Hyperaldosteronism: Symptoms and Treatment

Aldosterone is a hormone in your body that plays a part in maintaining the volume of fluid in your body. This hormone causes an increase in the reabsorption of sodium from the kidney while causing as increase in excretion of potassium. Aldosterone is produced by a pair of glands present over the kidney called adrenal gland. An increase in the level of this hormone leads to a condition called Hyperaldosteronism.

Causes of Hyperaldosteronism

Hyperaldosteronism can be classified into two major types depending upon the cause.

Primary hyperaldosteronism: caused due to an increase in production of aldosterone by the adrenal gland due to a genetic defect, a benign or cancerous aldosterone producing growth of the adrenal glands.

Secondary hyperaldosteronism: increase in levels of aldosterone in the blood due to non-adrenal reasons like diet or a disorder of the heart, kidney, liver.

Symptoms of Hyperaldosteronism

Hyperaldosteronism doesn’t have very specific symptoms. The most common symptom is hypertension which is not adequately controlled by taking regular medications. Primary hyperaldosteronism is generally diagnosed in individuals between the third and fifth decade.

Diagnosis of Hyperaldosteronism

Your doctor might suspect you have hyperaldosteronism when your blood pressure isn’t reaching normal values with the prescribed drugs. An accompanying low level of potassium also hints towards hyperaldosteronism. A few tests will be ordered to confirm the diagnosis:

• Plasma aldosterone to plasma rennin activity ratio: this test measures the level of aldosterone and rennin (hormone secreted by your kidney) in your blood. The ratio of their levels along with the absolute value of plasma aldosterone is a very sensitive and specific marker for hyperaldosteronism.

 If the above test comes to be positive you will have to undergo a few more tests to confirm hyperaldosteronism

• Saline infusion test: you will be given normal saline via an intra-venous line. After this your blood aldosterone levels will be measured. If the levels remain the same as before the chances of a diagnosis of primary hyperaldosteronism increases

To identify the cause of hyperaldosteronism your doctor might order another set of tests:

• CT scan: to look for growth in the adrenal glands, this could be producing the excess aldosterone.
• Adrenal vein sampling: a radiologist will take samples of blood from the vein exiting the adrenal glands on both side, and send the blood to measure the aldosterone level. A significant difference in aldosterone level in the samples indicates the presence of an aldosterone producing mass on one side.

Complications of Hyperaldosteronism

Hyperaldosteronism leads to hypertension and low levels of potassium both of which have long term consequences. These are:

• Increase in risk of cardiovascular disease like heart failure and left ventricular hypertrophy
• Increase in risk of kidney disease
• Stroke
• Arrhythmia
• Muscle cramps
• Weakness

Treatment of Hyperaldosteronism

• The treatment for hyperaldosteronism depends upon the cause of hyperaldosteronism.
• Surgical treatment: if the increase in aldosterone level is because of a benign or cancerous mass of the adrenal gland a surgical removal will lead to normalisation of the aldosterone levels.
• Medical treatment: if for some reason a surgery is not possible or the cause is not a growth of the adrenal gland aldosterone blocking drug is used.
• Spironolactone: this drug blocks the action of aldosterone in addition to blocking the action of male and female sex hormone, this leads to a variety of side effects like enlargement of breast in males (gynaecomastia) and menstrual irregularities in females.
• Eplerenone: a new drug which blocks only the action of aldosterone.
• To prevent the complications of hyperaldosteronism you will be advised to follow through a few life style changes to better control the hypertension; like moderate level of exercise everyday and dietary modifications.

Resources:

• American Association of Clinical Endocrinologists