Team Approach to Hyperaldosteronism Treatment

The Hypertension Center in the Smidt Heart Institute is applying a collaborative, multidisciplinary perspective to better diagnosis and treatment of patients with primary aldosteronism, an often misdiagnosed condition that can result in chronic hypertension and debilitating fatigue.

This approach, dubbed "Team Aldo," pulls together a premier team of experts in the fields of cardiology, endocrinology, interventional radiology and surgery, giving patients access to the kind of comprehensive care that can best address their needs.

"I don't know of any other cohesive multidisciplinary program like this on the west coast. It's rare and there aren't many places that have everything it takes to do it," said Ronald G. Victor, MD, director of the Hypertension Center and associate director of clinical research for the Heart Institute.

Victor is one of two cardiologists making up the innovative group. He is joined by fellow cardiologist Florian Rader, MD, MSc, endocrinologist Odelia Cooper, MD, interventional radiologist Marc Friedman, MD, and surgeon Edward Phillips, MD.

Primary aldosteronism occurs when the body produces too much of a hormone called aldosterone, sometimes due to the presence of a tumor on one or both adrenal glands, or because the gland is malfunctioning. Too much aldosterone leads to the retention of sodium and loss of potassium, resulting in chronic high blood pressure in patients along with a host of other symptoms including fatigue, sleep apneaheart arrhythmia and diabetes. Not only that, Victor said, but left untreated, the condition can damage the kidneys and lead to more accelerated enlargement of the heart.

When a patient is referred to the Hypertension Center by their primary care physician, the team's first move is to open the lines of communication and discuss the best approach for each individual.

"A team of people from differing specialties and backgrounds improves individualized patient care," said Phillips, executive vice chair of the Department of Surgery and the chief of General Surgery. "From diagnosis to treatment, the ‘disease' is different in every patient."

After initial screening and basic testing, the patient may undergo a procedure known as adrenal vein sampling, a highly accurate diagnostic tool that requires an exceptionally skilled interventional radiologist. The specialized technique, which is performed at Cedars-Sinai by Friedman, helps determine whether the problem is isolated on one side of the body, or if it's occurring in both glands. This helps the team determine what kind of treatment plan to pursue.

Friedman said the type of multidisciplinary collaboration employed by Team Aldo is becoming increasingly important in the practice of medicine.

"It enhances complex clinical problem solving while taking advantage of individual expertise to maximize patient outcomes," he said. "Time and again, I have witnessed this scenario with Team Aldo patients."

Prior to the formation of the team, Cedars-Sinai was only doing the adrenal vein sampling once every two to three years, Cooper noted. But since launching the collaboration, they've conducted five samplings over the past 12 months, which means more patients are getting the answers they need to achieve better outcomes.

And now, the team's success is beginning to stretch beyond primary aldosteronism. They now are being tapped to treat patients with other conditions, such as Cushing syndrome and a few patients with pheochromocytoma, Rader said.

Rader said only a handful of physicians are dealing with this level of highly specialized care, so communication and collaboration is vital.

Cooper agreed.

"You really have to have a flow of communication with all the providers who are caring for the patient, and that's really what it comes down to and this is one classic case of needing to have a team approach," she said.

"Whether it's in research or clinical care, it's all about teams now. No one provider, no one nurse can do everything."