What Is Hyperaldosteronism?

Medically Reviewed by Murtaza Cassoobhoy, MD on May 28, 2023
4 min read

‌Hyperaldosteronism is a condition where your adrenal gland makes too much aldosterone hormone. 

Aldosterone is a steroid hormone made in the outer part of your adrenal glands. This hormone helps your body maintain the right levels of fluid and sodium in your body and get rid of extra potassium. 

‌‌Too much aldosterone is called hyperaldosteronism. This extra aldosterone causes high blood pressure and low potassium levels. Sometimes it can look like moderate to severe high blood pressure and go undiagnosed for a long time. 

‌There are two types of hyperaldosteronism.

Primary hyperaldosteronism. This is caused when the adrenal gland makes too much aldosterone hormone. There are several reasons for this, and the most common one is a non-cancerous tumor called an adenoma on one gland. Other causes include the following:‌

  • ‌Bilateral adrenal hyperplasia or growth on each adrenal gland
  • A tumor outside the adrenal glands that release aldosterone
  • Cancerous tumor that releases aldosterone
  • A genetic disease called familial hyperaldosteronism type 1

‌This condition is also called Conn’s syndrome.

Secondary hyperaldosteronism. This type is caused by another problem in the body that results in too much aldosterone hormone. This isn’t due to a problem with the adrenal gland. Causes of secondary hyperaldosteronism can include the following:‌

  • A tumor that makes renin
  • ‌Heart failure
  • ‌Pregnancy
  • ‌Chronic liver disease
  • Renal artery stenosis or narrowing of kidney arteries
  • ‌Loss of fluids
  • ‌Shock 

‌‌These health conditions can activate a system called the renin-angiotensin-aldosterone system, which leads to excess aldosterone in your body. 

‌The most common sign of hyperaldosteronism is high blood pressure. It is usually hard to control and treat and doesn’t respond to medicine. Sometimes people with hyperaldosteronism take four or more types of blood pressure pills, which don’t seem to help. 

High blood pressure can cause other symptoms, including the following:‌

  • Headaches
  • ‌Dizziness
  • ‌Blurry vision
  • ‌Heart problems

‌Hyperaldosteronism can also cause low potassium. Not enough potassium can cause problems, especially with your muscles. Symptoms include the following:‌

  • Numbness
  • Tingling
  • ‌Temporary paralysis
  • ‌Weak muscles
  • ‌Cramps

‌Because aldosterone manages your fluids and electrolytes, you might also experience the following:‌

  • ‌Peeing more often 
  • ‌Waking up often to pee
  • ‌Being very thirsty
  • ‌Feeling weak and dizzy

‌Some people who have hyperaldosteronism don’t have any symptoms. 

‌Your doctor will do several tests to check for hyperaldosteronism, especially if you have high blood pressure that isn’t getting better with lots of medications.‌

Blood tests. Your doctor will do blood tests to check your potassium, aldosterone, and renin levels. Low potassium and high aldosterone can mean primary hyperaldosteronism while high renin can mean secondary hyperaldosteronism.

Urine tests. These tests are done over 24 hours to check if there is too much potassium in your pee. However, some doctors feel these tests aren’t the best way to diagnose hyperaldosteronism.

Saline infusion. Your doctor will give you a sodium tablet over 3 days and then test the amount of aldosterone in your urine. This can also be done with intravenous saline over 4 hours followed by a urine test.

Imaging tests. Tests like computed tomography or CT scans are used for primary hyperaldosteronism. Your doctor will use these to look for tumors and growths that can cause adrenal problems.

Adrenal vein sampling. Your doctor may use this test if the imaging tests aren’t very clear. This is usually done to find out if the problem affects one or both adrenal glands. It is also done before surgery.

Genetic testing. These tests look at your genes. If you are younger than 20 years old and have a family history of hyperaldosteronism, your doctor might order genetic testing.

‌Treatments for hyperaldosteronism vary depending on the type and cause. 

Surgery. Your doctor will usually recommend laparoscopic surgery for tumors or growths that are only on one adrenal gland. Having laparoscopic surgery means a shorter hospital stay and quicker recovery. ‌

Medications. If there are growths on both adrenal glands, your doctor will give you diuretic medications like spironolactone or eplerenone. You may also receive aldosterone-blocking medications. These don’t fix the problem but help manage the effects.

Other conditions. For secondary hyperaldosteronism, your doctor will treat the underlying health problem. This is usually done with medications.

Lifestyle changes. You might also have to make some lifestyle changes, especially if you have high blood pressure. These changes include the following:‌

‌High blood pressure is a symptom of hyperaldosteronism. If you have trouble controlling your high blood pressure, this can lead to the following serious problems:‌

  • Heart attack
  • Stroke
  • Heart failure
  • Heart disease
  • Kidney disease
  • Peripheral artery disease
  • Vascular dementia
  • Aortic aneurysm
  • Early death

‌Hyperaldosteronism also causes low levels of potassium, which can lead to the following:‌

  • Paralysis
  • Weakness
  • ‌Excessive peeing
  • ‌Constipation
  • Insulin problems
  • Diabetes 

‌If you have ongoing high blood pressure that’s hard to control, extreme thirst, or excessive peeing, make sure to talk to your doctor to rule out hyperaldosteronism.