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Primary Aldosteronism: A Curable Cause of Hypertension?
On this Page: Symptoms, Testing, Treatment, Misconceptions, Does your doctor have the latest information?, Conclusion

If you have high blood pressure, also called Hypertension, there is a 10-15% chance that it is caused by a treatable condition called Primary Aldosteronism, according to recent studies done on five continents. If your Hypertension is resistant to treatment, or requires multiple medications to control, the likelihood that you have Primary Aldosteronism rises dramatically. Some experts now advocate screening all hypertension patients for Primary Aldosteronism with a simple blood test. Even if your endocrinologist determines that you do not have Primary Aldosteronism, your Hypertension may still benefit from treatment with Aldosterone blocking medication.

Primary Aldosteronism causes hypertension, organ damage and will, ultimately, shorten your life. Primary Aldosteronism is a condition usually caused by either benign adrenal tumors called Adenomas, or by Hyperplasia, which is an increase in the growth of normal cells. In a very small percentage of cases, malignant tumor(s) may also raise Aldosterone levels. Regardless of cause, Primary Aldosteronism is characterized by elevated levels of the adrenal hormone, Aldosterone, and sub-normal levels of an enzyme called Renin, which is secreted by the kidneys. When the Aldosterone/Renin Ratio is too high, excessive water and salt are retained by the body, causing Hypertension.

Primary Aldosteronism can be treated with medication or surgery. This means that the root cause of your Hypertension may be treated with medication that is more effective than the Hypertension medication you’re currently taking. In some cases, a surgical cure is possible for Primary Aldosteronism - and its accompanying Hypertension. Since Primary Aldosteronism also causes heart damage and other problems, it’s important for Hypertension patients to get tested for Primary Aldosteronism, particularly so for those whose Hypertension is resistant to treatment.

According to the World Health Organization, approximately 600 million people suffer from Hypertension. This means that there are probably 60 to 90 million people worldwide with Primary Aldosteronism. Based on Hypertension statistics from the American Heart Association, there may be 7 to 11 million people with Primary Aldosteronism in the US alone. Treating the underlying cause of their Hypertension could save and/or improve millions of lives - and save billions of dollars - every year

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SYMPTOMS

The most obvious symptom of Primary Aldosteronism is high blood pressure, also called Hypertension. Fatigue and muscle weakness are not uncommon. A study linking Primary Aldosteronism to anxiety and depression has been recently published.

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TESTING

A relatively simple screening test to check blood levels of Aldosterone and Renin can determine if further testing and/or treatment by an Endocrinologist is needed. Cortisol levels may also be checked to provide additional diagnostic information. After a positive screening test, additional tests must be performed to confirm the diagnosis. These tests may include a 24-hour urinalysis, an Aldosterone Supression Test, Adrenal Venous Sampling and more. Most importantly, however, it is vital to find an Endocrinologist who has the very latest information about Primary Aldosteronism. Don’t be afraid to ask questions based on your own research.

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TREATMENT

If you are diagnosed with Primary Aldosteronism, Aldosterone blocking medication may enable your doctor to eliminate or reduce your current Hypertension medications. Aldosterone blocking medication may help control your Hypertension even if you do not have Primary Aldosteronism. Surgery is also an option, but only if just one adrenal gland is affected. Like virtually every other disease, Primary Aldosteronism is most successfully treated in its early stages. However, even after years of Primary Aldosteronism-induced Hypertension, treatment usually reduces the need for blood pressure medications and their accompanying side effects. Your doctor will determine if any of your medications should be changed.

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Recent Discoveries and Misconceptions About Primary Aldosteronism

Primary Aldosteronism, also called Conn’s Syndrome, was first described in 1954 by Dr. J. W. Conn. It was identified at that time as a cause of Hypertension. However, it has only been recently established that Primary Aldosteronism among Hypertension patients is not rare; it is the probable cause of High Blood Pressure in 10-15% of all Hypertension patients - and, although many Primary Aldosteronism patients eventually develop Hypokalemia (low serum potassium levels), most Primary Aldosteronism patients have normal potassium levels. Until recently, however, only Hypertension patients with low potassium levels were even checked for this disease. Then, starting in 1991, Australian endocrinologists Richard D. Gordon and Michael Stowasser began the first documented screening for Primary Aldosteronism in patients without regard to potassium levels. Their study has been key to revealing the widespread nature of this illness - and to earlier treatment. However, Diagnosis is still not a straightforward, standardized process, according to Dr. Gordon. In recent correspondence with us, he says,

“It is important for everybody to accept that questions of incidence and best practice are a work in progress. There are very good reasons why there are ongoing controversies, not least of which is the difficulty of measuring aldosterone accurately, and precise cut-off points for normality, which will probably prove elusive because aldosterone is important in regulation of normal blood pressure, and levels of aldosterone vary constantly with time of day, posture etc…”

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Does your doctor have the latest information about Primary Aldosteronism?

On July 24, 2007, Googling “Primary Aldosteronism” showed 179,000 results, with the Mayo Clinic and CNN leading the list. By September 5, a thousand more had been added. Many prominent hospitals, news organizations and medical publications are starting to get the word out, yet many medical organizations and practitioners don’t have the latest information. This is changing; just be aware that the word isn’t out everywhere.

If you have diagnosed Hypertension for which you are taking medication, particularly if that medication is not controlling your blood pressure effectively - prepare yourself with as much information about Primary Aldosteronism as possible, and make an appointment with your Primary Care Physician, Cardiologist or Endocrinologist. Be diplomatic if you’re presenting your healthcare professional with information he/she may not already have, but insist on being tested! Remember: when it comes to your health, you are your own best advocate.

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CONCLUSION

Primary Aldosteronism is the treatable - and sometimes curable- cause of 10-15% of all Hypertension. This disease also causes heart and kidney damage. Primary Aldosteronism is also linked to depression and anxiety, and has been associated with Diabetes.

Treatment with medication is usually very effective. In patients for whom surgery is deemed an appropriate option, surgery can cure Primary Aldosteronism.

According to some experts, all hypertensive patients should be screened for Primary Aldosteronism. If you have Hypertension, particularly Hypertension that requires more than one medication, or is resistant to treatment, ask your doctor to be screened for Primary Aldosteronism. Aldosterone blocking medication may help control your hypertension even if you don’t have Primary Aldosteronism. Treatment for Primary Aldosteronism can dramatically improve your quality of life. It might even save your life.

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