High aldosterone – hyperaldosteronism is due to too much aldosterone production by the adrenal glands. In this article, you will learn what are symptoms of too much aldosterone, various types of hyperaldosteronism, 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
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 the 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 hyperaldosteronsim.
- Secodary hyperaldosteronism.
Primary hyperaldosteronism (aldosteronism) is due to an excess production of aldosterone by your adrenal glands. It is a rare condition.
Aldosterone can be elevated secondary to a variety of medical diseases such as cirrhosis of liver, cogestive heart failure and dehydration. Hence the term secondary aldosteronism.
Causes of Primary Hyperaldosteronism
The most common cause of primary aldosteronism is an adrenal tumor. Less common cause is bilateral adrenal hyperplasia ( overgrowth.)
Diagnostic Tests of Primary Hyperaldosteronism
The most important point is to suspect primary aldosteronism in a person with high blood pressure who also have low blood potassium level in the absence of diurectic use.
Once primary aldosteronism is suspected, next step is further testing for primary aldosteroinsm, 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 hyperladosteronism.1
Once a diagnosis of primary aldosteronism is made, the next step is to do a CT scan or MRI of the adrenal glands to find out any adrenal tumor.
Treatment of Primary Hyperaldosteronism
Treatment of primary aldosteronism depends upon its cause. If an adrenal tumor is found, it should be surgically removed.
If no adrenal tumor is found, then the treament 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 hyperparathyroidism. In case of cirrhosis of liver and congestive heart failure, spironolactone may help to reduce the swelling of the ankles and the abdomen.