Primary Aldosteronism: Causes, Diagnosis, and Treatment

When dealing with primary aldosteronism, a condition where the adrenal glands overproduce aldosterone, causing excess sodium retention, low potassium, and high blood pressure. Also known as Conn's syndrome, it often shows up as hypertension that doesn’t respond to standard meds, or as unexplained hypokalemia. The most common trigger is an adrenal adenoma that secretes aldosterone autonomously. In short, primary aldosteronism causes resistant hypertension, originates from adrenal adenoma, and disrupts the normal balance of the renin‑angiotensin‑aldosterone system.

Understanding primary aldosteronism starts with knowing how it hijacks the renin‑angiotensin‑aldosterone system. Normally, low sodium triggers renin release, which ultimately leads to aldosterone production that restores balance. In primary aldosteronism, this feedback loop is broken: aldosterone stays high while renin is suppressed, creating the classic high aldosterone‑low renin profile. Screening relies on the aldosterone‑renin ratio (ARR); an elevated ARR flags the condition and prompts confirmatory tests like saline infusion or captopril challenge. Early detection matters because untreated primary aldosteronism raises the risk of cardiovascular events far more than regular hypertension. The ARR is a simple blood test, but interpreting it correctly requires awareness of interfering drugs and potassium levels.

Once confirmed, treatment splits into two pathways. If imaging shows a unilateral adrenal adenoma, surgical removal—adrenalectomy—often cures the excess hormone production. For bilateral adrenal hyperplasia or patients who can’t undergo surgery, medical therapy with mineralocorticoid‑receptor antagonists such as spironolactone or eplerenone blocks aldosterone’s effect, normalizes potassium, and brings blood pressure under control. Lifestyle tweaks—low‑salt diet, regular exercise—support these therapies. Monitoring includes periodic ARR checks and blood pressure measurements to ensure the disease stays in remission. In practice, treating primary aldosteronism not only lowers blood pressure but also reduces the long‑term risk of stroke, heart attack, and kidney damage, turning a potentially silent threat into a manageable condition.