Primary Aldosteronism

1 What is Primary Aldosteronism?

Primary aldosteronism is a disorder characterized by excessive production of the hormone aldosterone by adrenal glands.

Aldosterone plays an important role in maintaining the balance of sodium and potassium levels in the body.

Increased production of this hormone leads to the accumulation of salt and water, resulting in high blood pressure.

Elevated blood pressure increases the risk of conditions like stroke and heart diseases.

Treatment of primary aldosteronism is based on the underlying cause.

Medications, lifestyle changes and surgery are used to control this hormonal condition. 

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2 Symptoms

High blood pressure that does not respond to conventional treatment strategies is the main symptom of primary aldosteronism.

Hypertension is most often associated with low levels of potassium in blood. In some cases, potassium levels may remain normal.

Acidity level of the blood also is low. Hypertension and low potassium levels result in a number of symptoms like

Primary aldosteronism is more common in people above 45 years. Those with a family history of the disorder have a higher risk.

Being overweight and having a sedentary lifestyle also increases the chances of developing aldosteronism.

Too much salt in diet and alcohol abuse are known risk factors for the disorder.

3 Causes

One of the most common causes of aldosteronism is the hyperactivity of adrenal glands.

Hyperactive glands produce increased amounts of aldosterone. Conn’s syndrome, a condition characterized by the presence of a non-cancerous growth on adrenal glands, also cause excessive production of the hormone.

Primary aldosteronism may also be caused by cancer of cells in the cortical region of adrenal glands.

An inherited disorder called glucocorticoid-remediable aldosteronism cause elevated levels of aldosterone hormone. 

4 Making a Diagnosis

Making a diagnosis of primary aldosteronism is done by performing several tests.

Increased levels of enzyme renin and hormone aldosterone in blood indicate primary aldosteronism.

In aldosteronism, levels of renin is low while that of aldosterone remains high. Potassium levels in blood also remain low. Once the blood tests indicate chances of primary aldosteronism, additional tests are recommended for confirmation.

Confirmation test include

  • High sodium diet – diet high in sodium levels is given for three days. Aldosterone and sodium levels are measured to confirm the diagnosis.
  • Saline loading – saline is infused into the body for several hours before testing the levels of aldosterone.
  • Fludrocortisone suppression test – in this procedure aldosterone level is measured after administering fludrocortisone and high sodium-diet. 

Additional tests are recommended to identify the underlying cause of the disorder.

CT scan is used to identify the presence of tumor or any other abnormalities that result in hyperactivity of the gland.

Adrenal vein sampling is a standard test used in confirming the diagnosis of primary aldosteronism. In this procedure, blood samples from both adrenal veins are taken before and after infusion of adrenocorticotropic hormone.

This is followed by measuring the differences in levels of aldosterone in both sides. Significant difference in aldosterone level indicates adenoma.

5 Treatment

Treatment of primary aldosteronism is based on the underlying cause of the disorder. All treatment strategies focus on regulating the effect of increased hormonal content and preventing further complications.

Surgery is suggested to remove adrenal tumors so as to improve symptoms like high blood pressure and deficiency of potassium. Aldosterone level reduces gradually after the removal of tumor. Medications for controlling high blood pressure is adjusted accordingly after surgery.

Aldosterone-blocking drugs help to relieve the symptoms of aldosteronism like high blood pressure and low levels of potassium. Levels of these indicators may return to normal level once medications are stopped.

Aldosteronism caused by hyperactivity of the adrenal glands can be controlled by a combination of lifestyle changes and medications. Mineralocorticoid receptor antagonists are used to block the functioning of aldosterone. These drugs control high blood pressure and increase levels of potassium. These medications are usually combined with a healthy diet and regular exercise.

6 Prevention

There are no known methods for prevention of primary aldosteronism.

Early detection and treatment helps to prevent complications.

7 Alternative and Homeopathic Remedies

A few alternative and homeopathic remedies exist for managing the symptoms of primary aldosteronism.

Arsenicum album is used to reduce high blood pressure in homeopathy.

Acupuncture and herbal remedies are also recommended for controlling the symptoms, but do not have any scientific evidence. 

8 Lifestyle and Coping

Lifestyle modifications are necessary in order to cope with primary aldosteronism.

Healthy lifestyle is essential for keeping blood pressure low and maintaining long-term heart health.

Here are some healthy lifestyle suggestions:

  • follow a healthy diet,
  • maintain a healthy weight,
  • exercise,
  • quitting smoking, drinking,
  • limiting caffeine. 

9 Risks and Complications

There are several complications associated with primary aldosteronism.

High blood pressure often results in complications including heart diseases, left ventricular hypertrophy, stroke, kidney failure, and premature death.

Low levels of potassium may lead to cardiac arrhythmias, muscle cramps, excessive thirst and weakness