Primary Aldosteronism



Photo of bananas and salt

Primary aldosteronism is a condition in which your adrenal glands produce too much aldosterone. Excess aldosterone can cause your body to retain sodium and lose potassium, and that can be bad for your body, particularly your heart. A common symptom of primary aldosteronism is high blood pressure that doesn't come down even when you take blood pressure medication.

Until recently, primary aldosteronism was thought to be rare, but new studies suggest it is the most common cause of treatment-resistant high blood pressure, sometimes called essential hypertension. (See the Primary Aldosteronism Foundation website for the numbers.)

If you have high blood pressure and your doctor tells you to eat more potassium-rich foods—such as bananas—because your potassium levels are low, and to lay off the salt because your sodium is high, that could well be a sign you have primary aldosteronism. 

(Disclaimer: I am not a doctor and you should not read this blog as medical advice; I am just passing on my experience being treated for primary aldosteronism and what I have learned along the way.)

As I found out to my cost, untreated primary aldosteronism can lead to elevated blood pressure and increase your risk of stroke, heart disease, and atrial fibrillation. Finding out that I had primary aldosteronism in 2013 changed my life, mainly in good ways. Since then I have shared my story to help anyone who might benefit from hearing it. 

Fortunately, I had a form of hyperaldosteronism that can be cured with surgery, namely an adrenalectomy. Unfortunately, doctors were slow in diagnosing my PA, so by the time it was confirmed, PA had caused irreversible damage to my heart, leaving me with long-standing persistent atrial fibrillation (LSPAF). At the end of this blog post you will find links to my articles about my heart problems, aldosteronism, and adrenalectomy.

Primary aldosteronism is not rare! 

If you or someone you love is taking tablets for high blood pressure, now would be a good time to learn more about primary aldosteronism, "the most common specifically treatable and potentially curable form of hypertension" (BMJ, 2021). For more information visit the Primary Aldosteronism Foundation website.

If you ask your doctor about primary aldosteronism you may be told it is rare, but that is not the case. Recent advances in medical science have confirmed that PA is the most common cause of high blood pressure. If you are academically-inclined, here is one of the landmark studies of PA prevalence: The Unrecognized Prevalence of Primary Aldosteronism: A Cross-sectional Study.

As recently as 2013, when I got my primary aldosteronism diagnosed, most doctors were still being taught that PA was a rare condition. That meant they didn't think to look for it, even when patients had classic symptoms, like a lack of potassium combined with an excess of sodium.

Remember, PA means your adrenal glands produce too much aldosterone and this causes your body to retain sodium and lose potassium. The excess sodium causes water retention, thereby increasing your blood pressure. The lack of potassium can mess with the electrical system in your heart that keeps it beating properly). 

I vividly recall the man who was my cardiologist in 2013 telling me there was nothing more he could do about my high blood pressure and atrial fibrillation, even as he looked at blood test results showing my sodium was high and my potassium was low, despite being on a huge daily dose of potassium supplement. When I pointed this out he said: "You might want to ask your doctor about primary aldosteronism."

In other words, don't expect the consultant looking after your heart and your high blood pressure to be up to speed on PA. After all, aldosterone is a hormone, and in the unholistic medical systems that dominate healthcare in the US and UK, hormones are the responsibility of endocrinologists, not cardiologists. (Primary aldosteronism is sometimes referred to as Conn's syndrome, after Jerome W. Conn, the American endocrinologist who first identified it.)

Fortunately, the man who was my primary care doctor (GP) had heard of primary aldosteronism and was excited that he might have a patient with this rare condition. Why? Because it can be cured, and proper doctors get excited whenever there is a chance to cure someone of something. You can read about my experience, and cure, in these previous blog posts relating to my primary aldosteronism and adrenalectomy:

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