Improvement in quality of life and psychological symptoms after treatment for primary aldosteronism: Asian Cohort Study

Tan, Yen Kheng; Kwan, Yu Heng; Teo, David Choon Liang; Velema, Marieke; Deinum, Jaap; Tan, Pei Ting; Zhang, Meifen; Khoo, Joan; Loh, Wann Jia; Gani, Linsey; King, Thomas H.; Tan, Eng Loy; Soh, Shui Boon; Au, Vanessa; Tay, Tunn Lin; Dacay, Lily Mae; Ng, Keng Sin; Wong, Kang Min; Wong, Andrew Siang Yih; Ng, Foo Cheong; Aw, Tar Choon; Chan, Yvonne Hui Bin; Tong, Khim Leng; Lee, Sheldon Shao Guang; Chai, Siang Chew; Puar, Troy

doi:10.1530/ec-21-0125

Cited by 7 publications

(2 citation statements)

References 42 publications

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“…Another observation of interest was how many patients had a general feeling of being unwell, including the presence of bothersome symptoms such as headache, arthralgias, generalized pain, muscle cramps, fatigue, irritability, worries and sadness. This agrees with studies showing that patients with PA have worse quality-of-life compared to the general population [6,14,15], and that anxiety, irritable mood, high stress level, psychological distress, depression and nervousness are more common in patients with PA than healthy controls [15,16]. It can be speculated that some of these symptoms may be related to the effects of a long-standing overproduction of aldosterone on the brain [8], while others are more likely to be related to chronic hypokalemia and adverse effects from the blood pressure lowering treatment [17].…”

Section: Discussionsupporting

confidence: 91%

Illness perspectives in patients with primary aldosteronism

et al. 2022

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Objective The burden of symptoms and treatment in patients with primary aldosteronism (PA), as well as the patients’ experience of the health care is sparsely studied. The objectives of this study were to describe symptoms considered to be the most troublesome by patients with PA, and to explore health related worries and expectations following treatment. Methods This was an explorative qualitative study where 25 patients with PA, diagnosed between 2017 and 2019, were included; 13 patients who had undergone adrenalectomy and 12 who were receiving medical treatment. Data was collected during six group interviews and analyzed using a thematic approach. Results Three main themes were identified: 1) Distress of the past, where the most important issues were struggle to receive a correct diagnosis, impaired well-being and the consumption of a large number of tablets, 2) Satisfaction after receiving a correct diagnosis, both in patients with unilateral and bilateral disease, but also dissatisfaction with lack of information about the disease, and 3) Future concerns, where worries about the long-term effects of PA on health in general dominated. Conclusions Our findings illustrate several important issues related to PA where improvements in patient care are needed, including actions aiming at shortening the long diagnostic delay, a thorough information to the patients about the disease is of great importance, and that all patients with PA, regardless of treatment, would benefit from a structured long-term follow-up.

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Section: Discussionsupporting

confidence: 91%

Illness perspectives in patients with primary aldosteronism

et al. 2022

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“…The diagnostic process in PA can be simplified into 3 distinct steps: case finding, confirmatory, and subtyping tests. Accurate subtyping of PA as unilateral or bilateral is essential, as adrenalectomy for unilateral PA improves clinical outcomes ( 1 , 2 ) and quality of life ( 3 , 4 ). Adrenal vein sampling (AVS) is the gold-standard test in subtyping PA; however, its interpretation can be challenging.…”

Section: Introductionmentioning

confidence: 99%

Utility of Repeat Sampling in Bilateral Aldosterone Suppression During Adrenal Vein Sampling for Primary Aldosteronism

Halim,

Yong,

Egan

et al. 2024

JCEM Case Reports

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Primary aldosteronism (PA) is the most common form of secondary hypertension. Accurate subtyping of PA is essential to identify unilateral disease, as adrenalectomy improves outcomes. Subtyping PA requires adrenal vein sampling (AVS), which is technically challenging and results from AVS may not always be conclusive. We present a case of a 37-year-old man with PA whose AVS studies were inconclusive due to apparent bilateral aldosterone suppression (ABAS). As a result, our patient was misdiagnosed as having bilateral PA and medically managed until a repeat AVS showed lateralization to the right adrenal gland. ABAS is an underrecognized phenomenon that may confound the subtyping of PA. We recommend repeating AVS in such cases and discuss strategies to minimize ABAS.

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Diagnosis and management of adrenal incidentaloma: use of clinical judgment and evidence in dialog with the patient

Yoshida,

Horiuchi,

Otsuki

et al. 2023

Surg Today

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The prevalence of adrenal incidentaloma (AI) in imaging studies, including those of the adrenal glands, is estimated to be 1–5%. Essential factors for the proper management of AI include a correct diagnosis, adequate surgical skills, appropriate perioperative management, and sound dialogue with the patient. Aside from the possibility of overdiagnosis, patients with apparent signs or symptoms attributable to adrenal hormone excess have reasonable indications for surgery. At the same time, milder patients may be candidates for active surveillance without intervention. Even individuals with nonfunctioning AI may benefit from surgery if imaging studies depict the tumor as suggestive of malignancy. However, a differential diagnosis of AI may not be easy for surgeons with little experience in seeing such patients.Furthermore, a patient without a correct diagnosis may miss the window of opportunity for a cure or incur a greater risk of developing complications, such as adrenal insufficiency or cardiovascular events during or after surgery, due to inadequate management. The clinical practice guidelines for AI from around the world may be helpful for shared decision-making; however, Japan lacks established guidelines. In this review article, we propose practical guidelines relevant to management by summarizing the evidence for five key questions that are often asked in dialog with patients with AI.

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Improvement in quality of life and psychological symptoms after treatment for primary aldosteronism: Asian Cohort Study

Cited by 7 publications

References 42 publications

Illness perspectives in patients with primary aldosteronism

Illness perspectives in patients with primary aldosteronism

Utility of Repeat Sampling in Bilateral Aldosterone Suppression During Adrenal Vein Sampling for Primary Aldosteronism

Diagnosis and management of adrenal incidentaloma: use of clinical judgment and evidence in dialog with the patient

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