What is primary aldosteronism?
Primary aldosteronism (PA) is a type of aldosterone excess. 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 which 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.
How common is primary aldosteronism?
Please discuss with your doctor for further information.
What are the symptoms of primary aldosteronism?
The common symptoms of primary aldosteronism are:
- Moderate to severe high blood pressure
- High blood pressure that takes several medications to control (resistant hypertension)
- High blood pressure along with a low potassium level (hypokalemia)
There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.
When should I see my doctor?
If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.
What causes primary 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 increases my risk for primary aldosteronism?
There are many risk factors for primary aldosteronism, such as:
- 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)
Diagnosis & treatment
The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.
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 have one tumor or bilateral adrenal tumors (on both sides).
How is primary aldosteronism treated?
Treatment for primary aldosteronism depends on the underlying cause, but its basic goal is to normalize or block the effect of high aldosterone levels and prevent the potential complications of high blood pressure and low potassium levels.
Treatment for an adrenal gland tumor
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 containing the tumor (adrenalectomy) is usually recommended because it may permanently resolve high blood pressure and potassium deficiency, and it can bring aldosterone levels back to normal. Blood pressure usually drops gradually after a unilateral adrenalectomy. Your doctor will follow you closely after surgery and progressively adjust or eliminate your high blood pressure medications.
An adrenalectomy carries the usual risks of abdominal surgery, including bleeding and infection. However, adrenal hormone replacement is not necessary after a unilateral adrenalectomy because the other adrenal gland is able to produce adequate amounts of all the hormones on its own.
- Aldosterone-blocking drugs. If you’re unable to have surgery or prefer not to, primary aldosteronism caused by a benign tumor can also be treated with aldosterone-blocking drugs (mineralocorticoid receptor antagonists) and lifestyle changes. But high blood pressure and low potassium will return if you stop taking your medications.
Treatment for overactivity of both adrenal glands
A combination of medications and lifestyle modifications can effectively treat primary aldosteronism caused by overactivity of both adrenal glands (bilateral adrenal hyperplasia).
- Mineralocorticoid receptor antagonists block the action of aldosterone in your body. Your doctor may first prescribe spironolactone. This medication helps correct high blood pressure and low potassium, but it may cause problems.
In addition to blocking aldosterone receptors, spironolactone blocks androgen and progesterone receptors and may inhibit the action of these hormones. Side effects can include male breast enlargement (gynecomastia), decreased sexual desire, impotence, menstrual irregularities and gastrointestinal distress.
A newer, more expensive mineralocorticoid receptor antagonist called eplerenone acts just on aldosterone receptors, but 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.
- Lifestyle changes. High blood pressure medications are more effective when combined with a healthy diet and lifestyle. Work with your doctor to create a plan to reduce the sodium in your diet and maintain a healthy body weight. Getting regular exercise, limiting the amount of alcohol you drink and stopping smoking also may improve your response to medications.
Lifestyle changes & home remedies
What are some lifestyle changes or home remedies that can help me manage primary aldosteronism?
The following lifestyles and home remedies might help you cope with primary aldosteronism:
- Follow a healthy diet. Limit the sodium in your diet by focusing on fresh foods and reduced-sodium products, avoiding condiments, and removing salt from recipes. (3p6) Diets that also emphasize a healthy variety of foods — including grains, fruits, vegetables and low-fat dairy products — can promote weight loss and help lower blood pressure. Try the Dietary Approaches to Stop Hypertension (DASH) diet — it has proven benefits for your heart.
- Achieve a healthy weight. If your body mass index (BMI) is 25 or more, losing as few as 10 pounds (4.5 kilograms) may reduce your blood pressure.
- Regular aerobic exercise can help lower blood pressure. You don’t have to hit the gym — taking vigorous walks most days of the week can significantly improve your health. Try walking with a friend at lunch instead of dining out.
- Don’t smoke. Quitting smoking will improve your overall cardiovascular health. Nicotine in tobacco makes your heart work harder by constricting your blood vessels and increasing your heart rate and blood pressure. Talk to your doctor about medications that can help you stop smoking.
- Limit alcohol and caffeine. Both substances can raise your blood pressure, and alcohol can interfere with the effectiveness of some blood pressure medications. Ask your doctor whether moderate alcohol consumption is safe for you.
If you have any questions, please consult with your doctor to better understand the best solution for you.
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