Primary aldosteronism | |
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Other names | Primary hyperaldosteronism, Conn's syndrome |
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Aldosterone | |
Specialty | Endocrinology |
Symptoms | High blood pressure, poor vision, headaches, muscular weakness, muscle spasms[1][2] |
Complications | Stroke, myocardial infarction, kidney failure, abnormal heart rhythms[3][4] |
Usual onset | 30 to 50 years old[5] |
Causes | Enlargement of both adrenal glands, adrenal adenoma, adrenal cancer, familial hyperaldosteronism[6][1] |
Diagnostic method | Blood test for aldosterone-to-renin ratio[1] |
Treatment | Surgery, spironolactone, eplerenone, low salt diet[1] |
Frequency | 10% of people with high blood pressure[1] |
Primary aldosteronism (PA), also known as primary hyperaldosteronism, refers to the excess production of the hormone aldosterone from the adrenal glands, resulting in low renin levels and high blood pressure.[1] This abnormality is a paraneoplastic syndrome (i.e. caused by hyperplasia or tumors). About 35% of the cases are caused by a single aldosterone-secreting adenoma, a condition known as Conn's syndrome.[7][8]
Many patients experience fatigue, potassium deficiency and high blood pressure which may cause poor vision, confusion or headaches.[1][2] Symptoms may also include: muscular aches and weakness, muscle spasms, low back and flank pain from the kidneys, trembling, tingling sensations, dizziness/vertigo, nocturia and excessive urination.[1] Complications include cardiovascular disease such as stroke, myocardial infarction, kidney failure and abnormal heart rhythms.[3][4]
Primary hyperaldosteronism has a number of causes. About 33% of cases are due to an adrenal adenoma that produces aldosterone, and 66% of cases are due to an enlargement of both adrenal glands.[1] Other uncommon causes include adrenal cancer and an inherited disorder called familial hyperaldosteronism.[6] PA is under diagnosed; the Endocrine Society recommends screening people with high blood pressure who are at increased risk,[9] while others recommend screening all people with high blood pressure for the disease.[3] Screening is usually done by measuring the aldosterone-to-renin ratio in the blood (ARR) whilst off interfering medications and a serum potassium over 4, with further testing used to confirm positive results.[1] While low blood potassium is classically described in primary hyperaldosteronism, this is only present in about a quarter of people.[1] To determine the underlying cause, medical imaging is carried out.[1]
Some cases may be cured by removing the adenoma by surgery after localization with adrenal venous sampling (AVS).[1][10] A single adrenal gland may also be removed in cases where only one is enlarged.[4] In cases due to enlargement of both glands, treatment is typically with medications known as aldosterone antagonists such as spironolactone or eplerenone.[1] Other medications for high blood pressure and a low salt diet, e.g. DASH diet, may also be needed.[1][4] Some people with familial hyperaldosteronism may be treated with the steroid dexamethasone.[1]
Primary aldosteronism is present in about 10% of people with high blood pressure.[1] It occurs more often in women than men.[5] Often, it begins in those between 30 and 50 years of age.[5] Conn's syndrome is named after Jerome W. Conn (1907–1994), an American endocrinologist who first described adenomas as a cause of the condition in 1955.[11][12]
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