Primary Aldosteronism

Primary aldosteronism (PA) is a rare endocrine disorder characterized by the excessive production of aldosterone, a hormone produced by the adrenal glands that regulates electrolyte balance and blood pressure.

What is Primary Aldosteronism?

Primary aldosteronism occurs when one or both adrenal glands produce too much aldosterone, leading to an overactive renin-angiotensin-aldosterone system (RAAS). This results in sodium retention, potassium loss, and increased blood pressure.

Symptoms of Primary Aldosteronism

The symptoms of primary aldosteronism may include:

• Hypertension (high blood pressure)
• Hypokalemia (low potassium levels)
• Metabolic alkalosis (elevated blood pH)
• Muscle weakness
• Fatigue
• Headaches
• Dizziness or lightheadedness
• Nocturia (frequent urination at night)
• Polydipsia (excessive thirst)

Causes of Primary Aldosteronism

The causes of primary aldosteronism can be:

• Unilateral aldosterone-producing adenoma (APA): a benign tumor on one adrenal gland
• Bilateral adrenal hyperplasia (BAH): excessive growth of both adrenal glands
• Aldosterone-producing carcinoma: a rare, malignant tumor on one or both adrenal glands
• Familial hyperaldosteronism: a genetic disorder that affects the production of aldosterone

Diagnosis of Primary Aldosteronism

The diagnosis of primary aldosteronism involves:

• Physical examination and medical history
• Blood tests to measure aldosterone, renin, potassium, and sodium levels
• Imaging studies (CT or MRI scans) to visualize the adrenal glands
• Aldosterone-to-renin ratio (ARR) test: a blood test that measures the ratio of aldosterone to renin
• Saline infusion test: a test that measures the response of aldosterone levels to saline infusion
• Captopril challenge test: a test that measures the response of aldosterone levels to captopril administration

Treatments for Primary Aldosteronism

The treatments for primary aldosteronism depend on the underlying cause and may include:

• Surgery (adrenalectomy): removal of one or both adrenal glands, usually performed laparoscopically
• Mineralocorticoid receptor antagonists (MRAs): medications that block the effects of aldosterone, such as spironolactone or eplerenone
• Potassium supplements: to manage hypokalemia
• Blood pressure medications: to control hypertension, such as calcium channel blockers, ACE inhibitors, or beta blockers
• Lifestyle modifications: dietary changes, stress reduction, and regular exercise to manage blood pressure and reduce symptoms

Complications of Primary Aldosteronism

If left untreated, primary aldosteronism can lead to:

• Uncontrolled hypertension and cardiovascular disease
• Kidney damage and chronic kidney disease
• Cardiac arrhythmias and cardiac failure
• Osteoporosis and increased risk of fractures