Hyperaldosteronism: Overview and Management

When dealing with hyperaldosteronism, a condition where the adrenal glands release too much aldosterone, causing sodium retention, potassium loss, and raised blood pressure. Also known as primary aldosteronism, it often originates from an adrenal adenoma or from bilateral adrenal hyperplasia.

The excess aldosterone directly fuels hypertension, which is why many patients first notice a stubbornly high blood pressure reading. In fact, up to 10% of people with resistant hypertension have underlying hyperaldosteronism. This connection makes it crucial for clinicians to screen for the disorder whenever blood pressure refuses to respond to the usual trio of lifestyle changes and standard meds.

Understanding the renin‑angiotensin‑aldosterone system (RAAS) clears up why the disease behaves the way it does. Normally, low sodium triggers renin release, leading to angiotensin II formation and a balanced aldosterone output. In hyperaldosteronism the adrenal cortex bypasses that feedback loop, pumping out aldosterone regardless of renin levels. The resulting low‑renin state is a diagnostic clue that helps separate primary aldosteronism from secondary causes.

Key Topics Covered

Diagnosis hinges on two simple steps: measuring the plasma aldosterone concentration (PAC) and the plasma renin activity (PRA). A high PAC/PRA ratio flags the condition, prompting confirmatory tests such as saline infusion or oral sodium loading. Imaging, usually a CT scan of the abdomen, then pinpoints whether an adrenal adenoma is present or if the disease is bilateral, which guides treatment choice.

If imaging reveals a solitary adenoma, surgical removal—typically laparoscopic adrenalectomy—offers a cure. For bilateral disease or patients who cannot undergo surgery, doctors turn to mineralocorticoid antagonists such as spironolactone or eplerenone. These drugs block aldosterone receptors, allowing the kidneys to excrete excess sodium and retain potassium, which brings blood pressure down without the need for multiple antihypertensives.

Medication choice matters because each antagonist carries its own side‑effect profile. Spironolactone can cause gynecomastia in men and menstrual irregularities in women, while eplerenone tends to be better tolerated but is pricier. The dose‑response curve is steep: low doses may not control blood pressure, whereas high doses increase the risk of hyperkalemia, especially in patients with chronic kidney disease.

Beyond surgery and drugs, lifestyle tweaks still play a supportive role. A low‑sodium diet (under 2 g per day) reduces the workload on the remaining aldosterone‑sensitive pathways. Regular potassium‑rich foods—such as bananas, oranges, and leafy greens—help counteract the potassium‑wasting effect of excess aldosterone. Exercise improves overall cardiovascular health and can lower the dose of medication needed.

Follow‑up care is a long‑term commitment. After adrenalectomy, patients need periodic blood pressure checks and electrolyte panels for the first year to confirm the cure. Those on antagonists should have serum potassium and creatinine measured every few months, adjusting dosage as kidney function changes. The goal is to keep blood pressure under 130/80 mmHg while avoiding hypokalemia or hyperkalemia.

Because hyperaldosteronism sits at the crossroads of endocrinology and cardiology, it shows up in many of the drug‑focused articles on this site. You’ll find guides that compare spironolactone with other antihypertensives, safety tips for buying cheap generic mineralocorticoid blockers, and detailed breakdowns of how excess aldosterone interacts with diabetes‑related inflammation. All of those pieces help paint a full picture of how this hormone imbalance affects daily health.

Below, you’ll discover a curated set of resources that dive deeper into each of these areas—from diagnostic algorithms and surgical outcomes to medication comparisons and lifestyle strategies. Whether you’re a patient trying to understand your lab results or a clinician looking for up‑to‑date treatment options, the collection offers practical insights you can put to use right away.