Diagnosis and Screening for Hyperaldosteronism in Resistant Hypertension

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• Causes of High Aldosterone
• Screening for Hyperaldosteronism
• Importance of Early Detection
• Potassium Levels Misconception
• Treatment Options
• Full Transcript

Causes of High Aldosterone

Dr. David Ellison, MD, explains the primary causes of elevated aldosterone levels. He states that a small percentage of cases are due to inherited genetic mutations. These are known as Mendelian diseases and are considered very rare.

For most patients, hyperaldosteronism is a developmental disease. Dr. Ellison identifies two main syndromes. One involves excessive growth of the adrenal glands themselves, leading to overproduction. The other is caused by benign adrenal tumors, or adenomas, which develop somatic mutations.

Screening for Hyperaldosteronism

Screening for high aldosterone is a critical step in managing resistant hypertension. Dr. David Ellison, MD, emphasizes that the test for this condition is very simple. He strongly recommends it for patients whose high blood pressure is difficult to control with standard treatments.

Dr. David Ellison, MD, notes that this screening is currently underutilized in primary care. Identifying hyperaldosteronism allows physicians to pursue more targeted and effective treatment strategies. This can significantly improve patient outcomes.

Importance of Early Detection

Early detection of hyperaldosteronism is vital for patient health. Dr. David Ellison, MD, explains that high aldosterone has adverse consequences beyond elevating blood pressure. It can also cause direct damage to the cardiovascular system over time.

During his discussion with Dr. Anton Titov, MD, Dr. Ellison stressed that not every hypertensive patient needs screening. The focus should be on those with treatment-resistant hypertension. Finding the root cause enables clinicians to address the problem directly.

Potassium Levels Misconception

A major misconception involves the role of potassium in diagnosing hyperaldosteronism. The classic presentation includes hypertension paired with low blood potassium, or hypokalemia. However, Dr. David Ellison, MD, reveals this is not always the case.

He states that as many as 50% of patients with aldosterone-driven hypertension will have normal potassium levels. This is a critical development in understanding the disease. It means screening should not be skipped simply because a patient's potassium is normal.

Treatment Options

Once diagnosed, there are straightforward ways to treat hyperaldosteronism. Dr. David Ellison, MD, highlights that effective treatment can mitigate the risks to both blood pressure and cardiovascular health. The approach depends on the underlying cause of the aldosterone excess.

Treatment may involve medication to block aldosterone's effects or surgery to remove an adrenal adenoma. Dr. Ellison's insights confirm that a proper diagnosis is the key to unlocking these targeted and successful treatment options.

Full Transcript

Dr. Anton Titov, MD: You also mentioned that a lot of people could be walking around with a high level of aldosterone. Is that something genetic? Is it possible to check whether a person has a high level of aldosterone?

Dr. David Ellison, MD: Absolutely. All of the above. Some people are unlucky to inherit the disease; it tends to lead to hyperaldosteronism. That can be transmitted as a Mendelian disease, but that's a very small percentage. It's very rare for people to get that.

For most people who get high levels of aldosterone, it's more common and it's a developmental disease. It's actually caused by two different syndromes. One is just excessive growth of the adrenal glands producing too much aldosterone, and that's a relatively common situation.

I think we're coming to realize that that's not a discrete disease. Many people have elevated levels of aldosterone above what they need, but it may not classify as a discrete disease.

Another population of people who have high aldosterone levels has adenoma or benign tumors in their adrenal glands. These tumors actually have somatic mutations. These are not inherited mutations; these are mutations that develop as you grow up or as you get older, and these cause tumors that secrete excessive amounts of aldosterone.

In either case, I think the important thing to know is that most people who develop blood pressure that's hard to treat or resistant to hypertension really need to be screened for excessive aldosterone. This is a very simple test, but we believe that it's really underutilized by primary care physicians.

If you find elevated aldosterone levels, there are really some very straightforward ways to treat that. We believe that elevated aldosterone levels have adverse consequences not only for the blood pressure but also for the cardiovascular system, in addition to the blood pressure.

So we think it's very important for people to be screened for that. Not everybody with hypertension needs to be screened, but if you have difficulty treating hypertension, screening is recommended.

The other major development over the last few years is that patients with hyperaldosterone syndromes don't always present with low blood potassium levels. The classic presentation for hyperaldosteronism is low blood potassium and hypertension, but as many as 50% of patients who have high aldosterone-driven hypertension will not present with low blood potassium.

That's why it's recommended that we should simply screen people who have resistant hypertension, even if the potassium levels in their blood are normal.