Language
Country/Area
No result found
Do you know what primary aldosteronism is? How it can quietly affect your heart and kidneys?
Primary aldosteronism (PA) is a disease caused by excessive secretion of aldosterone by the adrenal glands. The abnormal increase of this hormone causes a decrease in the body's renin levels and further causes high blood pressure. This condition is usually a paraneoplastic syndrome caused by an adenoma or glandular hyperplasia, and about 35% of cases arise from a single aldosterone-secreting adenoma, a condition known as Connor's disease. Symptoms experienced by many patients include fatigue, potassium deficiency and high blood pressure, which may lead to problems such as poor vision, confusion or headaches.
"In many patients, symptoms of primary aldosteronism may be so mild that they may not even be noticed."
In addition to the above symptoms, patients may also experience muscle pain and weakness, muscle cramps, and pain in the lower back and kidneys, accompanied by tremors, tingling, dizziness, and frequent urination. Complications of this disease include cardiovascular diseases such as stroke, myocardial infarction, kidney failure and abnormal heart rhythm.
Etiology and genetics
The causes of primary aldosteronism vary. Approximately 33% of cases are caused by adrenal adenoma, and 66% of cases are caused by bilateral adrenal hyperplasia. Other less common causes include adrenal gland cancer and an inherited disorder called familial aldosteronism. It is worth noting that according to statistics, the incidence of primary aldosteronism in people with hypertension is about 10%, and the proportion of female patients is higher than that of male patients.
“Primary aldosteronism usually starts in people between the ages of 30 and 50.”
In many cases, patients may harbor underlying biological abnormalities. For example, mutations in the KCNJ5 gene may be present in 40% of patients with adenomas and are also associated with early-onset primary aldosteronism and bilateral adrenal hyperplasia.
PathophysiologyThe major effects of aldosterone are concentrated in the kidneys, particularly in the cells of the distal tubules and medullary collecting ducts. It promotes sodium reabsorption and potassium secretion, leading to sodium retention in the body, further increasing fluid volume and blood pressure. In addition, aldosterone affects the glomerular filtration rate of the kidneys, leading to a decrease in renin secretion, which forms a complex network of physiological connections in the body.
"Excess aldosterone can lead to hypernatremia, hypokalemia, and metabolic alkalosis."
Diagnosis and treatment
Because symptoms of primary aldosteronism can be subtle, many cases are often misdiagnosed or undiagnosed. In patients with hypertension, measurement of the aldosterone-to-renin ratio is recommended and is an important tool in the diagnosis of primary aldosteronism. If the diagnosis is positive, further medical imaging can help determine the specific adenoma or glandular hyperplasia.
Treatment varies depending on the cause. For a single benign adenoma, surgery (adrenalectomy) can usually cure the disease. For patients with bilateral adrenal hyperplasia, aldosterone antagonists such as spironolactone or epleren are commonly used as treatment options, which can effectively control blood pressure.
"With appropriate treatment, the prognosis for primary aldosteronism is considered good."
Epidemiology and socio-culture
It was previously believed that the prevalence of primary aldosteronism was less than 1%, but the latest research shows that its prevalence in primary care and referral centers can reach 12.7% and 29.8% respectively. The diagnosis rate of primary aldosteronism is low due to poor compliance among patients who meet screening criteria.
It is important for patients to understand primary aldosteronism and the profound effects it can have on heart and kidney health. As our understanding of the disease deepens and effective treatments become more common, are we paying enough attention to the underlying causes of abnormal blood pressure?
