Health Care Challenges in the Management of Primary Aldosteronism in Southeast Asia.

Autor:	Sukor N; Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia.; Department of Medicine, Hospital Canselor Tuanku Muhriz, Kuala Lumpur 56000, Malaysia., Sunthornyothin S; Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand., Tran TV; Department of Endocrinology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam., Tarigan TJ; Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia., Mercado-Asis LB; Faculty of Medicine and Surgery, University of Santo Tomas, Manila 1008, Philippines., Sum S; Department of Internal Medicine, Calmette Hospital, Phnom Penh 12201, Cambodia., Aung MW; Department of Endocrinology, University of Medicine 1, Yangon General Hospital, Yangon 11131, Myanmar., Yong AML; Department of Internal Medicine, R.I.P.A.S. Hospital, Bandar Seri Begawan BA1712, Brunei Darussalam., Tedjo T; Department of Internal Medicine, Faculty of Medicine, Universitas Diponegoro, Semarang, Jawa Tengah 50275, Indonesia., Villa M; Philippines Center for Diabetes, Thyroid and Endocrine Disorders, St. Luke's Medical Center, Taguig 1634, Philippines., Khaing NEE; Health Services Research, Changi General Hospital, Singapore 529889, Singapore., Azizan EA; Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia.; Department of Medicine, Hospital Canselor Tuanku Muhriz, Kuala Lumpur 56000, Malaysia., Kang WH; Department of Medicine, Faculty of Medicine and Health Sciences, University Tunku Abdul Rahman, Kuala Lumpur 53300, Malaysia., Lim V; Gleneagles Medical Centre, Singapore 258500, Singapore., Teo AED; Department of Medicine, Division of Endocrinology, National University Health System, Singapore 119228, Singapore., Zhang M; Department of Endocrinology, Changi General Hospital, Singapore 529889, Singapore., Tran H; Department of Endocrinology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam., Puar TH; Department of Endocrinology, Changi General Hospital, Singapore 529889, Singapore.; Duke National University of Singapore (NUS) Medical School, Singapore 169857, Singapore.
Jazyk:	angličtina
Zdroj:	The Journal of clinical endocrinology and metabolism [J Clin Endocrinol Metab] 2024 Jun 17; Vol. 109 (7), pp. 1718-1725.
DOI:	10.1210/clinem/dgae039
Abstrakt:	Context: While guidelines have been formulated for the management of primary aldosteronism (PA), following these recommendations may be challenging in developing countries with limited health care access. Objective: We aimed to assess the availability and affordability of health care resources for managing PA in the Association of Southeast Asian Nations (ASEAN) region, which includes low-middle-income countries. Methods: We instituted a questionnaire-based survey to specialists managing PA, assessing the availability and affordability of investigations and treatment. Population and income status data were taken from the national census and registries. Results: Nine ASEAN country members (48 respondents) participated. While screening with aldosterone-renin ratio is performed in all countries, confirmatory testing is routinely performed in only 6 countries due to lack of facilities and local assays, and cost constraint. Assays are locally available in only 4 countries, and some centers have a test turnaround time exceeding 3 weeks. In 7 countries (combined population of 442 million), adrenal vein sampling (AVS) is not routinely performed due to insufficient radiological facilities or trained personnel, and cost constraint. Most patients have access to adrenalectomy and medications. In 6 countries, the cost of AVS and adrenalectomy combined is more than 30% of its annual gross domestic product per capita. While most patients had access to spironolactone, it was not universally affordable. Conclusion: Large populations currently do not have access to the health care resources required for the optimal management of PA. Greater efforts are required to improve health care access and affordability. Future guideline revisions for PA may need to consider these limitations. (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society.)
Databáze:	MEDLINE
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