed management significantly
improve outcomes. However, adherence to recommended
diagnostic pathways in real-world practice remains
variable.
Case:We conducted a retrospective audit of patients diagnosed
with PA in a Malaysian tertiary centre from January 2018
to December 2025. Data collected included demographics,
clinical presentation, biochemical parameters, diagnostic
workup (aldosterone-renin ratio [ARR], confirmatory
testing, adrenal imaging, and adrenal venous sampling
[AVS]), treatment modality, and outcomes. Audit standards
were based on established international guidelines.
A total of 14 patients were included, with equal gender
distribution. The cohort comprised 57% Malay and 43%
Chinese. Most patients presented with hypertension
(mean ~170/100 mmHg), and hypokalemia was present
in approximately 70% of the patients. ARR and adrenal
imaging were performed in all patients (100%), while
confirmatory testing was conducted in 85% of the patients.
However, AVS utilization remained limited (50%).
Contributing factors included failed cannulation, technical
challenges in overweight patients, preference for medical
therapy, refusal of surgery, and limited access to AVS
services. The majority had unilateral adrenal adenoma
(~75%). Treatment was divided between surgical (55%) and
medical (45%) approaches. Post-treatment, hypokalemia
resolved in 90% of patients, with a significant reduction
in antihypertensive burden and complete hypertension
resolution in approximately 35% of the patients. Quality of
life improved in most patients.
Conclusion:This audit demonstrates good adherence to initial screening
and imaging in PA but highlights suboptimal utilization
of AVS. Barriers to AVS utilization are multifactorial,
encompassing technical, patient-related, and system level limitations. Addressing these barriers is essential to
optimize subtype-directed management and improve longterm cardiovascular outcomes in patients with PA. Despite
this, clinical outcomes were favorable. Strengthening
adherence to diagnostic pathways, particularly subtype
confirmation, may further improve patient outcomes.
- Full text:2026072811173510814EP_A003.pdf
