This hormonal disorder can cause high blood pressure and an increased risk of heart disease and stroke. Learn about causes and treatments.
Primary aldosteronism (al-DOS-tuh-ro-niz-um) is a hormonal disorder that leads to high blood pressure. It occurs when your adrenal glands produce too much of a hormone called aldosterone.
Your adrenal glands produce a number of essential hormones, including aldosterone. Usually, aldosterone balances sodium and potassium in your blood. But too much of this hormone can cause you to lose potassium and retain sodium. That imbalance can cause your body to hold too much water, increasing your blood volume and blood pressure.
Treatment options include medications, surgery and lifestyle changes.
Primary aldosteronism often doesn't cause clear symptoms. The first clue that you may have primary aldosteronism is usually high blood pressure, especially hard to control blood pressure.
Sometimes, primary aldosteronism causes low potassium levels. If this happens, you may have:
Ask your doctor about the possibility of having primary aldosteronism if you have:
Common conditions that can cause too much aldosterone include:
There are other, much rarer causes of primary aldosteronism, including:
Primary aldosteronism can lead to high blood pressure and low potassium levels. These complications in turn can lead to other problems.
Persistently elevated blood pressure can lead to problems with your heart and kidneys, including:
People with primary aldosteronism have a higher than expected risk of cardiovascular problems compared with people who only have high blood pressure.
Primary aldosteronism may cause low potassium levels. If your potassium levels are just slightly low, you may not have any symptoms. Very low levels of potassium can lead to:
If your doctor suspects primary aldosteronism, you'll likely have a test to measure levels of aldosterone and renin in your blood. Renin is an enzyme released by your kidneys that helps control blood pressure. If your renin level is very low and your aldosterone level is high, you may have primary aldosteronism.
If the aldosterone-renin test suggests primary aldosteronism, you'll need other tests to confirm the diagnosis and look for potential causes. Possible tests include:
Adrenal vein blood test. A radiologist draws blood from both your right and left adrenal veins and compares the two samples. If only one side has elevated aldosterone, your doctor may suspect a growth on that adrenal gland.
This test involves placing a tube in a vein in your groin and threading it up to the adrenal veins. Though essential for determining the appropriate treatment, this test carries the risk of bleeding or a blood clot in the vein.
Treatment for primary aldosteronism depends on the underlying cause. The basic goal is get your aldosterone levels back to normal or to block the effect of high aldosterone to prevent complications.
An adrenal gland tumor may be treated with surgery or medications and lifestyle changes.
Surgical removal of the gland. Surgical removal of the adrenal gland with the tumor (adrenalectomy) is usually recommended. Surgical removal may bring blood pressure, potassium and aldosterone levels back to normal. Your doctor will follow you closely after surgery and progressively adjust or eliminate your high blood pressure medications.
Risks of surgery include bleeding and infection. Adrenal hormone replacement isn't necessary because the other adrenal gland can make enough of all the hormones your body needs.
A combination of medications and lifestyle modifications can effectively treat primary aldosteronism caused by overactivity of both adrenal glands.
Medications. Mineralocorticoid receptor antagonists block the action of aldosterone in your body. Your doctor may first prescribe spironolactone (Aldactone). This medication helps correct high blood pressure and low potassium, but may cause other problems.
In addition to blocking aldosterone receptors, spironolactone may inhibit the action of other hormones. Side effects can include male breast enlargement (gynecomastia) and menstrual irregularities in women.
A newer, more-expensive mineralocorticoid receptor antagonist called eplerenone (Inspra) eliminates the sex hormone side effects associated with spironolactone. Your doctor may recommend eplerenone if you have serious side effects with spironolactone. You may also need other medications for high blood pressure.
A healthy lifestyle is essential for keeping blood pressure low and keeping long-term heart health. Here are some healthy lifestyle suggestions:
Since the symptoms of primary aldosteronism aren't always obvious, your doctor may be the one to suggest you get screened for the condition. Your doctor may suspect primary aldosteronism if you have high blood pressure and:
The screening test for primary aldosteronism may need some planning. The test can be performed while you're taking most blood pressure medications, but you may need to stop taking certain drugs, such as spironolactone (Aldactone) and eplerenone (Inspra), up to four weeks before testing. Your doctor may also ask you to avoid real licorice products for a couple of weeks before the test, as these can cause changes that mimic excess aldosterone.
After testing, you'll see your doctor for a follow-up appointment or you may be referred to a doctor who treats hormone disorders (endocrinologist). Here's some information to help you get ready for your appointment.
When you make the appointment, make a list of:
For primary aldosteronism, some basic questions to ask your doctor include:
Your doctor is likely to ask you several questions, include:
December 24th, 2020