Endocrine hypertension

The main outward sign of primary aldosteronism is high blood pressure. However, the condition may appear like ordinary hypertension (or essential hypertension – high blood pressure that does not have a known secondary cause). As a result, many people who have primary aldosteronism are unaware of the root cause of their high blood pressure or take unsuitable medications which are not directed at treating the aldosterone excess. They also face an increased risk of cardiovascular problems, including stroke, heart attacks and heart failure, compared to those who have similar blood pressure levels not caused by excessive aldosterone.

Primary aldosteronism is caused by the increased production of aldosterone from the adrenal gland(s).  The excessive aldosterone may be produced by a tumour or tumours on the adrenal gland or enlarged adrenal gland or glands.  In some cases, the condition can run in the family if caused by a genetic mutation that affects multiple family members.

Primary aldosteronism is diagnosed by blood and urine tests, and/or a CT scan of the adrenal glands. In some cases adrenal vein sampling, which measures and compares hormones produced by each adrenal gland, is needed.

Primary aldosteronism causes more injury to the heart and blood vessels than high blood pressure alone, so early diagnosis is important. Only one in 200 people with primary aldosteronism are diagnosed because many doctors do not screen for it.

The Endocrine Hypertension Service at our precinct, including Hudson Institute and Monash Health, offers Victoria’s only streamlined service for the diagnosis of primary aldosteronism, in addition to an outreach program supporting general practitioners to facilitate increased primary aldosteronism testing in the community.

Hypertension related to a hormone imbalance is usually treatable and possibly curable with surgery if it involves a tumour or tumours. In the case of primary aldosteronism, there are medications which specifically block the actions of aldosterone and therefore offer highly effective treatment.  Patients may need fewer medications compared to before the diagnosis because s/he is able to receive targeted treatment of the root cause of the hypertension rather than non-specific medications.  If the aldosterone is produced by an adrenal tumour, then the condition may be cured by surgical removal of the affected adrenal gland.

If undiagnosed, primary aldosteronism can lead to higher blood pressure that becomes increasingly difficult to control with medication. This can leave those who have it at risk of strokes, heart attacks at a younger age and in some cases heart and kidney failure. Others may end up taking numerous ineffective blood pressure medications while still suffering from high blood pressure. If correctly diagnosed, they have a good chance of controlling the condition with appropriate medication or surgery.