What is it?

Primary aldosteronism (PA) is a hormonal disorder characterized by excess of aldosterone. Aldosterone is one of the hormones secreted by the adrenal glands located on top of each kidney. Aldosterone helps control the sodium and potassium levels in the body; if excessive, aldosterone can cause retention of sodium in the body leading to elevation in blood pressure or hypertension. PA is a medical condition where the adrenals secrete a lot of aldosterone. The excess secretion can come from hyperactivity of both adrenals, a tumor in the adrenals, a genetic disorder, or in rare instances, cancer of the adrenals.

Why should primary aldosteronism be recognized?

PA is a treatable cause of hypertension. Early recognition and management can delay the complications of uncontrolled hypertension like heart attack, stroke, and kidney failure, both in younger and older patients suffering from PA.

The low potassium level (hypokalemia) associated with PA may be mild or severe. Mild decrease may have no symptoms, but severe hypokalemia may cause weakness, irregular heart beats, muscle cramps, increased thirst or urination.

What are the signs and symptoms?

PA commonly presents with the following:

  1. high blood pressure requiring many medications (three or more)
  2. high blood pressure in young persons (younger than 30 years old)
  3. occurrence if stroke in a young relative/family member (younger than 40 years old)
  4. low blood potassium level – muscle cramps, weakness

How is it diagnosed?

With some or all of the above findings, the doctor may suspect a person to have primary aldosteronism. In addition to routine tests for hypertension, the doctor will request for the blood tests plasma renin activity and plasma aldosterone level. PA is diagnosed if the plasma renin is low and the plasma aldosterone is high. Imaging studies like computed tomography (CT) scan or magnetic resonance imaging (MRI) will be done to check if the adrenals are enlarged or have lumps or tumors. Specialized procedures like saline loading test and adrenal venous sampling may be required in some patients.

How is it managed?

The management of PA depends on what causes it. Management includes surgery, medications, and lifestyle changes. A diet low in sodium, regular exercise, weight loss, stopping smoking and alcohol intake, and weight loss can further contribute to better blood pressure control. It can be treated with medications like spironolactone or if there is a tumor in the adrenal gland, surgical removal is also an option.

When to see an endocrinologist?

If you have hypertension that is difficult to control, that is needing at least 3 or more medications, or hypertension and with history of low potassium, contact your doctor for proper evaluation and treatment.


  1. Hormone Health Network.”Primary Aldosteronism | Hormone Health Network.”, Endocrine Society, 30 July 2021,