Primary Aldosteronism (Conn's Syndrome)

What is primary aldosteronism?

Primary aldosteronism, also known as Conn’s syndrome, is a condition that occurs when your adrenal glands make too much aldosterone. Aldosterone is a steroid hormone that helps regulate sodium and potassium in your blood.

High blood pressure (hypertension) and low blood potassium levels (hypokalemia) are the defining features of primary aldosteronism. People with the condition may have other symptoms, too, like headaches, muscle cramps or excessive thirst.

Untreated primary aldosteronism can lead to serious complications like heart attack and kidney failure. But prompt treatment can manage the condition successfully.

How common is primary aldosteronism?

Primary aldosteronism used to be a rare disorder. But today, 5% to 10% of adults with high blood pressure have it. It’s more common in women and people assigned female at birth (AFAB). Most people with this condition get a diagnosis in their 30s or 40s.

What are the signs and symptoms of primary aldosteronism?

People with primary aldosteronism usually develop high blood pressure and low potassium levels. Left unchecked, high blood pressure raises your risk for complications, including heart attack and stroke, while low potassium can cause heart rhythm irregularities (arrhythmia).

Other primary aldosteronism symptoms may include:

• Fatigue.
• Excessive thirst.
• Frequent urination (peeing more than you used to).
• Headache.
• Muscle cramps.
• Muscle weakness.
• Blurred vision.

What causes primary aldosteronism?

Primary aldosteronism happens when your adrenal glands produce too much aldosterone. This hormone helps regulate your body’s balance of water, sodium (salt), blood volume and blood pressure.

Issues that can cause an overproduction of aldosterone include:

• Benign (noncancerous) tumors in one or both adrenal glands.
• Inherited disorders (like congenital adrenal hyperplasia).
• Adrenal cancer (rare).

Secondary aldosteronism

Primary aldosteronism occurs when there’s an issue with your adrenal glands themselves. But sometimes, underlying conditions can cause excess aldosterone production. When this happens, providers call it secondary aldosteronism. Conditions related to secondary aldosteronism include:

• Liver disease.
• Renal artery stenosis (a narrowing of the arteries that carry blood to your kidneys).
• Heart failure.
• Some types of kidney cancer.
• Pregnancy.

What are the risk factors for primary aldosteronism?

Anyone can develop primary aldosteronism. But it’s more common in people with:

• Low blood potassium levels.
• High blood pressure starting before age 30.
• High blood pressure requiring three or more medications to manage.
• An adrenal tumor.

What are the complications of primary aldosteronism?

If you don’t treat primary aldosteronism, your blood pressure may increase to dangerous levels. It also disrupts the balance of electrolytes in your body. (Electrolytes are minerals that help balance the amount of water in your body.)

Electrolyte imbalances and prolonged high blood pressure increase your risk for serious complications like:

• Heart attack or heart failure.
• Irregular heartbeat.
• Kidney failure.
• Stroke.
• Temporary paralysis or the inability to move.

How is primary aldosteronism diagnosed?

Healthcare providers use blood tests to diagnose primary aldosteronism. These tests measure:

• Levels of hormones (like aldosterone and renin) in your blood.
• Electrolytes, including sodium and potassium.

It might take several blood tests to get an accurate diagnosis. This is because many blood pressure medications can interfere with blood test results. To counteract this, your provider might switch up your medication occasionally to ensure accuracy.

What tests will be done to diagnose primary aldosteronism?

Your healthcare provider may recommend further testing to rule out adrenal gland tumors. These tests may include:

• Computed tomography (CT) scans, which use X-rays to create pictures of internal body structures.
• Magnetic resonance imaging (MRI), which uses radio waves and high-powered magnets to visualize the inside of your body.

What is the best treatment for primary aldosteronism?

Primary aldosteronism treatment typically involves medication and/or surgery.

Medication

If both adrenal glands produce excess aldosterone, healthcare providers typically treat it with medications like spironolactone (Aldactone®) or eplerenone (Inspra®), which block the effects of aldosterone.

Surgery

If only one adrenal gland makes excess aldosterone, removing that gland (adrenalectomy) is an alternative to medication. In these cases, healthcare providers may suggest surgery.

Even after surgery, you might need medication until your blood pressure returns to normal. Your healthcare provider can tell you what to expect in your situation.

Can primary aldosteronism be prevented?

Currently, there’s no way to prevent this condition. Monitoring your blood pressure frequently can help spot issues.

How can I lower my risk?

You may be able to reduce your risk for primary aldosteronism by:

• Increasing your physical activity.
• Limiting alcohol intake.
• Reducing sodium in your diet.
• Stopping smoking.

What are the long-term effects of primary aldosteronism?

Underlying hypertension (high blood pressure) — a hallmark of this condition — increases your risk for stroke, heart failure, kidney disease and other conditions. People with primary aldosteronism usually notice reduced symptoms with treatment. Serious long-term effects typically only occur in those with untreated primary aldosteronism.

Outlook for primary aldosteronism

The outlook for primary aldosteronism is excellent with appropriate treatment. That’s why it’s important to schedule a visit with a provider as soon as you notice symptoms.

Left untreated, primary aldosteronism can lead to life-threatening complications like stroke, heart attack and kidney failure.

When should I see my healthcare provider?

If you develop symptoms like fatigue, excessive thirst or frequent urination, call a healthcare provider. They’ll need to run tests to determine a diagnosis.

Additionally, if you have consistently high blood pressure or low potassium, ask your provider if you should have testing for primary aldosteronism or related conditions.

What questions should I ask my doctor?

If you’ve received a primary aldosteronism diagnosis, here are some questions you may want to ask your healthcare provider:

• What caused this condition?
• What tests will I need?
• Do I have an adrenal gland tumor?
• Do I have any underlying conditions that could cause my symptoms?
• What treatment do you recommend?
• Should I monitor my blood pressure at home?