Primary and secondary hyperaldosteronism
Hyperaldosteronism can be primary or secondary.
Conn syndrome; Mineralocorticoid excess
Primary hyperaldosteronism is due to a problem of the adrenal glands themselves, which causes them to release too much aldosterone.
In contrast, with secondary hyperaldosteronism, a problem elsewhere in the body causes the adrenal glands to release too much aldosterone. These problems can be with genes, diet, or a medical disorder such as with the heart, liver, kidneys, or high blood pressure.
Most cases of primary hyperaldosteronism are caused by a noncancerous (benign) tumor of the adrenal gland. The condition mostly affects people 30 to 50 years old and is a common cause of high blood pressure in middle age.
Primary and secondary hyperaldosteronism have common symptoms, including:
- High blood pressure
- Low level of potassium in the blood
- Feeling tired all the time
- Muscle weakness
Exams and Tests
The health care provider will perform a physical exam and ask about your symptoms.
Tests that may be ordered to diagnose hyperaldosteronism include:
- Abdominal CT scan
- Blood aldosterone level
- Blood renin activity
- Blood potassium level
- Urinary aldosterone
- Kidney ultrasound
A procedure to insert a catheter into the veins of the adrenal glands may need to be done. This helps check which of the two adrenal glands is making too much aldosterone. This test is important because many people have small benign tumors in the adrenal glands that do not secrete any hormones. Relying only on a CT scan may result in the wrong adrenal gland being removed.
Primary hyperaldosteronism caused by an adrenal gland tumor is usually treated with surgery. It can sometimes be treated with medicines. Removing the adrenal tumor may control the symptoms. Even after surgery, some people still have high blood pressure and need to take medicine. But often, the number of medicines or doses can be lowered.
Limiting salt intake and taking medicine may control the symptoms without surgery. Medicines to treat hyperaldosteronism include:
- Drugs that block the action of aldosterone
- Diuretics (water pills), which help manage fluid buildup in the body
Secondary hyperaldosteronism is treated with medicines (as described above) and limiting salt intake. Surgery is usually not used.
The outlook for primary hyperaldosteronism is good with early diagnosis and treatment.
The outlook for secondary hyperaldosteronism depends on the cause of the condition.
Primary hyperaldosteronism can cause very high blood pressure, which can damage many organs, including the eyes, kidneys, heart and brain.
When to Contact a Medical Professional
Call for an appointment with your provider if you develop symptoms of hyperaldosteronism.
Carey RM, Padia SH. Primary mineralocorticoid excess disorders and hypertension. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 108.
Nieman LK. Adrenal cortex. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 214.