Primary Hyperaldosteronism

Primary Hyperaldosteronism General Information

In the past, Primary Hyperaldosteronism was considered to be a rare disease, but nowadays it is one of the most common medical conditions that can also lead to the appearance of Secondary Hypertension or HTN. The disease was first discovered by a man who also gave it the name of Conn syndrome. It is very important that the disease is diagnosed in time, although this can be challenging especially in the first stages of development. If the patient also develops secondary hypertension, the disease can be harder to cure. If the disease is diagnosed early, it can be easily cured in a short period of time with the available surgical intervention. In most cases, the diagnosis is made in three stages, including initial screening, confirmation of the diagnosis, and determination of what specific subtype of the disease the patient is suffering from. In the past, the main cause of Primary Hyperaldosteronism were considered to be aldosteromas, in more than a half of the cases, but in present, doctors believe that it can be triggered by a bilateral idiopathic adrenal hyperplasia. The disease can be classified depending on its cause; also the treatment and diagnosis for each cause is applied different. For the aldosteromas, the main treatment option is surgical extirpation and for the idiopathic adrenal hyperplasia is therapy based on aldosterone antagonists. There are also rarer cases in which Primary Hyperaldosteronism can be caused by certain risk factors that can include aldosterone secreting adenomas, primary adrenal hyperplasia or aldosterone secreting rennin responsive adenomas.

Primary Hyperaldosteronism Symptoms

In most cases, the signs and symptoms caused by Primary Hyperaldosteronism are not distinctive and the correct diagnosis is based on these manifestations. The most common manifestations of the disease can include: patients who present sudden and unprovoked hypokalemia, particularly if the patient also suffers from hypertension, patients who develop serious persistent hypokalemia accompanied by moderate doses of potassium wasting diuretics, or patients who suffer from refractory secondary hypertension. There are cases in which the patient’s disease can be asymptomatic, and it is very important for the doctor to know an exact medical history of the patient’s family in diagnosing the disease. The most common signs and symptoms that Primary Hyperaldosteronism can cause can include hypertension, which can not be experienced by all the patients due to aldosteronsterism involvement, weakness, abdominal pain or distension, and ileus caused by hypokalemia.

There are cases in which the patient can experience signs and symptoms caused by secondary hypertension, which can include renal insufficiency, cardiac failure, hemi paresis caused by stroke, carotid bruits, proteinuria, abdominal bruits, hypertensive encephalopathy and hypertensive retinal changes. It is very important to know that the Primary Hyperaldosteronism can not be associated with edema although the volume expanded state is associated with it. This manifestation is caused by sudden natriuresis and diuresis, and is more common in patients who present big amounts of atrial naturetic peptide. It is very important to treat the condition in the first stages of development to prevent any complications such as heart failure that can lead to the death of the patient.   

Primary Hyperaldosteronism Treatment

The main goals in treating Primary Hyperaldosteronism are normalization of the patient’s blood pressure, normalization of the patient’s serum potassium and other imbalanced electrolyte levels and normalization of the patient’s aldosterone levels. It is very important to achieve these goals because the patient can develop severe complications such as left ventricular hypertrophy, stroke, or acute coronary syndromes. In most cases, the main medicines used to control the disease are aldosterone antagonisms, by both Spironolactone and Eplerenone. Usually, by inhibiting the intracellular calcium flux in the patient adrenocortical cells, the dihydropyridine calcium channel blockers act by reducing the secretion of aldosterone as a response to certain factors such as potassium ACTH hormone, and angiotensin II hormone. It is very important for the patient to continue the treatment even after the health status has improved. The most common medicine used to maintain the general health of the patient is Nifedipine.

In treating Primary Hyperaldosteronism, doctors can also use ACE inhibitors or angiotensin receptor blocker or ARBs. In some cases, the health care provider can choose to apply mineralocorticoid antagonists such as Spironolactone, which is used to control the patient’s blood pressure and normalize the mentioned parameters, especially in patients that also present aldosteronomas. The side effects of this medicine usually depend on the salt and water balance rather than on its antagonism of aldosterone inside the patient’s kidney. There are less severe cases of Primary Hyperaldosteronism that do not require intensive medical care and can be treated with potassium sparing diuretics such as Triamterene or Amiloride. Amiloride is a medicine that by acts decreasing the function of the distal convoluted tubule by it does not combine with the mineralocorticoid receptors. There are cases in which the patient can present a lateralizable form of the disease and the best treatment option is medical therapy. Some doctors, in treating the lateralizable form of Primary Hyperaldosteronism, can choose to apply surgical treatment, especially in patients who also present aldostronomas.

To control the disease, before the surgical procedure is applied, doctors administrate a trial with Spironolactone, which acts by predicting the response of the patient’s blood pressure. In almost all the cases, the most commonly used surgical procedure is andrenaloectomy which can be performed using a frontal laparotomy or using a laparoscopic procedure. The laparoscopic option is usually applied in patients who are not able to withstand the usual laparotomies. Usually, the andrenaloectomy procedure is effective, but it can cause mild complications due to the effects of high blood pressure, hypokalemia and aldosterone secretion. Another way to treat Primary Hyperaldosteronism is to apply an incomplete resection of the adenoma with the remaining remnant hyperplastic tissue. After the surgical procedure has been done, the patient should receive a medical trial for eight to ten weeks, to decrease the blood pressure and to correct the metabolic syndromes that can be caused by the disease. It is very important to treat the condition in time because if not, it can cause severe complications that can threaten the patient’s life.