Why aren't doctors diagnosing primary aldosteronism?

Primary aldosteronism, also known as PA or Conn Syndrome, is a leading endocrine cause of high blood pressure. It increases the risk of stroke, heart attack, atrial fibrillation, and kidney failure. This condition can be caused by a unilateral aldosterone-producing adrenal tumor or overproduction of aldosterone from both adrenal glands.

While the former can be treated with surgery, the latter is treated with medications. Unfortunately, primary aldosteronism is frequently underdiagnosed, preventing patients from benefiting from these treatments.

Researchers from Hudson Institute of Medical Research and Monash University sought to determine the best way to detect and treat this significant cause of hypertension. They also investigated why it is often not considered as a diagnosis in the first place. The study, published in the journal Kidney Medicine, interviewed 38 healthcare professionals across Australia, including GPs, nephrologists, endocrinologists, and cardiologists from various locations.

The findings revealed several barriers to diagnosing and treating primary aldosteronism. These include the belief that patients with PA are older and have multiple health issues, not usually considered for screening; the perceived complexity and burden of the diagnostic process, discouraging initial investigation; and limited access to services that disrupt the diagnostic cascade, causing fragmented care and delays.

Dr Jun Yang, one of the study's lead authors, believes that PA is often inappropriately managed due to underdiagnosis. She emphasizes that patients can only benefit from treatment if they are diagnosed first. This study has provided valuable insights into the factors influencing clinicians' decision-making in PA screening, diagnosis, and management. These insights can guide the development of interventions to improve PA detection and care across different health sectors in Australia.