Primary and secondary hyperaldosteronism
Conn syndrome; Mineralocorticoid excessHyperaldosteronism is a disorder in which the adrenal gland releases too much of the hormone aldosterone into the blood.
Aldosterone
The aldosterone blood test measures the level of the hormone aldosterone in blood. Aldosterone can also be measured using a urine test.
Hyperaldosteronism can be primary or secondary.
Causes
Hyperaldosteronism occurs when the adrenal glands release too much aldosterone.
Primary hyperaldosteronism is due to a problem of the adrenal glands themselves. Most cases are caused by a noncancerous (benign) tumor of the adrenal gland.
Secondary hyperaldosteronism is due to a problem elsewhere in the body that causes the adrenal glands to release too much aldosterone. These problems can be with:
- Genes
- Diet
- Medical disorders such as with the heart, liver, kidneys, or high blood pressure
The condition mostly affects people 30 to 50 years old and is a common cause of high blood pressure in middle age.
Symptoms
Primary and secondary hyperaldosteronism have common symptoms, including:
- High blood pressure
- Low level of potassium in the blood
- Feeling tired all the time
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Headache
Headache
A headache is pain or discomfort in the head, scalp, or neck. Serious causes of headaches are rare. Most people with headaches can feel much better...
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Muscle weakness
Muscle weakness
Weakness is reduced strength in one or more muscles.
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Numbness
Numbness
Numbness and tingling are abnormal sensations that can occur anywhere in your body, but they are often felt in your fingers, hands, feet, arms, or le...
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Exams and Tests
Your health care provider will perform a physical exam and ask about your symptoms.
Tests that may be ordered to diagnose hyperaldosteronism include:
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Abdominal CT scan
Abdominal CT scan
An abdominal CT scan is an imaging method. This test uses x-rays to create cross-sectional pictures of the belly area. CT stands for computed tomog...
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Electrocardiogram (ECG)
Electrocardiogram
An electrocardiogram (ECG) is a test that records the electrical activity of the heart.
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Blood aldosterone level
Blood aldosterone
The aldosterone blood test measures the level of the hormone aldosterone in blood. Aldosterone can also be measured using a urine test.
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Blood renin activity
Blood renin activity
The renin test measures the level of renin in blood.
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Blood potassium level
Blood potassium
This test measures the amount of potassium in the fluid portion (serum) of the blood. Potassium (K+) helps nerves and muscles communicate. It also ...
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Urinary aldosterone
Urinary aldosterone
The 24-hour urinary aldosterone excretion test measures the amount of aldosterone removed in the urine in a day. Aldosterone can also be measured wit...
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Sometimes blood and urine tests may be done after eating a high salt diet or after receiving saline through a vein (intravenous). You may need to stop taking some medicines before the tests. Your provider will tell you what to do before the procedure.
Another procedure involves inserting a catheter into the veins of the adrenal glands. This helps check which of the two adrenal glands is making too much aldosterone. This test is important because many people have small benign tumors in the adrenal glands that do not secrete any hormones. Relying only on a CT scan may result in the wrong adrenal gland being removed.
Treatment
Primary hyperaldosteronism caused by an adrenal gland tumor is often treated with surgery. It can sometimes be treated with medicines.
Tumor
A tumor is an abnormal growth of body tissue. Tumors can be cancerous (malignant) or noncancerous (benign).
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:
- Medicines that block the action of aldosterone
- Water pills (diuretics), which help manage fluid buildup in the body
Secondary hyperaldosteronism is treated with medicines (as described above) and limiting salt intake. Surgery is usually 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.
Erection problems and enlarged breast tissue in men (gynecomastia) may occur with long-term use of medicines to block the effect of hyperaldosteronism.
Gynecomastia
When abnormal breast tissue develops in males, it is called gynecomastia. It is important to find out if the excess growth is breast tissue and not ...
When to Contact a Medical Professional
Contact your provider for an appointment if you develop symptoms of hyperaldosteronism.
References
Nieman LK. Adrenal cortex. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 208.
Young WF. Endocrine hypertension. In. Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 16.
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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 rate of metabolism in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).
Endocrine glands
illustration
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Adrenal gland hormone secretion - illustration
The adrenal gland secretes steroid hormones such as cortisol and aldosterone. It also makes precursors that can be converted to sex steroids (androgen, estrogen). A different part of the adrenal gland makes adrenaline (epinephrine). When the glands produce more or less hormones than required by the body, disease conditions may occur.
Adrenal gland hormone secretion
illustration
-
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 rate of metabolism 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 - illustration
The adrenal gland secretes steroid hormones such as cortisol and aldosterone. It also makes precursors that can be converted to sex steroids (androgen, estrogen). A different part of the adrenal gland makes adrenaline (epinephrine). When the glands produce more or less hormones than required by the body, disease conditions may occur.
Adrenal gland hormone secretion
illustration
Review Date: 7/30/2023
Reviewed By: Sandeep K. Dhaliwal, MD, board-certified in Diabetes, Endocrinology, and Metabolism, Springfield, VA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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