The information on this website is not intended for diagnosis or treatment. Please consult your physician for health concerns.

+90 850 321 50 00

Primary Hyperaldosteronism — Comprehensive

Conn Syndrome and Adrenal Causes of Resistant 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 — Comprehensive?

Primary hyperaldosteronism (PA) is autonomous, renin-independent aldosterone secretion causing sodium retention, hypokalemia, and hypertension.

Etiologies: aldosterone-producing adenoma (APA, 30-40%), bilateral idiopathic hyperaldosteronism (BIH, 60%), unilateral adrenal hyperplasia (rare), familial hyperaldosteronism (types 1-4, rare), aldosterone-producing carcinoma (very rare).

Familial type 1 (glucocorticoid-remediable aldosteronism, GRA): chimeric CYP11B1/CYP11B2 gene, suppressible by dexamethasone.

Pathophysiology: aldosterone excess → sodium retention, potassium wasting, hypertension, vascular remodeling, cardiac fibrosis.

PA causes more cardiovascular damage than essential hypertension at same blood pressure level (independent of BP).

Symptoms

Resistant hypertension (uncontrolled despite 3 antihypertensive agents including diuretic).
Hypokalemia (spontaneous or diuretic-induced; only in 30% of cases).
Muscle weakness, cramping, paralysis (severe hypokalemia).
Polyuria, polydipsia, nocturia (hypokalemic nephrogenic diabetes insipidus).
Headaches, palpitations, atrial fibrillation, left ventricular hypertrophy.
Metabolic alkalosis, alkaline urine.
Cardiovascular events: MI, stroke, heart failure (3-4 fold increased compared to essential HTN).
Renal: albuminuria, declining GFR over time.

Risk Factors

Hypertension under age 40 with no family history of HTN.
Severe or resistant hypertension.
Hypokalemia (spontaneous or thiazide-induced more than mild).
Adrenal incidentaloma with hypertension.
Family history of early-onset hypertension or stroke under age 40.
Hypertension with sleep apnea (often coexist).
First-degree relative of patient with confirmed PA.

When to See a Doctor?

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

  • Resistant hypertension on 3 or more agents.
  • Hypertension with spontaneous hypokalemia.
  • Hypertension before age 40.
  • Adrenal mass discovered incidentally.
  • Family history of stroke or MI before age 40.
  • Severe hypertension (BP over 160/100) requiring multiple agents.

Treatment Methods

01
Screening: aldosterone-to-renin ratio (ARR) over 20-30 with aldosterone over 15 ng/dL suggests PA.
02
Confirmatory testing: saline infusion test, captopril challenge, or oral sodium loading test.
03
Subtype differentiation: adrenal CT scan (4mm cuts) plus adrenal vein sampling (AVS, gold standard).
04
AVS criteria: lateralization index over 4 (with cosyntropin) suggests unilateral disease.
05
Surgical: laparoscopic adrenalectomy for unilateral APA (cure HTN in 50-60%, biochemical cure 90%).
06
Medical (BIH or non-surgical APA): spironolactone (12.5-100 mg/day) or eplerenone (25-100 mg/day BID).
07
Add amiloride, ACEI/ARB, or other antihypertensives as needed for BP control.
08
Glucocorticoid-remediable PA (GRA): low-dose dexamethasone (0.125-0.5 mg/day).
09
Monitor potassium, creatinine, blood pressure regularly.
10
Cardiovascular risk reduction: statin, lifestyle, weight management.
11
Genetic testing for familial forms in young patients with positive family history.

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.

Learn About Endokrinoloji Department

Let us help you

You can make an appointment with our specialists or contact us for your concerns.

Book AppointmentContact Us

Related Health Topics

Other articles from the same department you may want to explore.

Anaemia

Dahiliye (İç Hastalıkları)

Anaemia is a low haemoglobin level that reduces oxygen delivery, causing fatigue, pallor, and shortness of breath. It is not a disease itself but a sign of many underlying conditions. Most cases are correctable with appropriate diagnosis and treatment.

Iron Deficiency Anaemia

Dahiliye (İç Hastalıkları)

Iron deficiency anaemia develops when dietary intake, absorption, or losses create an iron shortfall, most often affecting women and children. Identifying the underlying cause is the core of management, alongside iron replacement.

Vitamin B12 Deficiency

Dahiliye (İç Hastalıkları)

Vitamin B12 deficiency can cause megaloblastic anaemia, neurological symptoms, and cognitive impairment. Early treatment with intramuscular or oral B12 largely prevents irreversible complications.

Hypertension (High Blood Pressure) Management

Dahiliye (İç Hastalıkları)

Hypertension is often called the silent killer because it progresses symptom-free for years and can damage the heart, brain, kidneys, and eyes. Regular monitoring, lifestyle change, and evidence-based drug therapy dramatically reduce cardiovascular risk.

Chronic Kidney Disease

Dahiliye (İç Hastalıkları)

Chronic kidney disease is one of the most common complications of chronic conditions such as diabetes and hypertension, and can be silent in its early stages.

Hepatitis B (HBV)

Dahiliye (İç Hastalıkları)

Hepatitis B is a DNA virus infection causing acute and chronic hepatitis with risk of cirrhosis and hepatocellular carcinoma; diagnosis integrates HBsAg, HBeAg, anti-HBc, and HBV DNA with management based on disease phase using nucleos(t)ide analogues (entecavir, tenofovir) and universal infant vaccination.

Hepatitis C (HCV)

Dahiliye (İç Hastalıkları)

Hepatitis C is an RNA virus causing chronic hepatitis that may progress to cirrhosis and hepatocellular carcinoma; modern direct-acting antiviral (DAA) pangenotypic regimens (sofosbuvir/velpatasvir, glecaprevir/pibrentasvir) achieve sustained virologic response over 95% in 8–12 weeks with universal adult screening and cure for nearly all patients.

Fatty Liver Disease

Dahiliye (İç Hastalıkları)

Non-alcoholic fatty liver disease (NAFLD) is closely related to obesity and metabolic syndrome and is largely reversible with early treatment.

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.