Cardiovascular Endocrinology

SUN-248 - Diagnostic Delay and Disease Severity in Primary Aldosteronism in an Understudied Population

Sunday, June 14, 2026

9:00 AM - 4:00 PM CT

Location: ENDOExpo; Poster Floor

Co-Author(s)

JM

Jessica Lopes Montozo, MD

Ribeirao Preto Medical School, University of Sao Paulo
Ribeirao Preto, United States
PE

Paula Conde Lamparelli Elias, MD, PhD

Ribeirao Preto Medical School, University of Sao Paulo
Ribeirao Preto, Brazil
AA

Anne Elise Alexandre, MD

Ribeirao Preto Medical School, University of Sao Paulo
Ribeirao Preto, Brazil
CM

Carlos Augusto Fernandes Molina, MD, PhD

Ribeirao Preto Medical School, University of Sao Paulo
Ribeirao Preto, Brazil
VM

Valdair Francisco Muglia, MD, PhD

Ribeirao Preto Medical School, University of Sao Paulo
Ribeirao Preto, Brazil
JE

Jorge Elias Jr, MD, PhD

Ribeirao Preto Medical School, University of Sao Paulo
Ribeirao Preto, Brazil
MC

Margaret Castro, MD, PhD

Ribeirao Preto Medical School, University of Sao Paulo
Ribeirao Preto, Brazil
AM

Ayrton Custodio Moreira, MD, PhD

Ribeirao Preto Medical School, University of Sao Paulo
Ribeirao Preto, Brazil

Abstract Poster Presenter(s)

Livia Mermejo, MD, PhD

Assistant Professor
Ribeirao Preto Medical School, University of Sao Paulo
Ribeirao Preto, Brazil

Senior Author/Primary Investigator(s)

Livia Mermejo, MD, PhD

Assistant Professor
Ribeirao Preto Medical School, University of Sao Paulo
Ribeirao Preto, Brazil

Disclosure(s):

Livia Mermejo, MD, PhD: No financial relationships to disclose

Background: Primary aldosteronism (PA) is frequently underdiagnosed, leading to prolonged exposure to aldosterone excess. In Brazil, we observed a long delay between the beginning of hypertension and the PA diagnosis as well as a higher incidence of hypokalemia at the diagnosis, suggesting patients with severe hyperaldosteronism.

Methods: We retrospectively analyzed patients with confirmed PA evaluated over a 25-year period in a single tertiary university hospital. Clinical and biochemical data were collected and PA severity was classified using Primary Aldosteronism Severity Classification (PACS), a severity classification for PA using three simple indicators -serum potassium, blood pressure, and plasma aldosterone concentration. Treatment outcomes were assessed using PASO (unilateral PA) and PAMO (bilateral PA) classifications.

Results: Among 122 patients (55% female), 48 underwent adrenalectomy for unilateral PA, 56 received medical therapy for bilateral disease or were not surgical candidates, and 18 remained under PA subtype investigation. Most diagnoses (86%) occurred in the past decade. Hypertension began at a median age of 33 years, with PA diagnosed at 53 years. Hypokalemia was present in 73% of patients, more commonly in unilateral than bilateral PA (83% vs. 66%). Patients with unilateral PA had higher aldosterone/renin (19.5 vs. 7.8) and aldosterone/potassium ratios (18.4 vs. 6.1; both p < 0.0001). Type 2 diabetes and dyslipidemia were more frequent in the bilateral group (both p = 0.03). After treatment, adrenalectomized patients required fewer antihypertensive medications and achieved better blood pressure and potassium control compared to patients with clinical treatment. PA severity was moderate or severe in 98% of patients, with severe disease more common in unilateral PA (60% vs. 32%; p = 0.006). Regarding outcomes, PASO showed that 38% of patients achieved complete clinical cure and 84% complete biochemical control while none of the bilateral PA patients achieved complete clinical control and 69% complete biochemical using PAMO classification.

Conclusions: In this Brazilian cohort, PA patients exhibited substantial delay in diagnosis and predominantly moderate-to-severe disease. Adrenalectomy provided superior clinical and biochemical outcomes compared with medical therapy, underscoring the importance of early detection and optimized management strategies.

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