Adrenal Gland Tumor Treatment Chennai

Primary Aldosteronism ‘ Conns Syndrome ’

Definition

Adrenal is a gland situated above the kidney and its secrete various hormones which maintain the salt, sweet, sex milieu of the body. In Primary Aldosteronism , it secretes high amount of hormone Aldosterone which in turn lead to salt and water accumulation. It retains sodium inside the body and excretes potassium. Due to the salt and water retention, patient has hypertension and due to potassium depletion patient may have repeated attacks of muscle weakness or paralysis, It is one of the causes of surgical correction of the hypertension.

Symptoms

The symptoms which may suggest primary aldosteronism are :

  • Moderate to severe blood pressure
  • Several medications are required to control the hypertension.
  • High blood pressure along with a low potassium level (hypokalemia)

Causes

Adrenal glands

Common conditions causing the overproduction of aldosterone include:

  • Growth in an adrenal gland — a condition also known as Conn’s syndrome
  • Overactivity of both the adrenal glands (bilateral adrenal hyperplasia)

In rare cases, primary aldosteronism may be caused by:

  • Cancerous (malignant) growths in the outer layer (cortex) of the adrenal gland
  • A rare type of primary aldosteronism called glucocorticoid-remediable aldosteronism (GRA) that runs in families and causes high blood pressure in children and young adults

Complications

Primary aldosteronism can lead to high blood pressure and low potassium levels. These complications in turn can lead to other problems.

Problems related to high blood pressure

Raised blood pressure due to primary aldosteronism have a higher risk of cardiovascular complications than due to essential hypertension. The increased risk is due to the high aldosterone levels, which can cause heart and blood vessel damage independently other than because of the complications related to high blood pressure.

Problems related to low potassium levels

Not all patient with primary aldosteronism have low potassium. When the potassium is very low it can lead to

  • Muscle cramps
  • Weakness
  • Cardiac arrhythmias
  • Excess thirst or urination

Preparing for your appointment

Primary aldosteronism is suspected when:

  • Uncontrolled blood pressure , not controlled with multiple medications.
  • Hypertension with low potassium, but in early phase of the disease potassium can be normal.
  • Enlarged adrenal when screened for some other disease.
  • Family history of early blood pressure or stroke at young age.

Tests and diagnosis

A variety of tests are available to help diagnose primary aldosteronism.

Screening test

Blood Aldosterone and Renin is checked. A combination of high aldosterone and low renin ratio is suggestive of primary aldosteronism.

Confirmation tests

To confirm the diagnosis following test are used:

  • Oral salt loading.Patient is asked to consume high-sodium diet for three days and than aldosterone and sodium levels in the urine is assessed.
  • Saline loading.Aldosterone levels are measured after sodium mixed with water (saline) is infused into your bloodstream for several hours.
  • Fludrocortisone suppression test (FST).A high-sodium diet with fludrocortisones — which mimics the action of aldosterone are given for several days, aldosterone levels in the blood is measured.

Additional tests

Once the diagnosis of primary hyeraldosteronism is made, the surgeon tries to localize the side of adrenal from which is secreted.

  • Abdominal computerized tomography (CT).A CT scan can help in lateralize the side but sometime
  • Adrenal vein sampling.Interventional radiologist withdraws blood from the adrenal vein / renal vein and peripheral veins. Comparison of hormone level in different sample is done to decide the side.
  • Treatments and drugsThe main aim of the treatment is to block the ill effect of high aldosterone in to form of raised BP and low potassium.

Treatment for an Adrenal Gland Tumor

An adrenal gland tumor may be treated with surgery or medications and lifestyle changes.

  • Surgical removal of the gland.Adrenalectomy or the surgical removal of adrenal is the preferred treatment for functioning adrenal tumor if lateralize. The preferred approach of surgical removal is minimal invasive (Key Hole) if feasible and safe.
  • Aldosterone-blocking drugs.If surgery cannot be done because of associated comorbidities or patient prefers not to have than it can be treated with medications and life style changes. But hypertension and low potassium tends to return once the drug is stopped.

Treatment for over activity of both adrenal glands

  • Medications.Mineralocorticoid receptor antagonists, blocks the action of aldosterone in the body. The preferred medication is spironolactone, which can be given orally. The side effects can include male breast enlargement (gynecomastia), decreased sexual desire (libido), impotence, menstrual irregularities and gastrointestinal distress.
  • Lifestyle changes.Patient needs to cut down on the salt intake and maintain an ideal body weight. Hypertension medications act best when combined with the lifestyle modifications.

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