Aldosteronism means an excess of aldosterone, which is of two types:
Primary aldosteronism is due to an excess production of aldosterone by your adrenal glands. It is a rare condition. It gives rise to high blood pressure and low potassium in the blood.
Causes of Primary Aldosteronism
The most common cause of primary aldosteronism is an adrenal tumor. Less common cause is bilateral adrenal hyperplasia.
Diagnostic Evaluation of Primary Aldosteronism
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.
Caution: Many patients with hypertension are on a diuretic which is the reason for low blood potassium level in these patients and not the primary aldosteronism.
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 level and Plasma Renin Activity. ( these are blood tests ).
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 Aldosteronism
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.
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.
Treatment obviously is the treatment of the main medical disease. In cirrhosis of liver and congestive heart failure, spironolactone is sometimes used to help in reducing the swelling of the ankles and the abdomen.
This article was written by Sarfraz Zaidi, MD, FACE. Dr. Zaidi specializes in Diabetes, Endocrinology and Metabolism.
Dr. Zaidi is a former assistant Clinical Professor of Medicine at UCLA and Director of the Jamila Diabetes and Endocrine Medical Center in Thousand Oaks, California.
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