Hyperaldosteronism

Key facts

• Hyperaldosteronism happens when the adrenal glands produce too much aldosterone, the hormone that balances sodium and potassium. The excess makes the body retain sodium and lose potassium, pushing blood pressure up in a way that resists standard treatment.
• It is believed to account for roughly 5 to 10 percent of all hypertension cases, yet it remains under-diagnosed because confirming it needs specific hormone testing. The tell-tale pattern is blood pressure that will not respond to two or three standard medicines, sometimes with low potassium causing muscle cramps, weakness or unusual thirst.
• Primary hyperaldosteronism usually comes from a benign tumour on one adrenal gland (Conn's syndrome) or both glands overproducing the hormone; secondary hyperaldosteronism has an external trigger such as chronic kidney disease or severe heart failure.
• Spironolactone is the main medicine for bilateral overactivity; a single overactive gland can sometimes be removed surgically instead.

Why blood pressure stays high despite treatment

High blood pressure often goes unexplained for years. Hyperaldosteronism is one reason: it is believed to cause roughly 5 to 10 percent of hypertension cases, yet it is regularly missed because diagnosis needs specific hormone testing rather than a standard blood pressure check. The pattern to watch for is blood pressure that does not respond well to two or three standard medicines, sometimes together with low potassium causing muscle cramps, weakness or unusual thirst.

What causes it

Primary hyperaldosteronism usually traces back to a benign tumour on one adrenal gland, known as Conn's syndrome, or to both adrenal glands overproducing the hormone. Secondary hyperaldosteronism has an external trigger, most often chronic kidney disease or severe heart failure, that pushes the body to raise aldosterone as a downstream response.

How it's managed

For bilateral adrenal overactivity, the main medical approach is an aldosterone-blocking agent. Spironolactone is the most established option: it counters the hormone directly, and blood pressure and potassium levels typically normalise over weeks. Broader heart and blood pressure medicines are often added alongside it depending on the underlying cause. If imaging identifies a single overactive gland, surgery to remove it can resolve the condition entirely.

When to see a doctor

Investigate unexplained high blood pressure, persistent low potassium, or both together with a doctor promptly. Untreated hyperaldosteronism raises the long-term risk of heart and kidney damage beyond what the blood pressure reading alone would suggest.

This page is educational and does not replace advice from a doctor or pharmacist who knows your health history.