Fishbein, Lauren

Abstract Disclosure: M.D. Figueiredo: None. J. Wagoner: None. W.F. Young: None. L.M. Fishbein: None. M.T. McDermott: None. Introduction: Primary aldosteronism (PA) accounts for at least 5% of hypertension cases and up to 20% of resistant hypertension. Underdiagnosis leads to delayed treatment and increases cardiovascular morbidity and mortality. Our objective was to assess the impact of an educational series for primary care providers (PCPs) on increasing screening rates for PA. Methods: Educational intervention consisted of a 5-day, 2-minute email series for 111 PCPs on PA screening, confirmation, and treatment (trained group). Following the training, EMR data were extracted for patients with PAC (plasma aldosterone concentration) or PRA (plasma renin activity), new hypertension diagnosis code, or a new MRA prescription within 1 year pre- or post-intervention and data pre- and post- intervention were compared. A proper screen included sending both PAC and PRA simultaneously. IRB approval was obtained. Results: In the pre-intervention year, 57 patients were properly screened for PA by the 111 PCPs. Post-intervention, 151 patients were screened for PA showing a 2.65-fold increase in screening with the educational intervention. Using a paired T-test across quartiles pre- and post-intervention, this increase was statistically significant (P=0.0148). We further demonstrated a sustained effect throughout the 12 months post-intervention per quartile (Q+1 n=29, Q+2 n=45, Q+3 n=33, Q+4 n=42). Of the total cohort screened (both pre- and post-intervention), 28% had a positive screen for PA (defined liberally as PAC >5 ng/dL with PRA <1 ng/mL/h). Discussion: The educational intervention drove an increase in PCP screening for PA in the year post-intervention and this increase was sustained across all quartiles of the year. Of the screened cohort (pre- and post-intervention), 28% screened positive for PA, and those patients were more frequently referred to specialists post-intervention. Our study has some limitations, including the relatively small sample size of PCPs educated and patients screened, and the 2020 start to the COVID-19 pandemic impact during the post-intervention period. Conclusion: Our findings advocate for continued education to reinforce PA screening criteria using an easy, not time consuming and effective educational tool. Continuous education is crucial to reinforce next steps in confirmation and treatment. Presentation: 6/3/2024

Abstract Context Urinary bladder paraganglioma (UBPGL) is rare. Objective We aimed to characterize the presentation and outcomes of patients diagnosed with UBPGL. Methods We conducted a multicenter study of consecutive patients with pathologically confirmed UBPGL evaluated between 1971 and 2021. Outcomes included repeat bladder surgery, metastases, and disease-specific mortality. Results Patients (n=110 total; n=56 [51%] women) were diagnosed with UBPGL at a median age of 50 years (interquartile range [IQR], 36-61 years). Median tumor size was 2 cm (IQR, 1-4 cm). UBPGL was diagnosed prior to biopsy in only 37 (34%), and only 69 (63%) patients had evaluation for catecholamine excess. In addition to the initial bladder surgery, 26 (25%) required multiple therapies, including repeat surgery in 10 (9%). Synchronous metastases were present in 9 (8%) patients, and 24 (22%) other patients with UBPGL developed metachronous metastases at a median of 4 years (IQR, 2-10 years) after the initial diagnosis. Development of metachronous metastases was associated with younger age (hazard ratio [HR] 0.97; 95% CI, 0.94-0.99), UBPGL size (HR 1.69; 95% CI, 1.31-2.17), and a higher degree of catecholamine excess (HR 5.48; 95% CI, 1.40-21.39). Disease-specific mortality was higher in patients with synchronous metastases (HR 20.80; 95% CI, 1.30-332.91). Choice of initial surgery, genetic association, sex, or presence of muscular involvement on pathology were not associated with development of metastases or mortality. Conclusions Only a minority of patients were diagnosed before biopsy/surgery, reflecting need for better diagnostic strategies. All patients with UBPGL should have lifelong monitoring for development of recurrence and metastases.

Abstract This manuscript is the result of the North American Neuroendocrine Tumor Society consensus conference on the medical management and surveillance of metastatic and unresectable pheochromocytoma and paraganglioma held on October 2 and 3, 2019. The panelists consisted of endocrinologists, medical oncologists, surgeons, radiologists/nuclear medicine physicians, nephrologists, pathologists, and radiation oncologists. The panelists performed a literature review on a series of questions regarding the medical management of metastatic and unresectable pheochromocytoma and paraganglioma as well as questions regarding surveillance after resection. The panelists voted on controversial topics, and final recommendations were sent to all panel members for final approval.

AbstractThis article is the result of the North American Neuroendocrine Tumor Society consensus conference on the medical management of pancreatic neuroendocrine tumors from July 19 to 20, 2018. The guidelines panel consisted of medical oncologists, pathologists, gastroenterologists, endocrinologists, and radiologists. The panel reviewed a series of questions regarding the medical management of patients with pancreatic neuroendocrine tumors as well as questions regarding surveillance after resection. The available literature was reviewed for each of the question and panel members voted on controversial topics, and the recommendations were included in a document circulated to all panel members for a final approval.