Primary aldosteronism (PA) is missed or misdiagnosed 95 percent of the time, according to the Primary Aldosteronism Foundation.
The disorder, also called Conn’s syndrome, causes the adrenal glands to make too much of a hormone called aldosterone, which helps regulate blood pressure by balancing sodium and potassium levels in your body.
Dr. Enrique Polanco, a board-certified specialist in internal medicine at Health First’s Holmes Regional Medical Center in Melbourne, said symptoms include excessive urination, swelling of hands and feet, constipation, and moderate to severe high blood pressure that is often resistant to drug treatments and accompanied by low potassium levels, fatigue, headaches, muscle weakness, numbness and sporadic temporary paralysis.
The condition is much more common than most physicians believe, according to Dr. Polanco. A study concluded in 2020, the Unrecognized Prevalence of Primary Aldosteronism, showed that PA is a prevalent syndrome that represents a major public health issue. Based on that study and on 2021 U.S. census data, 40 million Americans aged 18 or older have PA. That’s equal to 1 in 8 Americans, or 12 percent of the U.S. population.
These findings were reported in the NIH National Library of Medicine.
Dr. Polanco said that primary aldosteronism is one of the most common causes of secondary hypertension and can be cured if properly identified. Secondary hypertension is high blood pressure caused by another condition or disease.
“The problem,” he said, “is that it’s so often overlooked.”
Primary aldosteronism is mainly caused by overactivity of the adrenal glands or a benign tumor on one of the glands.
• Overactive adrenal glands resulting from overgrowth of adrenal tissue can affect both adrenal glands and cause them to produce too much aldosterone. The cause is unknown, but this condition accounts for 60 percent to 70 percent of primary aldosteronism cases.
• A benign, aldosterone-producing adrenal tumor on one of the adrenal glands is the underlying cause in about 30 percent to 40 percent of people with PA.
The Primary Aldosteronism Foundation cites several reasons why the disease is so often overlooked.
• It’s mistakenly considered a rare disease, although it’s not.
• Many primary care and internal medicine physicians haven’t been taught how widespread it is so it’s not on their radar when they’re diagnosing patients.
• There’s a lack of standardized testing.
• Several of the necessary tests are complex and expensive.
Treatment differs, depending on the cause. When caused by a benign tumor on the adrenal gland, the condition may be treated either surgically or with medication.
If surgery is the best option, an adrenalectomy is performed to remove both the tumor and the adrenal gland to which it is attached. This often permanently resolves the primary aldosteronism as the physician follows the patient’s progress closely, adjusting or eliminating medications as needed.
If surgery is not an option, aldosterone-blocking medications can be used to manage the condition. However, they’re not a cure and must be taken regularly to manage symptoms.
When overactive adrenal glands are the cause, medications known as mineralocorticoid receptor antagonists can block the effects of aldosterone in the patient’s body and help lower blood pressure and increase potassium levels.
Dr. Polanco said those with PA are not to blame. “There’s no lifestyle change they can – or could have – made,” he said. “It’s totally out of their control.”
When it is identified, a primary care doctor usually makes the initial diagnosis of PA, said Dr. Polanco. From there, the patient may be referred to an endocrinologist (who specializes in treating conditions related to hormones), nephrologist (who specializes in kidney disease), hepatologist (who specializes in diseases of the liver, gall bladder and pancreas), cardiologist (who specializes in diseases of the heart and blood vessels) and/or a surgeon, if a person requires adrenal gland removal.
Enrique Polanco, M.D., is board-certified in internal medicine, adult comprehensive echocardiography, nuclear cardiology, and cardiovascular disease. Dr. Polanco received his medical degree from Pontificia Universidad Catolica, Madre y Maestra in Santiago, Dominican Republic, and completed his residency at Wayne State University/Detroit Medical Center in Michigan, and a fellowship in general cardiology at Loyola University Medical Center in Maywood, Illinois. He completed his training in 1995 and has board certification in cardiovascular disease and Internal Medicine. He is accepting new patients at Health First Medical Group-Gateway, 1223 Gateway Dr., Suite 2F, Melbourne. 321-312-3487.
