12470 International Study Evaluating Time To Adrenalectomy For Primary Aldosteronism
Authors: Min Charmaine Ter Li , Han Koh Xuan , Araujo-Castro Marta , Gkaniatsa Eleftheria , Reincke Martin , Tran Thang Viet , Tran Hieu , Stowasser Michael , Grytaas Marianne Aardal , Turcu Adina , Matrozova Joanna , Sukor Norlela , Kocjan Tomaz , Baudrand Rene , Tsuiki Mika , Murakami Masanori , Yang Jun , Katabami Takuyuki , Naruse Mitsuhide , St-Jean Matthieu , Ceccato Filippo , Kiat Troy Puar Hai 
Published: October 2024

Abstract
Disclosure: C. Ter Li Min: None. K. Xuan Han: None. M. Araujo-Castro: None. E. Gkaniatsa: None. M. Reincke: None. T. Viet Tran: None. H. Tran: None. M. Stowasser: None. M.A. Grytaas: None. A. Turcu: None. J. Matrozova: None. N. Sukor: None. T. Kocjan: None. R. Baudrand: None. M. Tsuiki: None. M. Murakami: None. J. Yang: None. T. Katabami: None. M. Naruse: None. M. St-Jean: None. F. Ceccato: None. T. Puar Hai Kiat: None.
Background: Primary aldosteronism (PA) is a common cause of hypertension. Patients with unilateral PA can be cured by adrenalectomy. However, the time required to undergo specialised tests like adrenal vein sampling (AVS), and laparoscopic adrenalectomy may delay management. We assessed the current time-to-adrenalectomy (TTA) for patients with PA worldwide. Methods: We conducted an international, multi-center retrospective study involving 37 centers from 15 countries to determine the total time from first presentation to adrenalectomy, and each interval: screening (first presentation to first screening test), confirmatory, subtyping, and adrenalectomy. We included all patients with PA who underwent adrenalectomy from 1st January 2018 to 30th October 2022. After adrenalectomy, patients were evaluated using Primary Aldosteronism Surgery Outcome (PASO) consensus. Patient and center characteristics were compared at the 25th, 50th, and 75th percentiles of TTA using multivariable quantile regression. Multivariable linear regression was used to identify factors associated with longer intervals. Results: Among 708 included patients (mean age 49.2 years, 45.8% female), the overall median TTA was 14.0 months (IQR 7.1-25.2). The median intervals were 0.1 months (screening), 2.3 months (confirmatory), 4.2 months (subtyping), and 5.1 months (adrenalectomy). On multivariable analyses, patients with an additional screening test, an additional AVS, and who presented post-COVID-19 had a significantly longer TTA at the 75th percentile, by 3.2 months, 12.3 months, and 6.0 months respectively. Other factors that increased TTA were younger age, lower baseline diastolic blood pressure (BP) and more baseline BP medications. Factors associated with a longer screening interval included younger age, lower baseline potassium, and lower diastolic BP, while additional screening tests were associated with a longer confirmatory interval. Factors associated with a longer adrenalectomy interval were more baseline BP medications, additional confirmatory tests and additional AVS. Patients who presented post-COVID-19 were associated with longer time at all intervals. Compared to centers that routinely perform AVS, centers without AVS had shorter TTA (6.1 vs 16.5 months, P&lt;0.001), similar PASO clinical outcome, but poorer PASO biochemical outcome, with complete, partial and absent biochemical success seen in 66.4%, 11.9%, 21.6% vs 86.8%, 3.7%, 9.5%, P&lt;0.001, respectively. Conclusion: Based on real-world data from patients with PA managed in five continents, most patients required more than one year from first specialist presentation to adrenalectomy. The longest intervals are time required to undergo AVS and adrenalectomy. While omitting AVS may reduce the TTA, this is associated with poorer biochemical outcome. The COVID-19 pandemic contributed to delayed healthcare delivery worldwide.
Presentation: 6/1/2024