What to know about hyperaldosteronism

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The adrenal glands are two small, triangular-shaped glands that sit just above the kidneys. They produce hormones that help regulate a range of bodily functions, including blood pressure, metabolism, and immunity.

“Hyperaldosteronism” is the medical term for when one or both adrenal glands produce too much of the hormone aldosterone. This is a steroid hormone that causes the kidneys to release potassium and retain sodium, thereby influencing water levels throughout the body.

Hyperaldosteronism causes an imbalance in the body’s sodium, potassium, and fluid levels in a way that raises blood pressure.

There are two types of hyperaldosteronism:

• Primary hyperaldosteronism occurs due to an issue with the adrenal glands, such as a tumor or growth.
• Secondary hyperaldosteronism occurs due to an underlying disease that indirectly affects the adrenal glands, such as:
  • cirrhosis
  • kidney disease
  • left ventricular heart failure

The symptoms of hyperaldosteronism are similar to those of many other diseases. They include:

• high blood pressure
• excessive urine production
• swelling of the hands and feet
• constipation

More advanced cases may cause:

• muscle spasms
• muscle weakness
• muscle paralysis

For many people, the only symptom of hyperaldosteronism is high blood pressure.

Hyperaldosteronism can have different causes, depending on the type. Some examples are outlined below.

Primary hyperaldosteronism

Primary hyperaldosteronism occurs as a result of an issue with the adrenal glands themselves. Some potential causes include:

• noncancerous growths on the adrenal glands
• cancerous growths on the adrenal glands
• familial hyperaldosteronism, an inherited disorder that causes the adrenal glands to overproduce aldosterone

Secondary hyperaldosteronism

Secondary hyperaldosteronism occurs as a result of an underlying health issue that affects the adrenal glands. The issue does not stem from the adrenal glands themselves.

Some conditions that can cause secondary hyperaldosteronism include:

• cirrhosis with ascites, which is a buildup of fluid between the lining of the abdomen and the abdominal organs
• kidney disease, especially conditions affecting the blood vessels of the kidneys, such as renal stenosis
• advanced high blood pressure that damages the kidneys or blood vessels of the kidneys
• heart failure

When diagnosing hyperaldosteronism, a doctor may begin by asking about a person’s symptoms and medical history.

People with hyperaldosteronism may have low potassium levels in addition to high sodium levels and low calcium and magnesium levels. As such, a doctor may order blood work and take a urine sample to check levels of these substances in the blood and urine.

A doctor may also recommend an aldosterone suppression test. This involves giving a person large quantities of sodium for 3 days, and then checking aldosterone levels in their urine. High levels suggest hyperaldosteronism.

Finding the cause

If a person receives a diagnosis of hyperaldosteronism, a doctor will then work to determine the cause. Some tests the doctor may order include:

• imaging tests, such as a CT scan or a MRI scan, to look for growths on the adrenal glands
• blood samples from the adrenal veins to assess whether one or both adrenal glands are affected
• imaging scans of other organs, such as the heart, liver, or kidneys
• blood tests to assess liver and kidney function
• genetic testing to check for familial hyperaldosteronism

Some cases of hyperaldosteronism are curable, depending on the type and cause. “Adrenalectomy” is the medical term for the removal of one or both adrenal glands. This procedure may cure primary hyperaldosteronism in some cases.

Overall, the outlook for people living with hyperaldosteronism is good. The 10-year survival rate for both types of hyperaldosteronism is 90–95%. The main cause of death in people who do not survive is cardiovascular disease.

The treatment for hyperaldosteronism focuses on addressing the underlying cause of the disease. Some possible treatment options include:

• Adrenal gland removal: When just one adrenal gland overproduces aldosterone, a doctor may recommend surgery to remove the adrenal gland. This procedure is generally safe and effective.
• Medication: Spironolactone is a medication that can block aldosterone, which helps reduce blood pressure. A doctor may prescribe other blood pressure medications for people who cannot undergo surgery, or for people whose blood pressure does not go down following surgery.
• Treating other medical conditions: A person with secondary hyperaldosteronism will require treatment for the medical condition that is causing their hyperaldosteronism. A doctor may prescribe blood pressure–reducing medication while treating the underlying issue.

The main complication of hyperaldosteronism is cardiovascular disease, which increases the risk of heart attack, stroke, and death.

A person can reduce their risk of cardiovascular complications by treating the underlying cause of their hyperaldosteronism and adopting a heart-healthy lifestyle.

Below are some answers to frequently asked questions about hyperaldosteronism.

What type of doctor treats hyperaldosteronism?

Diagnosing hyperaldosteronism usually begins with visiting a primary care doctor. From here, a person may receive a referral to an endocrinologist. This type of doctor specializes in diagnosing and treating conditions related to hormones.

Depending on the cause of the hyperaldosteronism, a person may need to meet with other specialists, such as a:

• nephrologist, who specializes in diseases of the kidneys
• hepatologist, who specializes in diseases of the liver, gall bladder, and pancreas
• cardiologist, who specializes in diseases of the heart and blood vessels
• surgeon, if a person requires adrenal gland removal

Can it cause weight gain?

Weight gain is not a typical symptom of hyperaldosteronism. However, the condition can cause fluid retention, which a person may mistake for weight gain.

There is some evidence that obesity may increase the risk of idiopathic hyperaldosteronism. “Idiopathic” means the condition does not have a clear underlying cause.

Can it cause anxiety?

Anxiety is not a symptom of hyperaldosteronism. However, people with this condition may experience anxiety about the complications of the disease, or worry about the underlying condition that may be causing it.

Is it possible to treat it naturally?

Without medical treatment, hyperaldosteronism can cause severe and potentially life threatening cardiovascular disease.

Natural treatments will not cure hyperaldosteronism. However, certain lifestyle strategies can help reduce the risk of cardiovascular complications. Doctors may encourage people to try the following lifestyle strategies alongside their prescribed medical treatment:

• follow a low sodium diet
• perform regular exercise
• maintain a moderate weight
• manage stress levels

“Hyperaldosteronism” is the medical term for when one or both adrenal glands produce excess aldosterone. Too much of this hormone can cause high blood pressure. This can lead to serious and potentially life threatening cardiovascular complications, such as heart attack and stroke.

The treatment for hyperaldosteronism focuses on managing the underlying cause, maintaining healthy blood pressure, and reducing the risk factors for cardiovascular disease.

People with hyperaldosteronism may want to incorporate lifestyle strategies into their treatment plan to help protect against cardiovascular disease. Examples include following a low sodium diet, exercising regularly, and maintaining a moderate weight.