Primary Aldosteronism

What is primary aldosteronism?

Primary aldosteronism (PA) is a type of aldosterone excess (hyperaldosteronism). This condition occurs when your adrenals, two small glands located on the top of the kidney, produce too much of aldosterone. Aldosterone is a hormone that helps balance the levels of sodium (salt) and potassium in your body. Having too much aldosterone causes the body to hold on to sodium, resulting in salt and water build-up and a rise in blood pressure. Uncontrolled high blood pressure can put you at risk for stroke, heart attack, heart failure, or kidney failure. The risk of heart disease and stroke may be even greater in people with PA than in other people with high blood pressure.

When the increase of aldosterone is caused by a problem in your adrenals, the condition is called primary aldosteronism. When the problem originates outside the adrenals, it’s called secondary aldosteronism. The main causes of PA are:

• Overactivity of both adrenal glands, which occurs in about two-thirds of cases
• A noncancerous growth or tumor in one adrenal gland (also called Conn’s syndrome), which occurs in about one-third of cases
• An inherited disorder which affects aldosterone production, which is rare 
• A cancerous tumor of the adrenal gland, which is extremely rare

What are the clinical features for primary aldosteronism?

• High blood pressure that requires more than three medications to manage
• High blood pressure that started at a young age (less than age 30)
• Family history of stroke at a young age
• Low potassium level in your blood (called hypokalemia)

How is primary aldosteronism diagnosed?

To diagnose PA, your doctor will measure the levels of aldosterone and renin in your blood. Renin is a protein produced by the kidneys that helps regulate blood pressure. In PA, renin levels are low and aldosterone levels are high. If PA is diagnosed, your doctor will obtain an adrenal imaging study (usually CT or MRI) to see whether you might have one tumor or bilateral adrenal tumors (on both sides).

How is primary aldosteronism treated?

Treatment of PA depends on its cause and can include medication or surgery. If you and your doctor decide to pursue surgery, many times your doctor will order a test called "adrenal vein sampling", taking blood samples from each adrenal vein to measure aldosterone and cortisol. This test will demonstrate which adrenal gland(s) produces aldosterone in excess. If both adrenal glands are overactive, treatment with medication and lifestyle changes is often preferred over surgery. Your doctor may prescribe a special type of diuretic (“water pill”) that works to block the action of aldosterone in your body. You will also need to limit sodium (salt) in your diet.

When only one adrenal gland is overactive, medication and lifestyle changes can treat PA. However, doctors usually recommend surgery to remove the culprit adrenal gland. After surgery, you may still need to take medication. You should also follow a healthy lifestyle by:

• Reducing sodium in your diet
• Losing weight, if needed
• Exercising regularly
• Limiting alcohol intake
• Stopping smoking

Questions to ask your doctor

• Should I be tested to find out the cause of my high blood pressure?
• What are my treatment options? 
• What kind of medication should I take? How often should I take it?
• How long will I need to take medication?
• What are the benefits and risks of my medication?
• How often should I have follow-up appointments?
• Should I see an endocrinologist for my care?