Endocrinology, Diabetes and Thyroid Specialists (2024)

Understanding Hyperaldosteronism

This month we are going to be talking about Conn’s Syndrome, a disease causedby a tumor in the adrenal glands that is producing too much of the hormonealdosterone.

One of the functions of your adrenal glands is to produce a hormone calledaldosterone that plays an active role in your blood pressure. It does this bymaintaining the balance of sodium, potassium, and water in your blood.Hyperaldosteronism is an endocrine disorder that involves one or both of youradrenal glands creating too much of a hormone called aldosterone. This causesyour body to lose too much potassium and retain too much sodium, whichincreases water retention, blood volume, and blood pressure.

What are the symptoms?

The main symptom of hyperaldosteronism is high blood pressure, which canrange from moderate to severe. In some cases, high blood pressure related tohyperaldosteronism doesn’t respond to medication. In others, it may onlyrespond to a certain combination of medications.

High blood pressure does not typically have symptoms. But when it does, they caninclude: headaches, dizziness, vision problems, chest pain and shortness ofbreath.

The other main symptom of hyperaldosteronism is hypokalemia, which refers tolow potassium levels in your blood. While it doesn’t always cause symptoms,more moderate cases of hypokalemia may cause: fatigue, muscle cramps,increased thirst, increased urination, muscle weakness or palpitations.

Is Conn's Syndrome of the Adrenal Gland Rare?

No. Conn's Syndrome is not rare, it is common, typically occurring in patients over 30 years of age. It used to be thought that primary hyperaldosteronism was veryrare but we see a patient with Conn's several times per week. The reason Conn's Syndrome was thought to be rare is that many doctors did not know about it orwere not tested for it because many patients were not feeling very sick and so thedisease was not being diagnosed and the patients were just treated with highblood pressure pills (anti-hypertensives).

Unfortunately, over time having too much aldosterone being produced by youradrenal gland damages your heart, blood vessels and brain. But most doctorswere not actively screening their patients with high blood pressure to find thedisease. They should, as you will learn as you read on.

What causes it?

There are two types of hyperaldosteronism, known as primary and secondaryhyperaldosteronism. While they have similar symptoms, their causes aredifferent.

Primary hyperaldosteronism

Primary hyperaldosteronism is caused by a problem with one or both adrenalglands. It’s sometimes referred to as Conn’s syndrome. Some people are bornwith overactive adrenal glands. Others might have it due to: a benign tumor on
one of the adrenal glands, adrenocortical cancer, which is a rare aldosteroneproducing cancerous tumor, glucocorticoid-remediable aldosteronism, a type ofaldosteronism that runs in families and other types of inheritable issues thataffect the adrenal glands.

Secondary hyperaldosteronism

Secondary hyperaldosteronism is caused by something outside the adrenalglands. It’s usually related to reduced blood flow to your kidneys. Several thingscan cause this, including: a blockage or narrowing of the renal artery, chronic liverdisease, heart failure and diuretic medications.

How is it diagnosed?

If you have symptoms of hyperaldosteronism, we at Palmetto Endocrinology willlikely start by doing a blood test to check your levels of aldosterone and renin, anenzyme released by your kidney that works with aldosterone to help balanceblood pressure. People with hyperaldosteronism generally have low renin levelsand high aldosterone levels.

Depending on the results of your blood test, we might run some other tests,including:

• Captopril challenge test. This blood test measures your aldosterone, renin,and other levels after you receive a dose of the medication captopril, anACE inhibitor.
• Saline infusion test. This blood test measures your aldosterone, renin, andother levels after you receive an IV sodium and saline solution.
• Salt-loading test. This measures the levels of aldosterone and sodium inyour urine after following a high-sodium diet for three to five days.
• Fludrocortisone suppression test. This is very similar to the salt-loadingtest, but it includes taking fludrocortisone, an oral steroid that mimicsaldosterone.
• CT or MRI scans of the abdomen. These imaging tests allow your doctor tocheck for any tumors on or around your adrenal glands.
• Adrenal vein sample. This involves taking a blood sample directly from theveins of each adrenal gland and testing the amount of aldosterone in it. Ifblood from one gland has significantly more aldosterone, you may have abenign tumor on one gland. If blood from each gland has similarly highlevels of aldosterone, both glands are likely overactive.

If you already take medication for high blood pressure, we might ask you to stoptaking it for a brief period of time while they do these tests.

How is it treated?

Treating hyperaldosteronism focuses on reducing your aldosterone levels orblocking the effects of aldosterone, high blood pressure, and low bloodpotassium. There are several ways to do this, depending on what’s causing yourhyperaldosteronism.

• Medication - We might prescribe a mineralocorticoid receptor antagonist, suchas spironolactone. This type of medication blocks the effects of aldosterone onyour body, such as high blood pressure and low blood potassium. You may stillneed to take additional medications to help manage your blood pressure.
• Surgery - If you have a tumor on one of your adrenal glands, we will refer you to adoctor who may be able to remove the affected gland. Following the procedure,called an adrenalectomy, you’ll likely notice a gradual decrease in blood pressure. As you heal, we will regularly monitor your blood pressure to determine whether it’s time to change your blood pressure medication. Eventually, you may be ableto stop taking it completely.
• Lifestyle changes -In addition to medication and surgery, there are several lifestyle changes you can make to provide additional health benefits and help counteract the effects of too much aldosterone. These include:
  • Eating a healthy diet. Following a balanced diet that helps you maintain a healthy weight can reduce your blood pressure. Start by choosing fresh, unprocessed foods to reduce your salt intake. Try incorporating elements of the DASH diet, which is designed for people with high blood pressure. In addition, many blood pressure medications work better when combined with a healthy diet. A diet lower in salt is often key in hyperaldosteronism.
  • Exercising. Consistent exercise, even just a 30-minute walk a few times a week, can help to reduce blood pressure.
  • Reducing alcohol and caffeine. Caffeine and alcohol can both increase your blood pressure. Some blood pressure medications are also less effective when taken with alcohol.
  • Quitting smoking. Smoking cigarettes constricts your blood vessels, which increases your heart rate and can raise blood pressure. Smoking also increases your risk of heart attack and stroke, even without high blood pressure.

Are there any complications?

High levels of aldosterone can cause a variety of healthproblems. ResearchTrusted Source, which is based in Oxford, England shows itcan cause direct injury to heart tissues, leading to scarring and enlargement of theleft side of the heart. In addition to injuring blood vessels and causing othercomplications related to high blood pressure, untreated hyperaldosteronism canput you at greater risk for: heart attacks, heart failure, stroke and kidney failure.

To avoid complications, work with us to come up with a long-term treatment plan
for your high blood pressure. Make sure to regularly follow up to check for anychanges in your blood potassium levels as well.

Living with hyperaldosteronism

While the effects of hyperaldosteronism can lead to complications over time, thecondition itself can be managed with the right treatments. For many people, thebest plans involve a combination of surgery, medication, and lifestyle changes.We at Palmetto Endocrinology are well versed and ready to help you. Please callfor an appointment today.

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