SAT-280 - Primary Aldosteronism Screening using Low-Threshold Criteria in an Outpatient Clinic

Primary aldosteronism is an underdiagnosed cause of hypertension, largely due to low testing rates. We hypothesized that expanding screening to include lower-threshold criteria compared to previous guidelines could improve detection. We evaluated the prevalence of primary aldosteronism in patients with hypertension, comparing those who met the previous Endocrine Society guideline criteria (2016) to those who met additional, broader criteria. This was a prospective cohort pilot study conducted over 2 years as a continuation of a prior study. The extended study aimed to evaluate broader screening criteria for primary aldosteronism. Hypertensive patients were separated into two groups. The standard group (SG) met the previous Endocrine Society screening guidelines for primary aldosteronism. The low-threshold group (LG) included hypertensive patients on 2 antihypertensive medications, but did not meet any of the previous criteria for screening. Plasma aldosterone concentration (PAC) and plasma renin activity (PRA) were ordered for each patient. Those with an aldosterone-to-renin ratio (ARR) >20 were considered to have a positive screen. Positive cases were classified as either "Confirmed Cases" (CC, no further testing needed) or "Oral Sodium Loading" (OSL, required confirmatory testing). In the SG, 7 of 45 (15.6%) had a positive ARR (3 were CC and 4 required OSL). In the LG, 5 of 18 (27.8%) had a positive ARR (2 were CC and 3 required OSL). In total, 12 out of the 63 patients (19.0%) screened positive for primary aldosteronism. A substantial number of patients screened positive for primary aldosteronism in both the standard and low-threshold groups. Notably, a higher proportion of positive cases was observed in the low-threshold group. These findings support the recent guideline changes of having a lower threshold to screen for primary aldosteronism.

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