Hyperaldosteronism As a Cause of Hypertension
The adrenal glands are located just above the kidneys on both sides, and are retroperitoneal organs.
They have several functions, and among these is the production of several steroid compounds used by the body to control various aspects of metabolism and homeostasis.
One of these is aldosterone, which is produced in the adrenal cortex.
Aldosterone is what is called a mineralocorticoid, meaning it helps control the homeostasis of sodium and potassium in the body.
Over production of aldosterone can be from a tumor of one or both adrenal glands that over-secretes aldosterone, or from a condition called primary hyperaldosteronism where the adrenal glands just over-produce the steroid.
Hyperaldosteronism is fairly common, being the most common cause of secondary hypertension in adults age 40-64.
Secondary hypertension is hypertension caused by an underlying problem and not essential hypertension that occurs as a problem without an apparent cause.
In medical school most physicians were taught to screen for hyperaldosteronism by ordering a serum potassium level, which if low on patients not taking a diuretic or other medication known to cause low potassium levels was a clue to do further evaluation for hyperaldosteronism.
It is now known that a low serum potassium is noted in only about 30% of patients with hyperaldosteronism.
The best screening test at this time is a serum aldosterone/renin ratio.
If the ratio is >20 and the aldosterone level is >15 then hyperaldosteronism is likely and further evaluation, usually by an endocrine specialist is indicated.
This condition is common, required specific treatment, and is likely under diagnosed.
In the US we are doing a poor job of diagnosing and treating hypertension with 30% of hypertensive adults unaware of their diagnosis, and over 50% of patients not at goal levels of blood pressure control.
Finding and treating the minority of hypertensive patients with hyperaldosteronism will be a big step in the right direction to help improve our overall success in diagnosis and treatment of hypertension.
They have several functions, and among these is the production of several steroid compounds used by the body to control various aspects of metabolism and homeostasis.
One of these is aldosterone, which is produced in the adrenal cortex.
Aldosterone is what is called a mineralocorticoid, meaning it helps control the homeostasis of sodium and potassium in the body.
Over production of aldosterone can be from a tumor of one or both adrenal glands that over-secretes aldosterone, or from a condition called primary hyperaldosteronism where the adrenal glands just over-produce the steroid.
Hyperaldosteronism is fairly common, being the most common cause of secondary hypertension in adults age 40-64.
Secondary hypertension is hypertension caused by an underlying problem and not essential hypertension that occurs as a problem without an apparent cause.
In medical school most physicians were taught to screen for hyperaldosteronism by ordering a serum potassium level, which if low on patients not taking a diuretic or other medication known to cause low potassium levels was a clue to do further evaluation for hyperaldosteronism.
It is now known that a low serum potassium is noted in only about 30% of patients with hyperaldosteronism.
The best screening test at this time is a serum aldosterone/renin ratio.
If the ratio is >20 and the aldosterone level is >15 then hyperaldosteronism is likely and further evaluation, usually by an endocrine specialist is indicated.
This condition is common, required specific treatment, and is likely under diagnosed.
In the US we are doing a poor job of diagnosing and treating hypertension with 30% of hypertensive adults unaware of their diagnosis, and over 50% of patients not at goal levels of blood pressure control.
Finding and treating the minority of hypertensive patients with hyperaldosteronism will be a big step in the right direction to help improve our overall success in diagnosis and treatment of hypertension.