High aldosterone (hyperaldosteronism) is due to too much aldosterone production by the adrenal glands. In this article, you will learn the symptoms of too much aldosterone, various types of hyperaldosteronism and diagnostic tests including high aldosterone to renin ratio. In addition, you will learn about the treatment of elevated aldosterone levels.
Symptoms of Too Much Aldosterone
An elevated level of aldosterone gives rise to high blood pressure and low potassium in the blood. Typically, high blood pressure due to hyperaldosteronism is difficult to control with medications. For this reason, a patient may suffer from complications of uncontrolled hypertension such as stroke, congestive heart failure, and chronic kidney failure.
In addition, low potassium in the blood may cause muscle weakness, irregular rhythm of the heart and excess urination.
Types Of Hyperaldosteronism
Hyperaldosteronism is of two types:
- Primary Hyperaldosteronism.
- Secondary Hyperaldosteronism.
Primary Hyperaldosteronism
Primary Hyperaldosteronism (aldosteronism) is due to an excess production of aldosterone by your adrenal glands. It is a rare condition.
Secondary Hyperaldosteronism
Aldosterone can be elevated secondary to a variety of medical diseases such as cirrhosis of liver, congestive heart failure and dehydration. Hence the term Secondary Hyperaldosteronism (aldosteronism).
Causes of Primary Hyperaldosteronism
The most common cause of Primary Hyperaldosteronism is an adrenal tumor. Less common cause is bilateral adrenal hyperplasia (overgrowth.)
Diagnostic Tests for Primary Hyperaldosteronism
The most important point is to suspect Primary Hyperaldosteronism in a person with high blood pressure who also has low blood potassium level in the absence of diuretic use.
Once Primary Hyperaldosteronism is suspected, next step is further testing for Primary Hyperaldosteronism, which includes:
- 24-hour urine for aldosterone and potassium level, with a simultaneous blood potassium level.
- Plasma aldosterone to Plasma Renin Activity (PRA). Typically, aldosterone level is high and PRA suppressed in patients with Primary Hyperaldosteronism. In general, a high aldosterone to renin ratio is considered to be diagnostic of Primary Hyperaldosteronism. In an excellent study, authors concluded that high aldosterone to renin ratio of more than 30 is diagnostic of Primary Hyperaldosteronism.1
Once a diagnosis of Primary Hyperaldosteronism is made, the next step is to do a CT scan or MRI of the adrenal glands to find out if there is an adrenal tumor.
Treatment of Primary Hyperaldosteronism
Treatment of Primary Hyperaldosteronism depends upon its cause. If an adrenal tumor is found, it should be surgically removed.
If no adrenal tumor is found, then the treatment is with drugs:
Spironolactone or Amiloride
Spironolactone is the primary drug of choice. It is very effective. Watch out for elevation in blood potassium level which can be life-threatening.
Another potential side-effect of spironolactone is low testosterone in some men.
Amiloride is a good alternative if spironolactone is not tolerated. Amiloride can also give rise to high blood potassium level, but it does not reduce testosterone level.
Treatment of Secondary Hyperaldosteronism
Obviously, treat the underlying medical disease, such as dehydration, that is causing Secondary Hyperaldosteronism. In case of cirrhosis of liver and congestive heart failure, spironolactone may help to reduce the swelling of the ankles and the abdomen.
