Is your blood pressure still not under control despite taking medication? The cause may be Hyperaldosteronism!

Do you have high blood pressure , or “ pressure ” as we all know it? Maybe you are taking one, two, or even more medications prescribed by your doctor. But do you find it difficult to control your blood pressure even after taking so many medications? If so, the reason for this may not be something that everyone usually thinks about. Today we are going to talk about a special medical condition that can cause high blood pressure that is not easily controlled by medications. That is Hyperaldosteronism. Although the name is a bit complicated, let’s understand it very simply.

What is Hyperaldosteronism?

Simply put, Hyperaldosteronism is the production of too much of the hormone "Aldosterone" by the adrenal glands in our body.

Now you're probably thinking, what are these adrenal glands ? What is this aldosterone hormone?

Imagine, above the two kidneys in our body, there are two small glands, like two little caps. That's what we call the adrenal glands. These are a very important part of our endocrine system. These two small glands make several types of hormones that are essential for the daily activities of our body.

A special hormone produced by these glands is called aldosterone . The main function of this hormone is to regulate our blood pressure . It does this by controlling the levels of sodium and potassium in our blood. This hormone works in our body like a traffic police officer controlling traffic on a road.

So, in the case of Hyperaldosteronism, what happens is that this aldosterone hormone is produced in excess. Then the amount of sodium in our body increases and the amount of potassium decreases. The end result of this is high blood pressure (Hypertension) and low potassium levels in the blood (Hypokalemia) .

There are two main types of this.

Doctors divide this condition into two main types, depending on the cause.

1. Primary Hyperaldosteronism: This is also called “Conn's syndrome.” This condition occurs when the adrenal glands themselves produce too much aldosterone. The cause lies within the gland itself.

2. Secondary Hyperaldosteronism: Here there is no problem with the adrenal glands. But due to a problem elsewhere in the body, the adrenal glands are stimulated in response and produce more aldosterone.

Who is most commonly affected by this condition?

This condition usually affects people between the ages of 30 and 50. Research has also shown that this condition is slightly more common in women than in men.

Some studies suggest that between 5% and 10% of people with high blood pressure may have primary hyperaldosteronism. Experts believe that as many as 25% of people with medication-resistant hypertension may have the condition.

What are the symptoms of this?

Sometimes, if the condition is very mild, there may be no symptoms at all. However, many people develop symptoms.

The main and most common symptom seen in this condition is high blood pressure (Hypertension) , especially high blood pressure that is difficult to control even with the use of several medications.

Other symptoms are caused by two things: high blood pressure and low blood potassium levels (Hypokalemia). Let's clearly separate these symptoms.

Why does this condition of Hyperaldosteronism occur?

As we discussed earlier, the reasons for this vary according to the two main types.

Causes of Primary Hyperaldosteronism

The problem here lies in the adrenal gland itself.

• Most common cause: Most often, this is caused by a non-cancerous tumor (adrenal adenoma) that develops in the adrenal gland. This is not cancer, so there is nothing to worry about. This tumor produces too much of the hormone aldosterone.
• Other rare causes:
• Enlargement of only one adrenal gland (unilateral adrenal hyperplasia).
• Aldosterone production by a cancerous tumor (adrenocortical carcinoma) (this is very rare).
• A genetic condition that is passed down through generations (Familial hyperaldosteronism).

Causes of Secondary Hyperaldosteronism

Here the adrenal glands are healthy. But they are stimulated for another reason. The main reason is the reduced blood supply to the kidneys .

To understand this, we need to know a little about a very interesting system in our body that controls blood pressure. It's called the Renin-Angiotensin-Aldosterone System .

Think of this as a chain reaction:

1. When our blood pressure drops or our blood sodium levels drop, our kidneys sense it.

2. Then the kidneys release an enzyme called "renin" into the blood.

3. This renin converts a protein called "Angiotensinogen", which is produced by the liver, into "Angiotensin I".

4. Next, this angiotensin I becomes “Angiotensin II”.

5. Ultimately, it is this angiotensin II that increases blood pressure by constricting blood vessels and stimulating the adrenal glands to produce aldosterone.

Now, in secondary hyperaldosteronism, what happens is that due to some medical condition, the amount of blood going to the kidneys decreases. Then the kidneys mistakenly think that the pressure in the body is low. So, the kidneys call for help and that chain reaction starts. As a result, they produce more of the hormone aldosterone, when there's really no need for it.

Conditions that reduce blood supply to the kidneys and cause secondary hyperaldosteronism:

• Obstructive renal artery disease.
• Conditions that cause fluid to accumulate in the body, such as heart failure.
• Cirrhosis of the liver.
• Nephrotic syndrome, a kidney disease.

How does a doctor diagnose this condition?

When you tell your doctor about your symptoms, especially high blood pressure that is not controlled by medication, he or she may suspect this condition. Then, they may order several tests to confirm this.

1. Blood tests:

• If a routine electrolyte blood panel shows slightly elevated sodium levels (Hypernatremia) and low potassium levels (Hypokalemia) , suspicion increases.
• Next, there are two specific blood tests that can be used to diagnose this condition: Plasma Renin Concentration (PRC) or Plasma Renin Activity (PRA) .
• If you have Primary Hyperaldosteronism, your renin levels (PRC and PRA) will be lower than normal.
• If you have secondary hyperaldosteronism, your renin levels will be higher than normal.

2. Aldosterone Suppression Test:

• This test involves giving you extra sodium (salt) over a period of time. It can be a solution you take by mouth or a saline solution you give into a vein.
• Then, your urine is collected over 24 hours and the amount of aldosterone in that urine is measured.
• In a healthy person, excess sodium intake reduces the body's production of aldosterone. However, in a person with hyperaldosteronism, this does not happen.

3. Imaging Tests:

• If blood tests confirm that you have primary hyperaldosteronism, your doctor will order a test like a CT scan (Computed Tomography scan) to find the cause. This can check for a tumor on the adrenal gland.

What are the treatments for this?

Treatment depends on the cause of the condition. However, the main goal is to control your blood pressure.

• For primary hyperaldosteronism caused by a tumor:

Doctors often recommend surgery to remove the tumor and the gland in question . After this surgery, most people's blood pressure and potassium levels return to normal. However, some people may continue to have high blood pressure after surgery, and they may need to continue taking medication.

• For other causes and secondary hyperaldosteronism:

In these cases, treatment is with medication . Also, if it is a secondary condition, it is essential to treat the underlying disease (e.g., heart disease).

Some of the most commonly used medications for this purpose are:

• Spironolactone (Spironolactone – Aldactone®)
• Eplerenone (Eplerenone – Inspra®)
• Amiloride (Amiloride – Midamor®)

What will happen after treatment? And what are the complications?

The prognosis for this condition, that is, the future state, depends on the cause.

Primary hyperaldosteronism is usually very well-tolerated if diagnosed early and treated appropriately . In secondary hyperaldosteronism, the outcome depends on whether the underlying condition can be controlled.

The main complications that can occur in this condition are caused by uncontrolled high blood pressure for a long time. These are serious problems related to the cardiovascular system.

Therefore, it is very important to properly control blood pressure.

Can this situation be prevented?

In most cases, there is nothing we can do to prevent this condition from occurring. Because it is caused by changes that occur inside our body. But the best thing is that once it is diagnosed, it can be treated and complications can be prevented.

Hyperaldosteronism, aldosterone, adrenal glands, Conn's syndrome, high blood pressure, hypertension, pressure, potassium, sodium, kidneys, hormones