EQUIPping tertiary care for the optimal diagnosis of primary aldosteronism (PA).

Background

The EQUIPPA project was awarded $2,993,294 by the Medical Research Future Fund in 2022 with the aim to equip tertiary care for the optimal diagnosis of primary aldosteronism. At present, there is a growing gap between the demand for testing and lack of capacity for the accurate and timely diagnosis of primary aldosteronism in the tertiary care setting.

This project looks at establishing a sustainable research infrastructure embedded in health services across states, involving multidisciplinary clinicians in developing, validating and implementing innovative diagnostic methods.

Overall, EQUIPPA aims to build the roadmap for scalable strategies to optimise the diagnosis of primary aldosteronism and improve patient outcomes around Australia.

Our expert team

The EQUIPPA project has been designed by clinical research leaders across the disciplines of endocrinology, nephrology, chemical pathology and radiology who work at the coalface of PA diagnosis and management in tertiary health services. Its academic rigour is strengthened by the input of academic experts in the areas of biostatics, health economics and implementation science.

Our partnering Institutes

• Monash Health
• Monash University
• University of NSW
• University of Queensland
• University of Western Australia

Project scope

AIM 1 – PROSALDO Australia

This is a collaborated project with researchers in Germany to develop and test a different way of measuring aldosterone and related hormones which may be more reliable than current tests. Once validated, the system will be harmonised across chemical pathology laboratories around Australia. This is to address the issue of inconsistent and potentially confusing results for patients and clinicians.

• A/Prof Jun Yang, Endocrinologist, Hudson Institute of Medical Research VIC
• A/Prof Damon Bell, Chemical Pathologist, PathWest WA
• A/Prof Zhong Lu, Chemical Pathologist, Pathology Monash Health VIC
• Prof Andrea (Rita) Horvath, Chemical Pathologist, NSW Health Pathology, NSW
• Prof Zoltan Endre, Nephrologist, South East Sydney Local Health District NSW
• Dr Moe Thuzar, Endocrinologist, Metro South Hospital and Health Services QLD

AIM 2 – Validating algorithms to bypass AVS

This project evaluates and validates algorithms for efficient subtyping of primary aldosteronism as either unilateral disease (caused by one adrenal gland) or bilateral disease (caused by both adrenal glands). The results, once implemented, will minimise the requirement for invasive adrenal venous sampling (AVS) for those patients with bilateral disease as they are not expected to benefit from AVS. The findings, if positive, could also facilitate provision of the treatment for patients with unilateral PA by bypassing AVS.

• A/Prof Jun Yang, Endocrinologist, Hudson Institute of Medical Research VIC
• Dr Elisabeth Ng, PhD Candidate, Hudson Institute of Medical Research VIC
• Prof Michael Stowasser, Endocrinologist, Metro South Hospital and Health Services QLD
• A/Prof Damon Bell, Chemical Pathologist PathWest WA Dr StellaMay Gwini, Biostatistics Scientist, Hudson Institute of Medical Research VIC

Aim 3 – AVS Scale Up

In this project, interventional radiologists, endocrinologists, chemical pathologists, nephrologists and consumers will be involved in the development of guidelines for AVS in Australia and New Zealand. By developing evidence-based but also practical guidelines for both performing and interpreting AVS, we hope to standardise AVS practice across Australia and New Zealand to ensure optimum patient care and patient outcome.  With the expertise from our implementation team, we will evaluate barriers to setting up accessible and successful AVS services.  The results will help to formulate recommendations for improved AVS services. Our health economics team will look to optimise patient experience and outcome by surveying patients’ experience after AVS. Collectively, this aim will contribute to an overall strategy to advance the provision of AVS services in Australia.

• A/Prof Winston Chong, Radiologist, Monash Health VIC
• A/Prof Jun Yang, Endocrinologist, Hudson Institute of Medical Research VIC
• Prof Andrea (Rita), Chemical Pathologist, Horvath NSW Health Pathology, NSW
• Prof Michael Stowasser, Endocrinologist, Metro South Hospital and Health Services QLD
• Prof Helen Skouteris, Monash Warwick Professor in Health and Social Care Improvement and Implementation Science, Monash University VIC
• Dr Heather Morris, Implementation Scientist, Monash University VIC
• Dr Angela Melder, Implementation Scientist, Monash University VIC
• A/Prof Gang Chen, Health Economics Scientist, Monash University VIC

Aim 4 – Nuclear medicine alternative to AVS

In this project, a feasible alternative to AVS is being tested to reliably identify surgically curable unilateral adrenal disease. This novel method of identifying surgically curable PA uses non-invasive nuclear medicine imaging. This is necessary to simplify the process of identifying curable disease and reduce the need for the current “gold-standard” but invasive tests such as AVS.

• Prof Peter Fuller, Endocrinologist, Hudson Institute of Medical Research VIC
• Dr Jimmy Shen, Endocrinologist, Hudson Institute of Medical Research VIC
• Dr Ian Jong, Nuclear Medicine Specialist, Imaging, Monash Health VIC
• A/Prof Jun Yang, Endocrinologist, Hudson Institute of Medical Research VIC
• Dr Elisabeth Ng, PhD Candidate, Hudson Institute of Medical Research VIC

Publications

Morris H, Melder A, Ng E, Skouteris H, Chong W, and Yang J. (2024) A scoping review of adrenal vein sampling in practice settings: Applying an implementation science lens. Journal of Clinical and Translational Science 8: e214, 1–9. doi: 10.1017/cts.2024.656. View published manuscript

Jun Yang, Damon A. Bell, Richard Carroll, Cherie Chiang, Diane Cowley, Emma Croker, James C. G. Doery, Marianne Elston, Paul Glendenning, Julie Hetherington, Andrea R. Horvath, Shanshan Lu‐Shirzad, Elisabeth Ng, Amanda Mather, Nimalie Perera, Muddassir Rashid, Nirupa Sachithanandan, Jimmy Shen, Michael Stowasser, Michael J. Swarbrick, Hong Lin Evelyn Tan, Moe Thuzar, Simon Young, Winston Chong (2024) Adrenal Vein Sampling for Primary Aldosteronism: Recommendations From the Australian and New Zealand Working Group. Clinical Endocrinology. DOI: https://doi.org/10.1111/cen.15139. View published manuscript

Elisabeth Ng, Winston Chong, Kenneth K Lau, Stella May Gwini, Richard W Carroll, James CG Doery, Peter J Fuller and Jun Yang (2023) The where, who and how of adrenal vein sampling in Australia and New Zealand. Journal of Medical Imaging and Radiation Oncology. DOI: doi:10.1111/1754-9485.13573. View published manuscript

Conference Presentations

Unlocking implementation information from clinical research

Are aldosterone assays by LC-MS/MS harmonised in Australia?

Steroid profiling by LC-MS/MS and primary aldosteronism