What is Primary Hyperaldosteronism or Primary Aldosteronism?

Human adrenal glands are found at the top of each kidney and produce hormones which are responsible for the regulation of blood pressure, immune system, metabolism and other important functions. Despite their small size, these glands dictate a lot of what goes on in the human body.

Causes of Primary Hyperaldosteronism or Primary Aldosteronism

Primary hyperaldosteronism or primary aldosteronism is defined as a hormonal disorder whose result is high/ elevated blood pressure. These adrenal glands manufacture several necessary hormones including aldosterone. Aldosterone is responsible for the balance of potassium and sodium in the blood.

The adrenal glands manufacture excessive aldosterone in the condition of primary hyperaldosteronism or primary aldosteronism, so much so that you lose potassium while retaining sodium. Excessive amounts of sodium being retained hold on to water in the body. This results in increased blood pressure and blood volume.

It is important to diagnose and treat primary hyperaldosteronism or primary aldosteronism because these high levels of blood pressure increase an individual's chances of suffering from heart disease and even stroke. Additionally, it may be possible to cure high blood pressure connected to primary hyperaldosteronism or primary aldosteronism.

People who have primary hyperaldosteronism or primary aldosteronism can count on treatment options such as lifestyle changes, surgery and medication.

What are Adrenal Glands in Human Body?

Our body has two adrenal glands. Both are found on top of the kidneys. They are composed of the cortex (outer part) and medulla (inner part). The medulla produces hormones that have an effect on several parts of the sensitive nervous system. The role of the cortex is important for the regulation of salt and potassium levels. The cortex and medulla both have an effect on blood pressure.

Causes of Primary Hyperaldosteronism or Primary Aldosteronism

There are several widespread conditions that lead to excessive production of aldosterone which inturn causes primary hyperaldosteronism or primary aldosteronism. They include:

  • Idiopathic hyperaldosteronism which refers to a situation where both adrenal glands of the kidneys are overactive.
  • A benign tumor in the adrenal gland that is an aldosterone-manufacturing adenoma. This condition is also referred to as primary hyperaldosteronism or primary aldosteronism.

There are also few other cases as listed below that cause primary hyperaldosteronism or primary aldosteronism:

  • Glucocorticoid- remediable aldosteronism which is a rare primary hyperaldosteronism or primary aldosteronism type running in families. It leads to blood pressure in young adults and children.
  • When there is a malignant growth on the cortex (outer layer) of your adrenal gland also known as adrenal cortical cancer can also cause primary hyperaldosteronism or primary aldosteronism.

Signs and Symptoms of Primary Hyperaldosteronism or Primary Aldosteronism

The major signs and symptoms of primary hyperaldosteronism or primary aldosteronism are listed below:

  • High levels of blood pressure accompanied by a low level of potassium. This is also referred to as hypokalemia is the major symptom of primary hyperaldosteronism or primary aldosteronism.
  • High levels of blood pressure that requires different types of medication to keep under control. This is also referred to as resistant hypertension is also a symptom of primary hyperaldosteronism or primary aldosteronism.
  • Reasonable to very high levels of blood pressure.

Blood pressure should be monitored on a regular basis especially for people with risk factors for blood pressure levels that are above normal. Such factors include:

  • Dietary imbalances such as little potassium or excessive salt intake.
  • Tobacco use
  • Drinking too much alcohol
  • Sedentary lifestyles
  • Being overweight
  • History of high levels of blood pressure among family.
  • 45 years and above.

Primary hyperaldosteronism or primary aldosteronism symptoms may not be obvious all the time. For this reason, your doctor could be the one that recommends that you arrange an appointment to ensure you are screened. If your blood pressure is high, your doctor may have grounds to suspect that you have primary hyperaldosteronism or primary aldosteronism. He may also suspect you have primary hyperaldosteronism or primary aldosteronism if you exhibit the following:

  • A family or personal history of stroke or high blood pressure at young ages could be a symptom of primary hyperaldosteronism or primary aldosteronism.
  • A growth on either of the adrenal glands that could have been noted incidentally from an imaging test is another symptom of primary hyperaldosteronism or primary aldosteronism.
  • Low levels of blood potassium. However, many individuals who have primary hyperaldosteronism or primary aldosteronism still show normal levels of potassium in their blood, particularly in the initial stages of the illness.
  • Levels of blood pressure stay consistently high. This is especially worrying if you are taking more than three different drugs for it, also known as resistant hypertension.

There may be a little planning required for a primary hyperaldosteronism or primary aldosteronism screening test. It is possible for the test to be performed even as you continue with your medication for high levels of blood pressure. However, there may be a need to stop taking medication such as eplerenone and spironolactone about six weeks prior going through the test for primary hyperaldosteronism or primary aldosteronism. You may also be advised by your doctor to stay away from products containing real licorice, a few weeks before undertaking the test. This is because real licorice can lead to changes that imitate surplus aldosterone.

Tests to Diagnose Primary Hyperaldosteronism or Primary Aldosteronism

There are a number of tests that are available for primary hyperaldosteronism or primary aldosteronism diagnosis.

Screening Tests to Diagnose Primary Hyperaldosteronism or Primary Aldosteronism

At the beginning, your doctor may have to measure the rennin and aldosterone levels present in your blood. The enzyme produced by the kidneys and is responsible for the regulation of blood pressure is known as rennin. Low levels of rennin combined with high levels of aldosterone suggest that the reason for the elevation of your blood pressure may be primary hyperaldosteronism or primary aldosteronism.

Confirmation Tests to Diagnose Primary Hyperaldosteronism or Primary Aldosteronism

Should the rennin-aldosterone test imply that you have primary hyperaldosteronism or primary aldosteronism you will require another test as confirmation of the diagnosis.

These tests include the ones listed below:

  • Fludrocortisones suppression test for primary hyperaldosteronism or primary aldosteronism is taken after a few days during which you follow a diet high in sodium and fludrocortisones. Fludrocortisones imitate the characteristics of aldosterone. After intake of these items, the aldosterone levels present in the blood are determined.
  • Oral salt loading test for primary hyperaldosteronism or primary aldosteronism. Here, you will follow a diet rich in sodium for up to three days. After this, the doctor will determine the levels of sodium and aldosterone in the urine.
  • Saline loading test for primary hyperaldosteronism or primary aldosteronism includes a mixture of water and sodium (saline) is introduced into the bloodstream for some hours. After this, the doctor will perform the test.

Further tests for Diagnosing Primary Hyperaldosteronism or Primary Aldosteronism

In the event that you are diagnosed with primary hyperaldosteronism or primary aldosteronism, the doctor will conduct extra exams to establish if the root cause is the over activity of the two adrenal glands or the aldosterone-secreting adenoma. Examples of these exams are:

  • Adrenal vein sampling test for primary hyperaldosteronism or primary aldosteronism. In this case, a radiologist will draw blood samples from both of the left and right adrenal veins then compare them. The existence of an aldosteronoma could be indicated by higher levels of aldosterone in either the left or right adrenal vein. If the levels of aldosterone are similar on both sides, it means that there is over activity in both sides. For the exam, a tube is placed in a vein located in your groin. It is then threaded up into the adrenal vein. Even though this test is important for establishing the right course for treatment, it bears the risk of a clotting in the vein or even bleeding.
  • Abdominal computerized tomography scan for primary hyperaldosteronism or primary aldosteronism helps to make out tumors or enlargements on the adrenal gland that indicate that there may be over-activity. Following a CT scan, you may still be required to take more tests since the imaging test could have missed out on vital abnormalities. It may also identify tumors that do not secrete aldosterone.

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Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: May 3, 2016

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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