What is aldosteronism?
Primary aldosteronism (al-DOS-tuh-ro-niz-um) is a type of hormonal disorder that leads to high blood pressure. Your adrenal glands produce a number of essential hormones. One of these is aldosterone, which balances sodium and potassium in your blood.
In primary aldosteronism, your adrenal glands produce too much aldosterone, causing you to lose potassium and retain sodium. The excess sodium in turn holds on to water, increasing your blood volume and blood pressure.
Diagnosis and treatment of primary aldosteronism are important because people with this form of high blood pressure have a higher risk of heart disease and stroke. Also, the high blood pressure associated with primary aldosteronism may be curable.
Options for people with primary aldosteronism include medications, lifestyle modifications and surgery.
What are the symptoms for aldosteronism?
The main signs 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)
When to see a doctor
Have your blood pressure checked regularly, especially if you have risk factors for high blood pressure. Ask your doctor about the possibility of having primary aldosteronism if:
- You're age 45 or older
- You have a family history of high blood pressure
- You have high blood pressure that began at age 44 or younger
- You're overweight
- You have a sedentary lifestyle
- You use tobacco
- You drink a lot of alcohol
- You have dietary imbalances (too much salt, not enough potassium)
What are the causes for aldosteronism?
Common conditions causing the overproduction of aldosterone include:
- A benign growth in an adrenal gland (aldosterone-producing adenoma) — a condition also known as Conn's syndrome
- Overactivity of both adrenal glands (idiopathic hyperaldosteronism)
In rare cases, primary aldosteronism may be caused by:
- A cancerous (malignant) growth of the outer layer (cortex) of the adrenal gland (adrenal cortical carcinoma)
- A rare type of primary aldosteronism called glucocorticoid-remediable aldosteronism that runs in families and causes high blood pressure in children and young adults
What are the treatments for aldosteronism?
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).
Medications. 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.
What are the risk factors for aldosteronism?
The condition is usually manifested with low potassium levels and high blood pressure in the blood. Anyone can develop aldosteronism. There are certain risk factors that make an individual more susceptible to the condition, including
- If the person is already being treated with three or more medications for hypertension.
- Patients who have a family history of Aldosteronism
- When the person has Hypokalemia (Low potassium level) or Hypertension (High Blood Pressure)
- Individuals who have been diagnosed with high blood pressure at the age of 40 or over.
- People who are diagnosed with low potassium levels in the blood.
- When the individual is obese or overweight due to a sedentary lifestyle
- If the person has the habit of using tobacco or drinking excess alcohol
- People who follow imbalanced dietary changes such as excess salt or insufficient potassium level.
- When the condition is left unnoticed, the condition will increase the risk of developing complications, including stroke, irregularities in heart rhythm, and heart attack.
- Dietary changes and the administration of certain medications will aid in controlling the symptoms without surgery.
Is there a cure/medications for aldosteronism?
The treatment focuses on lowering the aldosterone level and preventing its effects.
- Medications – When surgery is not preferred in some individuals, aldosterone-blocking medications or a mineralocorticoid receptor antagonist such as Spirnololacone to manage the blood pressure and block the effects of aldosterone on your body.
- Surgery – When the condition is caused due to a benign tumor on the adrenal gland, the affected gland can be removed from adrenalectomy. It will gradually decrease the blood pressure and completely cure the condition.
- Lifestyle changes – Along with medication and surgery, incorporating lifestyle changes will aid in preventing the effect of too much aldosterone and provide health benefits. It includes consuming a healthy diet, regular exercise patterns, limiting the intake of alcohol, and caffeine, and quitting smoking.
- Though the effects of the conditions lead to various complications, they can be managed with the best treatment plan, which involves surgery, medications, and lifestyle changes.