Hyperaldosteronism - primary and secondary

Definition

Primary and secondary hyperaldosteronism are conditions in which the adrenal gland releases too much of the hormone aldosterone.

Alternative Names

Conn syndrome

Causes, incidence, and risk factors

Persons with primary hyperaldosteronism have a problem with the adrenal gland that causes it to release too much aldosterone.

In secondary hyperaldosteronism, the excess aldosterone is caused by something outside the adrenal gland that mimics the primary condition.

Primary hyperaldosteronism used to be considered a rare condition, but some experts believe that it may be the cause of high blood pressure in some patients. Most cases of primary hyperaldosteronism are caused by a noncancerous (benign) tumor of the adrenal gland. The condition is common in people ages 30 - 50.

Secondary hyperaldosteronism is generally related to high blood pressure. It is also related to disorders such as:

• Cirrhosis of the liver
• Heart failure
• Nephrotic syndrome

Symptoms

• Fatigue
• Headache
• High blood pressure
• Intermittent paralysis
• Muscle weakness
• Numbness

Signs and tests

• Abdominal CT scan
• ECG
• Plasma aldosterone level
• Plasma renin activity
• Serum potassium level
• Urinary aldosterone

Occasionally, it is necessary to insert a catheter into the veins of the adrenal glands to determine which of the adrenals contains the growth.

This disease may also affect the results of the following tests:

• CO2
• Serum magnesium
• Serum sodium
• Urine potassium
• Urine sodium

Treatment

Primary hyperaldosteronism caused by a tumor is usually treated with surgery. Removing adrenal tumors may control the symptoms. Even after surgery, some people have high blood pressure and need to take medication.

Watching your salt intake and taking medication may control the symptoms without surgery. Medications used to treat hyperaldosteronism include:

• Spironolactone (Aldactone; Aldactazide), a diuretic ("water pill")
• Eplerenone (Inspra), which blocks the action of aldosterone

Surgery is not used for secondary hyperaldosteronism, but medications and diet are part of treatment.

Expectations (prognosis)

The prognosis for primary hyperaldosteronism is good with early diagnosis and treatment. The prognosis for secondary hyperaldosteronism will vary depending on the cause of the condition.

Complications

Impotence and gynecomastia (enlarged breasts in men) may occur with long-term spironolactone treatment in men, but this is uncommon.

Calling your health care provider

Call for an appointment with your health care provider if you develop symptoms of hyperaldosteronism.