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Primary Hyperaldosteronism

An adrenal disorder of autonomous aldosterone production and an important cause of treatable hypertension.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Endokrinoloji department. Book Appointment →

What is Primary Hyperaldosteronism?

Primary hyperaldosteronism (PA) is characterized by excessive aldosterone secretion from one or both adrenal glands independent of the renin-angiotensin system. It is the most common cause of secondary hypertension and is found in 5-15% of hypertensive patients.

Aldosterone excess results in sodium-water retention, hypertension, and potassium loss (hypokalemia). The main forms are bilateral adrenal hyperplasia (65%) and adrenal adenoma (Conn's syndrome, 30%). Unilateral adenoma can be cured surgically.

Screening test: plasma aldosterone-to-renin ratio (ARR). Confirmation is by salt-loading or fludrocortisone suppression testing. Adrenal venous sampling (AVS) is the standard method to distinguish bilateral hyperplasia from unilateral adenoma.

Symptoms

Difficult-to-control hypertension
Low potassium (hypokalemia): muscle weakness, cramps
Frequent nighttime urination (nocturia)
Headaches and general fatigue
Palpitations and arrhythmias
Mild metabolic alkalosis

Risk Factors

Resistant hypertension (uncontrolled with ≥3 medications)
Hypokalemia not corrected by medication
Combination of adrenal incidentaloma and hypertension
Family history of primary hyperaldosteronism or early-age stroke
Resistant hypertension together with sleep apnea

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Hypertension uncontrolled by multiple antihypertensive medications
  • Unexplained low potassium found on blood tests
  • Adrenal mass detected together with hypertension
  • Severe hypertension presenting at a young age

Treatment Methods

01
Unilateral adenoma: laparoscopic adrenalectomy (curative — blood pressure returns to normal in 30-70%)
02
Bilateral hyperplasia: medical therapy with mineralocorticoid receptor antagonist (spironolactone or eplerenone)
03
Spironolactone: started at 12.5-25 mg/day, titrated to target blood pressure
04
Potassium replacement: oral support until spironolactone is initiated
05
Preoperative spironolactone for 4-6 weeks: stabilizes blood pressure and potassium
06
Family screening: if a familial form of hyperaldosteronism is suspected

Which Department to Visit?

You can visit our Endokrinoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.