FREQUENTLY ASKED QUESTIONS ABOUT PRIMARY ALDOSTERONISM

Q: If my Hypertension is controlled with medication, why check for Primary Aldosteronism?

A: Hypertension medications do not address some of the damaging effects of Primary Aldosteronism. If your Endocrinologist determines that you have Primary Aldosteronism, and that an Aldosterone-blocking medication or surgery is an appropriate treatment option for you, it will be a more specific solution for your Hypertension - while also addressing the other damaging effects of Primary Aldosteronism. It’s important to note, however, that you should NEVER change or stop taking any of your Hypertension medications unless your doctor gives you specific orders to do so.

Q: What’s different about the medications used to treat Primary Aldosteronism?

A: Medications used to treat Primary Aldosteronism treat not only Hypertension, but also the damaging effects of Primary Aldosteronism on the heart and other organs. If Primary Aldosteronism is the cause of your Hypertension, treating that cause directly will probably enable your doctor to reduce your Hypertension medication dosages.

The most commonly used Aldosterone blocking drug is Spironolactone, which is relatively cheap and works well. Unfortunately, Spironolactone has side effects for many people. A newer, more expensive drug is Eplerenone, developed to help people with Congestive Heart Failure. It targets Aldosterone more specifically, and has fewer side effects than Spironolactone. Your Endocrinologist will advise you regarding the relative risks/benefits of Aldosterone blocking drugs

Q: Should I consider surgery?

A: If testing shows that you are a good candidate for surgery, your surgeon may want to remove just the tumor responsible for excess Aldosterone production, or the entire affected adrenal gland. In either case, surgery is the only Primary Aldosteronism treatment which actually cures the problem without need for Aldosterone blocking medications. The most common form of remedial surgery for Primary Aldosteronism, unilateral adrenalectomy (removal of one adrenal gland), is an option if only one of the adrenals is producing too much Aldosterone.

Most Primary Aldosteronism is caused either by Adenomas, which are small, benign tumors of the adrenal glands, or by Hyperplasia, which is abnormal growth of normal cell tissue in one or both adrenal glands. Removal of one of our two adrenal glands is usually a fairly straightforward, laparoscopic procedure. However, determining which gland is affected is complicated: A CT scan or MRI can sometimes identify the affected gland or glands, but in many cases a definitive diagnosis requires an invasive and somewhat risky procedure called Adrenal Venous Sampling, which involves sampling the blood directly from each gland. This test should only be done at a facility which does a lot of these procedures regularly, in which case the test accuracy is maximized and the risk is minimal. However, if both adrenals are proven to be affected, medication is the only treatment option available.

Some studies also show that, although Aldosterone blocking medication helps control hypertension and prevents further heart damage, only surgery facilitates the actual reversal of damage caused by Primary Aldosteronism. You and your Endocrinologist can discuss these options and decide what’s best for you.

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