Primary aldosteronism

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at April 30, 2016
StartDiseasesPrimary aldosteronism

The natural balance of sodium and potassium in the body is essential for maintaining many different functions. If certain hormones become imbalanced, potassium and sodium levels can fluctuate sharply, resulting in primary aldosteronism. Primary aldosteronism can cause many complications, so it is necessary to seek treatment immediately for this health condition.


Definition & Facts

Primary aldosteronism is defined as a hormonal disorder because it occurs when the adrenal glands create too much aldosterone, a hormone, leading to a reduction in potassium levels. If a person has primary aldosteronism, his or her body will try to get rid of most potassium and hold onto any sodium that is ingested.

This causes a person to retain large quantities of water. Water retention causes higher blood volume levels, so blood pressure raises. High blood pressure may ultimately cause stroke or heart disease.

Symptoms & Complaints

The most common and most recognizable symptom of the adrenal glands producing too much aldosterone (hyperaldosteronism) is blood pressure that may be moderate to severely high. These high blood pressure levels are characterized by their ability to remain high even if the patient has already tried several medications to lower the high blood pressure.

The unusual blood pressure levels of a patient with primary aldosteronism is also accompanied by low potassium levels that seem to happen suddenly even if the patient is consuming the recommended amount of potassium. Low potassium levels may be revealed through blood tests, but they also cause many physical symptoms.

Patients who have primary aldosteronism often feel exhausted, have muscles that cramp suddenly, experience debilitating headaches, muscle weakness, and have heart palpitations. Sometimes, the muscular weakness can result in random bouts of paralysis that occur before quickly subsiding.


There are many issues that can cause the adrenal glands to start overproducing aldosterone hormones. One of the most common causes of primary aldosteronism is a benign tumor that grows on one of the adrenal glands. This puts pressure on the adrenal glands, so they may start to secrete too much aldosterone. A benign growth on the adrenal glands is the most common cause of primary aldosteronism among people aged 30 to 50.

Though most tumors that cause primary aldosteronism are noncancerous, in rare cases, it may be caused by a malignant tumor that grows on the outside layer of the glands. This type of cancer is called adrenal cortical cancer, and it may cause primary aldosteronism. Aldosteronism can just be caused by the adrenal glands becoming over-activated, which can be caused by diet, lifestyle choices, or other medical disorders; in these cases, it is considered secondary hyperaldosteronism.

A particularly rare type of primary aldosteronism, glucocorticoid remediable aldosteronism, is caused by genetic mutations. This type of primary aldosteronism runs in families and can affect children. It can be treated with glucocorticoids.

Diagnosis & Tests

If a patient has medication-resistant hypertension, a doctor may use a blood test as the first method for diagnosing primary aldosteronism. Blood tests can reveal low potassium levels, high aldosterone levels, and low levels of renin, an enzyme that typically regulates blood pressure. After these blood tests show that the patient may have primary aldosteronism, the doctor will do additional tests to confirm this diagnosis.

In an oral salt loading test, the patient eats a high sodium diet over the course of three days, and then the doctor examines aldosterone levels in the patient's urine. A saline loading test is very similar, but the patient has a sodium and water solution injected into their bloodstream for a few hours instead of eating a high sodium diet for days. After one of these tests confirms the diagnosis, a doctor will run more tests to find the cause of the patient's primary aldosteronism.

An abdominal CT scan, may reveal a tumor on the adrenal gland that is causing the primary aldosteronism, or it may show an enlarged adrenal gland that is overactive. The individual gland that is making too much aldosterone can be discovered by a test that inserts a catheter through the leg veins and into the adrenal glands.

Treatment & Therapy

Once the cause of the primary aldosteronism is discovered, a doctor can began developing a treatment plan for the patient. Generally, the goal of treatment is to lower aldosterone levels or prevent the body from lowering potassium levels. For a tumor on the adrenal gland, the most effective treatment is surgery to remove whichever gland has the tumor. This brings potassium, sodium, and aldosterone levels back to normal, and the body can function with just one adrenal gland producing hormones. However, if the patient does not want to risk surgery or the adrenal glands are just overactive, patients can take mineralocorticoid receptor antagonists, which keep the body from absorbing aldosterone.

In addition to these treatment methods, lifestyle changes can also be used to further lower blood pressure. Eating a low sodium diet, regularly exercising, avoiding caffeinated foods or beverages, quitting or not smoking tobacco, minimizing the amount of alcoholic drinks, and having a healthy body weight can all decrease blood pressure. For the rare cases of people who have glucocorticoid-remediable aldosteronism, taking glucocorticoids is the only needed treatment.

Prevention & Prophylaxis

There is currently no known method of preventing tumors from growing on the adrenal glands. However, there are plenty of ways of preventing high blood pressure from further exacerbating a patient's condition. Having a healthy lifestyle is the best way to avoid the negative effects of high blood pressure.

In order to prevent blood pressure from reaching dangerous levels, people should make sure they are at a healthy weight and not consume too much sodium, alcohol and caffeine. Regularly doing cardiovascular exercise can also greatly help at maintaining healthy blood pressure levels.