New Study in JAMA Surgery Challenges One-Size-Fits-All Approach to Diagnosing Curable Cause of High Blood Pressure

Researchers Introduce Personalized Strategy to Reduce Unnecessary Procedures and Expand Access to Life-Changing Surgery

TAMPA, FL, UNITED STATES, March 25, 2026 /EINPresswire.com/ -- A multidisciplinary team from the Carling Adrenal Center at the Hospital for Endocrine Surgery (HCA Florida) has published a landmark article in JAMA Surgery, the world’s leading surgical journal, proposing a transformative, patient-centered approach to diagnosing and treating primary aldosteronism — a common yet frequently missed hormonal cause of high blood pressure that is often curable with surgery.

The study, “Tailored Vein Sampling and Surgery in Primary Aldosteronism,” challenges long-standing clinical assumptions about the routine use of adrenal vein sampling (AVS), a complex and invasive diagnostic procedure traditionally considered mandatory before surgery.

Addressing a Critical Gap—and Widespread Confusion

Primary aldosteronism affects an estimated 5% to 20% of patients with hypertension, yet fewer than 1% are diagnosed, leaving millions at risk for serious complications including heart attack, stroke, and kidney disease. Despite the fact that the condition is often curable with surgery, many patients never reach treatment due to confusion surrounding diagnostic requirements—particularly whether AVS is always necessary.

“For years, there has been significant confusion around whether adrenal vein sampling is required for every patient before surgery,” said Tobias Carling, MD, PhD, FACS, world-renowned adrenal surgeon and Director of the Carling Adrenal Center. “This research helps bring much-needed clarity. By taking a more individualized, evidence-based approach, we can reduce unnecessary procedures and ensure that more patients have access to curative treatment without delay.”

Rethinking the Role of Adrenal Vein Sampling

Adrenal vein sampling is used to determine whether excess hormone production originates from one adrenal gland or both. While valuable in select cases, the study highlights several limitations:

- AVS is technically complex and invasive
- Available only at a limited number of specialized centers
- Carries risks including vein rupture, bleeding, and scarring

As illustrated in clinical examples within the study (page 1), complications from AVS can even make subsequent surgery more difficult due to scarring and tissue damage.

This has led many patients to believe that surgery is not an option unless AVS is completed, creating delays, uncertainty, and in many cases, missed opportunities for cure.

A Personalized, Evidence-Based Approach

The study proposes a tailored strategy that uses disease severity, imaging results (such as CT scans), and individual patient characteristics to determine when AVS is truly needed.

For example:

- Patients with clear, unilateral tumors on imaging—especially in severe cases—may proceed directly to surgery without AVS
- Patients with milder disease often do not require surgery or AVS at all
- AVS remains most valuable in complex or unclear cases where results would change treatment decisions

This approach introduces a new framework that aligns diagnostic testing with clinical need rather than applying a universal requirement.

A Curable Cause of High Blood Pressure Often Missed

Unlike most forms of hypertension, primary aldosteronism can frequently be cured. The condition occurs when one or both adrenal glands produce excess aldosterone, a hormone that causes sodium retention, potassium loss, and persistent high blood pressure.

Curative adrenalectomy — surgical removal of the overactive adrenal tissue — can normalize hormone levels and significantly improve or eliminate hypertension in appropriately selected patients.

“Primary aldosteronism is one of the most important yet underrecognized causes of high blood pressure,” added Carling. “When diagnosed correctly, many patients can be cured — not just treated — with surgery.”

A Looming Public Health Challenge

With new guidelines recommending broader screening, the number of diagnosed cases is expected to rise dramatically. The study estimates that in the United States alone:

- More than 3 million patients could be identified with primary aldosteronism
- Over 2.6 million AVS procedures could be required under current practices
- Approximately 646,000 surgeries may be indicated

Yet fewer than 1% of interventional radiologists perform AVS at high volume, creating a significant bottleneck in care. Without a more flexible approach, many patients could be left untreated despite having a curable condition.

National Leadership in Adrenal Vein Sampling

The Hospital for Endocrine Surgery’s AVS program, led by interventional radiologist Karan Patel, MD, now performs more adrenal vein sampling procedures than any other program in the United States.

This high-volume expertise enhances diagnostic accuracy, reduces complications, and enables treatment of the most complex cases.

“High-quality AVS requires extensive experience,” said Dr. Patel. “Our program’s scale allows us to deliver precise results that guide life-changing treatment decisions for patients with primary aldosteronism.”

Precision Surgery Is Changing Outcomes

The publication highlights the growing role of personalized adrenal surgery, including function-preserving techniques that remove tumors while preserving healthy adrenal tissue.

These approaches can achieve biochemical cure rates of 65% to 85% in selected patients while minimizing the risk of adrenal insufficiency.

Advanced pathology, molecular testing, and emerging imaging technologies may further refine treatment decisions and reduce reliance on invasive procedures in the future.

Why This Matters for Patients

Primary aldosteronism is frequently overlooked, even in patients with difficult-to-control hypertension. Warning signs may include:

- High blood pressure requiring multiple medications
- Low potassium levels
- Early-onset hypertension
- Family history of stroke or hypertension
- Adrenal tumors detected on imaging

Because the condition is often curable, early recognition and referral to a specialized center can be life-changing.

Multidisciplinary Research Driving Innovation

The article was co-authored by an internationally recognized team:

Tobias Carling, MD, PhD — Carling Adrenal Center
Karan Patel, MD — Interventional Radiology, Hospital for Endocrine Surgery
Constantine A. Stratakis, MD, PhD — Hospital for Endocrine Surgery Research Center
Fabio R. Faucz, PhD — Hospital for Endocrine Surgery Research Center

Their collaboration reflects the center’s integrated model combining surgery, interventional radiology, endocrinology, and translational research to improve outcomes for patients with adrenal disorders.

About the Carling Adrenal Center
The Carling Adrenal Center, part of the Hospital for Endocrine Surgery in Tampa, Florida, is one of the world’s highest-volume centers dedicated exclusively to adrenal disorders. Patients travel from across the United States and internationally for expert evaluation and treatment of conditions including primary aldosteronism, Cushing’s syndrome, pheochromocytoma, adrenal tumors, and adrenal cancer.

The center is recognized for its multidisciplinary expertise, advanced surgical techniques, and leadership in clinical research that shapes international standards of care.

About the Hospital for Endocrine Surgery
The Hospital for Endocrine Surgery is a specialty hospital focused exclusively on diseases of the thyroid, parathyroid, and adrenal glands. Its surgeons perform among the highest volumes of endocrine procedures in the world, achieving outcomes that consistently exceed national benchmarks.

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