Conn’s Syndrome

Understanding Hyperaldosteronism

This month we are going to be talking about Conn’s Syndrome, a disease caused by a tumor in the adrenal glands that is producing too much of the hormone aldosterone.

One of the functions of your adrenal glands is to produce a hormone called aldosterone that plays an active role in your blood pressure. It does this by maintaining the balance of sodium, potassium, and water in your blood.  Hyperaldosteronism is an endocrine disorder that involves one or both of your adrenal glands creating too much of a hormone called aldosterone. This causes your body to lose too much potassium and retain too much sodium, which increases water retention, blood volume, and blood pressure.

What are the symptoms?

The main symptom of hyperaldosteronism is high blood pressure, which can range from moderate to severe. In some cases, high blood pressure related to hyperaldosteronism doesn’t respond to medication. In others, it may only respond to a certain combination of medications.

High blood pressure does not typically have symptoms. But when it does, they can include: headaches, dizziness, vision problems, chest pain and shortness of breath.

The other main symptom of hyperaldosteronism is hypokalemia, which refers to low potassium levels in your blood. While it doesn’t always cause symptoms, more moderate cases of hypokalemia may cause: fatigue, muscle cramps, increased thirst, increased urination, muscle weakness or palpitations.

Is Conn's Syndrome of the Adrenal Gland Rare?

No. Conn's Syndrome is not rare, it is common, typically occurring in patients over 30 years of age. It used to be thought that primary hyperaldosteronism was very rare but we see a patient with Conn's several times per week. The reason Conn's Syndrome was thought to be rare is that many doctors did not know about it or were not tested for it because many patients were not feeling very sick and so the disease was not being diagnosed and the patients were just treated with highblood pressure pills (anti-hypertensives).

Unfortunately, over time having too much aldosterone being produced by your adrenal gland damages your heart, blood vessels and brain. But most doctors were not actively screening their patients with high blood pressure to find the disease. They should, as you will learn as you read on.

What causes it?

There are two types of hyperaldosteronism, known as primary and secondary hyperaldosteronism. While they have similar symptoms, their causes are different.

Primary hyperaldosteronism

Primary hyperaldosteronism is caused by a problem with one or both adrenal glands. It’s sometimes referred to as Conn’s syndrome. Some people are born with overactive adrenal glands. Others might have it due to: a benign tumor on
one of the adrenal glands, adrenocortical cancer, which is a rare aldosteroneproducing cancerous tumor, glucocorticoid-remediable aldosteronism, a type of aldosteronism that runs in families and other types of inheritable issues that affect the adrenal glands.

Secondary hyperaldosteronism

Secondary hyperaldosteronism is caused by something outside the adrenal glands. It’s usually related to reduced blood flow to your kidneys. Several things can cause this, including: a blockage or narrowing of the renal artery, chronic liver disease, heart failure and diuretic medications.

How is it diagnosed?

If you have symptoms of hyperaldosteronism, we at Palmetto Endocrinology will likely start by doing a blood test to check your levels of aldosterone and renin, an enzyme released by your kidney that works with aldosterone to help balance blood pressure. People with hyperaldosteronism generally have low renin levels and high aldosterone levels.

Depending on the results of your blood test, we might run some other tests, including:

• Captopril challenge test. This blood test measures your aldosterone, renin, and other levels after you receive a dose of the medication captopril, an ACE inhibitor. 
• Saline infusion test. This blood test measures your aldosterone, renin, and other levels after you receive an IV sodium and saline solution. 
• Salt-loading test. This measures the levels of aldosterone and sodium in your urine after following a high-sodium diet for three to five days. 
• Fludrocortisone suppression test. This is very similar to the salt-loading test, but it includes taking fludrocortisone, an oral steroid that mimics aldosterone. 
• CT or MRI scans of the abdomen. These imaging tests allow your doctor to check for any tumors on or around your adrenal glands. 
• Adrenal vein sample. This involves taking a blood sample directly from the veins of each adrenal gland and testing the amount of aldosterone in it. If blood from one gland has significantly more aldosterone, you may have a benign tumor on one gland. If blood from each gland has similarly high levels of aldosterone, both glands are likely overactive.

If you already take medication for high blood pressure, we might ask you to stop taking it for a brief period of time while they do these tests.

How is it treated?

Treating hyperaldosteronism focuses on reducing your aldosterone levels or blocking the effects of aldosterone, high blood pressure, and low blood potassium. There are several ways to do this, depending on what’s causing your hyperaldosteronism.

• Medication - We might prescribe a mineralocorticoid receptor antagonist, such as spironolactone. This type of medication blocks the effects of aldosterone on your body, such as high blood pressure and low blood potassium. You may still need to take additional medications to help manage your blood pressure.
• Surgery - If you have a tumor on one of your adrenal glands, we will refer you to a doctor who may be able to remove the affected gland. Following the procedure, called an adrenalectomy, you’ll likely notice a gradual decrease in blood pressure.  As you heal, we will regularly monitor your blood pressure to determine whether it’s time to change your blood pressure medication. Eventually, you may be able to stop taking it completely.
• Lifestyle changes  -In addition to medication and surgery, there are several lifestyle changes you can make to provide additional health benefits and help counteract the effects of too much aldosterone.  These include:
  • Eating a healthy diet. Following a balanced diet that helps you maintain a healthy weight can reduce your blood pressure. Start by choosing fresh, unprocessed foods to reduce your salt intake. Try incorporating elements of the DASH diet, which is designed for people with high blood pressure. In addition, many blood pressure medications work better when combined with a healthy diet. A diet lower in salt is often key in hyperaldosteronism.
  • Exercising. Consistent exercise, even just a 30-minute walk a few times a week, can help to reduce blood pressure.
  • Reducing alcohol and caffeine. Caffeine and alcohol can both increase your blood pressure. Some blood pressure medications are also less effective when taken with alcohol.
  • Quitting smoking. Smoking cigarettes constricts your blood vessels, which increases your heart rate and can raise blood pressure. Smoking also increases your risk of heart attack and stroke, even without high blood pressure.

Are there any complications?

High levels of aldosterone can cause a variety of health problems. ResearchTrusted Source, which is based in Oxford, England shows it can cause direct injury to heart tissues, leading to scarring and enlargement of the left side of the heart. In addition to injuring blood vessels and causing other complications related to high blood pressure, untreated hyperaldosteronism can put you at greater risk for: heart attacks, heart failure, stroke and kidney failure. 

To avoid complications, work with us to come up with a long-term treatment plan
for your high blood pressure. Make sure to regularly follow up to check for any changes in your blood potassium levels as well.

Living with hyperaldosteronism

While the effects of hyperaldosteronism can lead to complications over time, the condition itself can be managed with the right treatments. For many people, the best plans involve a combination of surgery, medication, and lifestyle changes. We at Palmetto Endocrinology are well versed and ready to help you. Please call for an appointment today.

Author

Joseph Mathews, MD, FACP, FACE, ECNU, CCD Joseph W. Mathews M.D., a board certified Endocrinologist and Medical Director of Palmetto Endocrinology, was born and raised in South Carolina. He earned his Bachelor of Science in Biology from the College of Charleston, Cum Laude. He then achieved his M.D. at the Medical University of South Carolina where he also completed his residency in Internal Medicine and a Fellowship in Endocrinology, Diabetes, and Metabolism. Dr. Mathews is also a Fellow of both the American College of Endocrinology and the American College of Physicians, holds an Endocrine Certification in Neck Ultrasound (ECNU) and is a Certified Clinical Densitometrist (CCD). He has extensive experience performing ultrasound guided fine needle aspiration biopsies. His practice includes a range of specializations including prescribing and fitting patients with insulin pumps. Dr. Mathews' practice has drawn patients from out of state to benefit from his expertise in thyroid disorders, diabetes, cortisol problems and their Endocrine disorders.