Primary Aldosteronism' Conn's Syndrome'

Definition

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

Symptoms

The symptoms which may suggest primary aldosteronism are 

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

Causes

1. 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).
2. 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) 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 has a higher risk of cardiovascular complications than essential hypertension. The increased risk is due to the high aldosterone levels, which can cause heart and blood vessel damage independently other than the complications related to high blood pressure.

Problems related to low potassium levels

Not all patients with primary aldosteronism have low potassium. When the potassium is deficient, it can lead to

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

Preparing for your appointment

Primary aldosteronism is suspected when:

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

Tests and diagnosis

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

Screening Test

Blood Aldosterone and Renin are checked. A combination of high Aldosterone and low renin ratio suggests primary aldosteronism.

Confirmation Tests

To confirm the diagnosis following tests are used:

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

Additional Tests

Once the diagnosis of primary hyperaldosteronism is made, the surgeon tries to localize the side of the Adrenal from which it is secreted.

1. Abdominal computerized tomography (CT). A CT scan can help lateralize the side but sometimes.
2. Adrenal vein sampling. Interventional radiologist withdraws blood from the adrenal vein / renal vein and peripheral veins. A comparison of hormone levels in the different samples is made to decide the side.
3. Treatments and drugs. The main aim of the treatment is to block the ill effect of high Aldosterone in the 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.

1. Surgical removal of the gland. Adrenalectomy or the surgical removal of the Adrenal is the preferred treatment for functioning adrenal tumors if lateralized. The preferred approach of surgical removal is minimal invasive (Key Hole) if feasible and safe.
2. Aldosterone-blocking drugs. If surgery cannot be done because of associated comorbidities or the patient prefers not to have it, it can be treated with medications and lifestyle changes. But hypertension and low potassium tend to return once the drug is stopped.

Treatment for over activity of both adrenal glands

1. Medications. Mineralocorticoid receptor antagonists block 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.
2. Lifestyle changes. The patient needs to cut down on salt intake and maintain an ideal body weight. Hypertension medications act best when combined with lifestyle modifications.