Primary aldosteronism, also known as Conn's syndrome, is an endocrine disorder characterized by excessive production of aldosterone hormone from the adrenal glands. This autonomous overproduction leads to hypertension and electrolyte imbalances, particularly low potassium levels.
Primary aldosteronism has two main causes. Bilateral adrenal hyperplasia accounts for about 60% of cases, where both adrenal glands become enlarged and overproduce aldosterone. Aldosterone-producing adenomas represent about 35% of cases, involving a benign tumor on one adrenal gland. Rare causes include carcinomas and familial forms.
Primary aldosteronism causes several characteristic symptoms. The most common is hypertension, which is often resistant to standard blood pressure medications. Low potassium levels lead to muscle weakness, fatigue, and potentially dangerous heart rhythm problems. Patients may also experience headaches and excessive thirst due to electrolyte imbalances.
Diagnosing primary aldosteronism involves a three-step process. First, screening with the aldosterone-to-renin ratio test identifies potential cases. Second, confirmatory tests like saline infusion or oral sodium loading prove autonomous aldosterone production. Finally, subtype differentiation using CT scans and adrenal vein sampling determines whether the condition is unilateral or bilateral, which is crucial for treatment planning.
Treatment for primary aldosteronism depends on the underlying cause. For unilateral disease like adenomas, surgical removal of the affected adrenal gland is often curative. For bilateral hyperplasia, medical management with mineralocorticoid receptor antagonists like spironolactone or eplerenone is preferred. Both approaches aim to control blood pressure and normalize potassium levels, significantly improving patient outcomes.