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Hyperaldosteronism - primary and secondary

Conn syndrome; Mineralocorticoid excess

 

Hyperaldosteronism is a disorder in which the adrenal gland releases too much of the hormone aldosterone into the blood.

Hyperaldosteronism can be primary or secondary.

Causes

 

Primary hyperaldosteronism is due to a problem of the adrenal glands themselves, which causes them to release too much aldosterone.

In contrast, with secondary hyperaldosteronism, a problem elsewhere in the body causes the adrenal glands to release too much aldosterone. These problems can be with genes, diet, or a medical disorder such as with the heart, liver, kidneys, or high blood pressure.

Most cases of primary hyperaldosteronism are caused by a noncancerous (benign) tumor of the adrenal gland. The condition is most common in people 30 to 50 years old.

 

Symptoms

 

Primary and secondary hyperaldosteronism have common symptoms, including:

  • High blood pressure
  • High level of calcium in the blood
  • Fatigue
  • Headache
  • Muscle weakness
  • Numbness
  • Paralysis that comes and goes

 

Exams and Tests

 

Tests that may be ordered to diagnose hyperaldosteronism include:

  • Abdominal CT scan
  • ECG
  • Plasma aldosterone level
  • Plasma renin activity
  • Serum potassium level
  • Urinary aldosterone

A procedure to insert a catheter into the veins of the adrenal glands may need to be done. This helps check which of the two adrenal glands is making too much aldosterone.

 

Treatment

 

Primary hyperaldosteronism caused by an adrenal gland tumor is usually treated with surgery. It can sometimes be treated with medicines. Removing the adrenal tumor may control the symptoms. Even after surgery, some people still have high blood pressure and need to take medicine. But often, the number of medicines or doses can be lowered.

Limiting salt intake and taking medicine may control the symptoms without surgery. Medicines to treat hyperaldosteronism include:

  • Drugs that block the action of aldosterone
  • Diuretics (water pills), which help manage fluid buildup in the body

Secondary hyperaldosteronism is treated with medicines (as described above) and limiting salt intake. Surgery is not used.

 

Outlook (Prognosis)

 

The outlook for primary hyperaldosteronism is good with early diagnosis and treatment.

The outlook for secondary hyperaldosteronism depends on the cause of the condition.

 

Possible Complications

 

Primary hyperaldosteronism can cause very high blood pressure, which can damage many organs, including the eyes, kidneys, heart and brain.

Impotence and gynecomastia (enlarged breasts in men) may occur with long-term use of medicines. But this is uncommon.

 

When to Contact a Medical Professional

 

Call for an appointment with your health care provider if you develop symptoms of hyperaldosteronism.

 

 

References

Carey RM, Padia SH. Primary mineralocorticoid excess disorders and hypertension. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 108.

Nieman LK. Adrenal cortex. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 227.

 
  • Endocrine glands

    Endocrine glands - illustration

    Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the pace of chemical activity in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).

    Endocrine glands

    illustration

  • Adrenal gland hormone secretion

    Adrenal gland hormone secretion - illustration

    Adrenal glands produce hormones such as estrogen, progesterone, steroids, cortisol, and cortisone, and chemicals such as adrenalin (epinephrine), norepinephrine, and dopamine. When the glands produce more or less hormones than required by the body, disease conditions may occur.

    Adrenal gland hormone secretion

    illustration

    • Endocrine glands

      Endocrine glands - illustration

      Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the pace of chemical activity in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).

      Endocrine glands

      illustration

    • Adrenal gland hormone secretion

      Adrenal gland hormone secretion - illustration

      Adrenal glands produce hormones such as estrogen, progesterone, steroids, cortisol, and cortisone, and chemicals such as adrenalin (epinephrine), norepinephrine, and dopamine. When the glands produce more or less hormones than required by the body, disease conditions may occur.

      Adrenal gland hormone secretion

      illustration

    A Closer Look

     

      Self Care

       

        Tests for Hyperaldosteronism - primary and secondary

         

           

          Review Date: 7/24/2015

          Reviewed By: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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