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Adrenal (Excluding Mineralocorticoids)

SAT-419 - Variation by Speciality and Region in Perioperative Management of Primary Aldosteronism: An International Survey

Saturday, June 13, 2026
9:30 AM - 4:30 PM CT
Location: ENDOExpo; Poster Floor
Disclosure(s):
Sho Katsuragawa, MD, MPH: No financial relationships to disclose
Background
Perioperative management of primary aldosteronism (PA) is not standardized and may vary by clinician’s speciality and geographic region. We aimed to characterise variations in the perioperative management of PA according to speciality and region.

Methods
An international online survey was conducted between August and October 2025, targeting internists and surgeons involved in perioperative PA care. The questionnaire, co-designed with expert clinicians and patient representatives, assessed practices across the pre-, peri-, and post-operative periods. The survey was distributed via academic society mailing lists and professional networks. Responses were analysed by clinician’s speciality (internists or surgeons) and geographic region (Asia or non-Asia).

Results
A total of 271 clinicians (187 physicians and 84 surgeons) from 29 countries across five continents responded; regional data were available for 228 participants (118 from Asia; 110 from non-Asia). Internists (predominantly endocrinologists) were primarily from Asia (69%), while 47% of surgeons (mostly endocrine surgeons) were from North America. Collaboration patterns differed by region: internists in Asia primarily partnered with urologists (58%), whereas those outside of Asia collaborated primarily with endocrine surgeons (66%). Surgeons more frequently reported that >60% of their patients underwent adrenal vein sampling prior to adrenal surgery (84% vs. 52% of internists), while 15% of surgeons reported that ≤60% of patients underwent AVS compared to 42% of internists. Outpatient renin monitoring before surgery was routine for 62% of internist but only 9% of surgeons. Similarly, 94% of internists performed post-operative aldosterone and renin measurements, whereas only 66% of surgeons did, likely reflecting shared endocrine follow-up. Regional variations were also marked: 96% of clinicians outside of Asia reported an average hospital stay of ≤3 days, while 60% in Asia reported 4–7 days. Clinicians in Asia performed more frequent (every ≤3 months) post-operative aldosterone and renin assessments (45%) compared with those outside of -Asia (13%). This trend was consistent when stratified by internists (47% in Asia and 24% in non-Asia) or surgeons (25% and 2%, respectively). Most clinicians both in Asia (57%) and outside of Asia (66%) were familiar with the Primary Aldosteronism Surgical Outcome (PASO) criteria.

Conclusions
Specialty-based and regional variations exist in PA perioperative care. Further studies are needed to investigate whether the variations affect surgical outcomes and healthcare costs, which can inform the development of evidence-based, standardized perioperative guidelines.

*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*