What if your high blood pressure isn’t just genetic or stress-related—but caused by a hidden hormone imbalance? Hyperaldosteronism is a lesser-known condition that could be silently driving your numbers up. Many people live with it for years without knowing. In this article, discover how hyperaldosteronism affects the body—and why early detection can make all the difference.
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What Is Hyperaldosteronism and Why Does It Matter?
Hyperaldosteronism is a condition in which the adrenal glands produce too much aldosterone—a hormone that helps regulate blood pressure by managing sodium and potassium levels. When aldosterone levels are abnormally high, the body retains excess sodium and water while losing too much potassium. This imbalance leads to high blood pressure (hypertension) and low potassium levels (hypokalemia).
The condition is important to recognize because it often causes a type of high blood pressure that doesn’t respond well to standard treatments. If left untreated, hyperaldosteronism can significantly raise the risk of serious health issues, including heart attacks, strokes, and kidney damage. Low potassium levels can also lead to symptoms like muscle weakness, cramps, and potentially dangerous heart rhythm disturbances.
There are two main types of hyperaldosteronism. Primary hyperaldosteronism originates within the adrenal glands, often due to a benign tumor or adrenal hyperplasia. Secondary hyperaldosteronism is caused by conditions outside the adrenal glands—such as kidney disease or congestive heart failure—that overstimulate aldosterone production. Understanding the type and underlying cause is essential for proper diagnosis and effective treatment.
Main Causes: Why Does It Happen?
The underlying causes of hyperaldosteronism depend on whether the condition is classified as primary or secondary. Comprehending these distinctions is crucial for accurate diagnosis and treatment.
Primary Hyperaldosteronism (Conn’s Syndrome)
Primary hyperaldosteronism arises from problems within the adrenal glands themselves, leading to excessive production of aldosterone. The most common causes include:
- Aldosterone-producing adenoma: A benign tumor in one of the adrenal glands that triggers abnormal hormone secretion.
- Bilateral adrenal hyperplasia: An overgrowth of both adrenal glands, resulting in elevated aldosterone levels.
- Familial hyperaldosteronism: A rare genetic form of the disorder that runs in families.
- Adrenal carcinoma: Though uncommon, malignant tumors in the adrenal glands can also cause excess aldosterone production.
Secondary Hyperaldosteronism
In secondary hyperaldosteronism, the adrenal glands are not the source of the problem but are instead overstimulated by other parts of the body. This overstimulation leads to increased aldosterone production. Common causes include:
- Renal artery stenosis: Narrowing of the arteries supplying the kidneys, which increases renin production and stimulates aldosterone release.
- Heart failure: Reduced heart function limits blood flow to the kidneys, prompting the body to produce more aldosterone in an attempt to retain fluid and maintain blood pressure.
- Cirrhosis: Liver disease can disrupt fluid balance, activating hormonal pathways that raise aldosterone levels.
- Nephrotic syndrome: A kidney disorder that affects fluid and electrolyte regulation, contributing to elevated aldosterone.
Recognizing whether hyperaldosteronism is primary or secondary is key to determining the appropriate course of treatment and managing the condition effectively.
How to Recognize the Symptoms and When to Suspect It
It can be difficult to detect early on, as it may not cause noticeable symptoms right away. Nevertheless, certain signs can raise red flags and help guide timely diagnosis and intervention.
Common Symptoms
One of the most consistent signs is high blood pressure, particularly if it is resistant to standard treatments or requires multiple medications to manage. Another key indicator is low potassium levels, which can result in fatigue, muscle cramps, weakness, and even irregular heartbeats. The body’s effort to maintain electrolyte balance can also lead to frequent urination and excessive thirst. In some cases, individuals may experience headaches or vision problems associated with severe hypertension. More extreme potassium deficiencies may cause numbness or even temporary paralysis.
When to Suspect It
Healthcare providers may suspect hyperaldosteronism under specific circumstances. It becomes more likely when a young adult under 40 develops high blood pressure, or when a patient needs three or more medications to achieve blood pressure control. Other warning signs include unexplained low potassium levels and a family history of early-onset hypertension or stroke.
Diagnosis and Treatment: Can It Be Cured?
Diagnosing it begins with blood tests that measure levels of aldosterone and renin. A high aldosterone-to-renin ratio (ARR) is a common screening marker that can indicate the presence of the condition. If the ARR is elevated, additional tests may be used to confirm the diagnosis and identify the cause.
Further evaluations might include salt-loading tests, which assess whether aldosterone levels remain high even when salt intake is increased. Imaging tests, such as CT or MRI scans, help detect adrenal tumors or gland enlargement. In more detailed cases, adrenal vein sampling may be used to pinpoint which adrenal gland is producing excess aldosterone.
Treatment depends on the underlying cause:
- If an aldosterone-producing adenoma is found, surgical removal of the tumor (adrenalectomy) is often a curative option.
- In cases of bilateral adrenal hyperplasia, where both glands are overactive, treatment usually involves medications such as spironolactone or eplerenone, which block the effects of aldosterone.
- For secondary hyperaldosteronism, treatment focuses on addressing the root condition, such as managing heart failure or correcting narrowing of the kidney arteries.
Can It Be Cured?
Yes—especially when caused by a single adrenal tumor, surgery can result in a full cure. In other situations, like bilateral hyperplasia or secondary causes, the condition may not be cured outright but can be effectively managed with medications and lifestyle changes, often requiring lifelong care to maintain health and prevent complications.
Sources.
Papadopoulou-Marketou, N., Vaidya, A., Dluhy, R., & Chrousos, G. P. (2015). Hyperaldosteronism.
Blumenfeld, J. D., Sealey, J. E., Schlussel, Y., Vaughan, E. D., Sos, T. A., Atlas, S. A., … & Laragh, J. H. (1994). Diagnosis and treatment of primary hyperaldosteronism. Annals of Internal Medicine, 121(11), 877-885.