Hyperaldosteronism
Also known as: Primary aldosteronism, Conn's syndrome
Hyperaldosteronism is a condition in which the adrenal glands produce too much aldosterone, a hormone that tells the kidneys to retain sodium and water and to excrete potassium. The result is high blood pressure that is often hard to control, and sometimes low potassium levels that cause weakness and cramps. Primary hyperaldosteronism, also called Conn's syndrome, is caused by a benign adrenal tumour or by overactivity of both adrenal glands, and is now recognized as one of the most common curable causes of high blood pressure. Secondary hyperaldosteronism arises when something else, such as heart failure, liver cirrhosis or narrowed kidney arteries, stimulates aldosterone release. Identifying the condition matters because excess aldosterone damages the heart, blood vessels and kidneys beyond the effect of blood pressure alone, and targeted treatment with surgery or specific medications is highly effective.
At a Glance
- Common symptoms
- High blood pressure, often requiring several medications to control, Muscle weakness, cramps or, rarely, temporary paralysis from low potassium, Fatigue
- Main treatments
- Laparoscopic removal of the affected adrenal gland when a single-sided adenoma is confirmed, which cures low potassium and improves or cures high blood pressure in most people, Mineralocorticoid receptor antagonist medication (spironolactone or eplerenone) for bilateral disease or when surgery is not suitable, Potassium supplements until potassium levels are controlled
- Category
- Endocrine · Under-recognized; a notable share of people with high blood pressure, particularly those with resistant hypertension
- See a doctor if
- High blood pressure that remains uncontrolled despite multiple medications
Symptoms
Causes
- A benign aldosterone-producing tumour (adenoma) on one adrenal gland
- Enlargement and overactivity of both adrenal glands (bilateral adrenal hyperplasia), the most common cause
- Rare inherited forms of familial hyperaldosteronism
- Very rarely, adrenal cancer
- Secondary causes such as narrowing of the kidney arteries, heart failure, cirrhosis or diuretic use that stimulate the adrenal glands
Risk Factors
- High blood pressure that is resistant to treatment or diagnosed at a young age
- Low potassium found on a blood test
- An adrenal nodule discovered on imaging
- A family history of early high blood pressure, stroke or primary aldosteronism
- Obstructive sleep apnea, which is associated with higher rates
Diagnosis
- A screening blood test measuring the aldosterone-to-renin ratio, ideally after adjusting medications that interfere
- Blood potassium and sodium levels
- Confirmatory testing, such as a saline infusion or oral salt loading test, to see whether aldosterone can be suppressed
- CT scan of the adrenal glands to look for a nodule
- Adrenal vein sampling, a specialist procedure to determine whether one or both glands are overproducing, before considering surgery
Treatment
- Laparoscopic removal of the affected adrenal gland when a single-sided adenoma is confirmed, which cures low potassium and improves or cures high blood pressure in most people
- Mineralocorticoid receptor antagonist medication (spironolactone or eplerenone) for bilateral disease or when surgery is not suitable
- Potassium supplements until potassium levels are controlled
- Additional blood pressure medications as needed
- Treatment of the underlying cause in secondary hyperaldosteronism
- Supportive: reducing dietary sodium, which helps lower blood pressure and potassium loss in this condition
- Supportive: regular exercise, a healthy weight, limiting alcohol and treating sleep apnea
Prevention
- Primary hyperaldosteronism cannot be prevented, but early detection prevents heart and kidney damage
- Ask your doctor about screening if your blood pressure needs three or more medications, started before age 40, or is accompanied by low potassium
- Limit salt intake
- Maintain a healthy weight, exercise regularly and avoid smoking to protect your heart and blood vessels
- Take blood pressure medication as prescribed and keep follow-up appointments
When to See a Doctor
- High blood pressure that remains uncontrolled despite multiple medications
- High blood pressure diagnosed before age 40 or with low potassium
- Muscle weakness, cramps or palpitations, especially if you also have high blood pressure
- Severe weakness, inability to move limbs or a very irregular heartbeat (seek emergency care)
- An adrenal nodule found on a scan done for another reason
Frequently Asked Questions
Related Conditions
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