Understanding Hyperaldosteronism: Causes, Symptoms, and Treatment
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer: What Is Hyperaldosteronism?
Hyperaldosteronism is a condition in which the adrenal glands release too much aldosterone, a hormone that makes the kidneys hold sodium and water and lose potassium. The extra fluid raises blood volume and blood pressure. Primary hyperaldosteronism is an important, often undiagnosed cause of hard-to-control high blood pressure, possibly affecting 5% to 10% of people with hypertension. [1] [3]
What the research says
Surgery was linked to better heart outcomes than medicine for one-sided disease. A meta-analysis of 12 studies covering 6,148 people with primary aldosteronism found that surgery was linked to fewer composite cardiovascular outcomes than medical treatment (OR 0.49), less persistent high blood pressure (OR for non-cure 0.31), and fewer major cardiovascular events and deaths (OR 0.60). The authors note that large randomized trials are lacking (Huang et al., Frontiers in Endocrinology, 2021 [4]).
Atrial fibrillation was more common with medicine than with surgery. In a pooled analysis of 3 studies covering 2,705 people with primary aldosteronism, new-onset atrial fibrillation was more common in those treated with aldosterone-blocking medicine than in those who had adrenalectomy (pooled OR 2.83, 95% CI 1.76–4.57). Compared with people who had essential hypertension, the odds were also higher with medicine (OR 1.91, 95% CI 1.11–3.28) (Tsai et al., Frontiers in Endocrinology, 2021 [5]).
Primary aldosteronism can harm the kidneys. A meta-analysis of 46 studies (6,056 people with primary aldosteronism and 9,733 with other types of high blood pressure) found higher odds of microalbuminuria (OR 2.09, 95% CI 1.40–3.12) and proteinuria (OR 2.68, 95% CI 1.89–3.79). The authors concluded that this organ damage can be reduced by specific treatment (Monticone et al., Journal of Hypertension, 2020 [6]).
Key Takeaways
Feature | Primary Hyperaldosteronism | Secondary Hyperaldosteronism |
Common Name | Conn’s syndrome | None |
Root Cause | A problem inside the adrenal glands, most often a noncancerous tumor or enlargement [1] | Reduced blood flow to the kidneys or conditions that cause fluid retention [1] |
Renin Levels | Low | High |
Aldosterone Levels | High | High |
Main Symptom | High blood pressure that is hard to control | High blood pressure plus signs of the underlying disease |
Main Treatment | Treating the underlying condition and controlling blood pressure [1] |
What is hyperaldosteronism, and how does it affect blood pressure?
Aldosterone is a key hormone in the renin-angiotensin-aldosterone system (RAAS), which helps control blood pressure. When this system is overactive, the body is pushed into long-term high blood pressure that often does not respond well to standard blood pressure medicines.
Types of Hyperaldosteronism
Primary hyperaldosteronism: the problem starts in the adrenal glands. The most common cause is overactivity of both adrenal glands (bilateral hyperplasia); a noncancerous tumor (adenoma) on one gland is the next most common. [1]
Secondary hyperaldosteronism: the adrenal glands are healthy but receive “false signals” to make more hormone. This usually happens when the kidneys receive less blood flow than they need, for example in heart failure, liver cirrhosis or kidney artery disease. [1]
What are the symptoms of hyperaldosteronism?
Many people with mild hyperaldosteronism have no symptoms other than high blood pressure. As blood pressure rises and potassium drops, other signs can appear.
Signs of High Blood Pressure
Headaches: can be severe and may not respond to over-the-counter relief.
Dizziness: a lightheaded or spinning feeling.
Vision changes: blurred vision or trouble focusing.
Shortness of breath: especially during mild physical activity.
Signs of Low Potassium (Hypokalemia)
Muscle weakness: a feeling of heaviness or lack of strength in the limbs; in severe cases it can lead to temporary paralysis. [1]
Muscle spasms and cramps: frequent, painful contractions.
Tingling and numbness: often in the hands, feet or face.
Extreme thirst and frequent urination: the kidneys lose some ability to concentrate urine.
Fatigue: tiredness that does not improve with rest.
What causes hyperaldosteronism, and what are the risk factors?
Hyperaldosteronism mostly affects adults between 30 and 50 years old and occurs more often in women. [1]
Adrenal adenomas: noncancerous tumors that act as independent “factories” for aldosterone and are a common, often surgically curable cause of the primary form. [1]
Adrenal hyperplasia: the adrenal glands become enlarged and overactive.
Rarer primary causes: enlargement of one adrenal gland, aldosterone-producing adrenal cancer, and an inherited condition called familial hyperaldosteronism type 1. [1]
Renal artery disease: narrowed arteries to the kidneys trigger the secondary form. [1]
Heart, liver and kidney conditions: chronic diseases that cause fluid retention, such as heart failure, cirrhosis and nephrotic syndrome, can activate the RAAS. [1]
How is hyperaldosteronism diagnosed?
Because high blood pressure is so common, hyperaldosteronism is often missed unless specific tests are ordered. [3] The Endocrine Society's 2025 guideline suggests screening everyone with high blood pressure using the aldosterone-renin ratio; its 2016 guideline focused on high-risk groups (Funder et al., Journal of Clinical Endocrinology & Metabolism, 2016 [2]).
Blood screening: measures aldosterone and renin. In the primary form, aldosterone is high while renin is low. [1]
Electrolyte panel: checks for low potassium, and sometimes mildly high sodium or low magnesium. [1]
Salt loading (aldosterone suppression) test: extra sodium is given by mouth or by IV to see whether the body lowers its aldosterone production as it should. [1]
Imaging (CT or MRI): scans of the abdomen to look for a tumor or enlarged glands. [1] [2]
Adrenal venous sampling: a specialized procedure that shows whether one or both glands are overproducing the hormone. [2] [3]
How is hyperaldosteronism managed and treated?
The main goal of treatment is to bring blood pressure down and restore potassium balance to protect the heart, brain and kidneys.
Treatment Type | Description |
Surgery (Adrenalectomy) | |
Aldosterone Antagonists | Medicines such as spironolactone or eplerenone that block the effects of aldosterone. [1] |
Lifestyle Changes | A low-sodium diet to reduce fluid retention and blood pressure. [3] |
Managing Underlying Causes | Treating heart failure, liver disease or kidney artery disease to resolve secondary hyperaldosteronism. [1] |
What is the outlook and prognosis for hyperaldosteronism?
The outlook for primary hyperaldosteronism is generally good when it is diagnosed and treated early. [1] Removing a tumor can bring a significant drop in blood pressure, although some people still need blood pressure medicine afterward. Without treatment, long-term high blood pressure from hyperaldosteronism raises the risk of atrial fibrillation, thickening of the heart muscle, heart attack, stroke and kidney damage. [1] [6] The outlook for secondary hyperaldosteronism depends on the underlying cause. [1]
Conclusion
Hyperaldosteronism is a treatable cause of high blood pressure that deserves investigation, especially when several blood pressure medicines have not worked. By finding the root cause, whether it is a small adrenal tumor or a systemic condition elsewhere in the body, healthcare providers can build a treatment plan that protects long-term heart and kidney health.
Frequently Asked Questions
Is hyperaldosteronism the same as Conn’s syndrome?
Conn’s syndrome is another name for primary hyperaldosteronism. It is most often caused by a noncancerous adrenal tumor (adenoma). [1]
Can I have normal potassium and still have this condition?
Yes. Low potassium is not always present, so a normal potassium level does not rule out hyperaldosteronism. High blood pressure, especially blood pressure that is hard to control, is often the main clue.
Why does aldosterone cause high blood pressure?
It makes the kidneys keep sodium and water in the bloodstream. The extra fluid increases blood volume, which puts more pressure on the artery walls.
Is surgery for adrenal tumors dangerous?
Adrenalectomy is usually done laparoscopically (with small incisions and a camera). With an experienced surgical team it is considered safe and, for a tumor on one side, can be curative. [2] [3]
What are the side effects of spironolactone?
Common side effects include breast tenderness or enlargement (gynecomastia) and erectile dysfunction in men, and menstrual irregularities in women, because the drug can affect other hormones.
Can secondary hyperaldosteronism be cured?
It is usually managed by treating the underlying condition, such as heart failure, liver disease or a narrowed kidney artery, and by controlling blood pressure. [1]
How common is this condition?
Some studies suggest that 5% to 10% of people with high blood pressure have primary hyperaldosteronism, and experts estimate it may affect as many as 25% of people whose blood pressure is resistant to medication. [1]
Should I limit salt if I have hyperaldosteronism?
Yes. A low-sodium diet is an important part of management, because sodium adds to the fluid retention caused by excess aldosterone. [3]
What happens if I leave it untreated?
Untreated hyperaldosteronism can lead to long-term high blood pressure and complications such as atrial fibrillation, thickening of the heart muscle, heart attack, stroke and kidney damage. [1] [6]
Does hyperaldosteronism run in families?
There are rare inherited forms (familial hyperaldosteronism), but most cases are not directly inherited.
Can stress cause hyperaldosteronism?
Stress can raise blood pressure, but it does not cause the adrenal glands to make excess aldosterone in the way this condition does.
What is renin?
Renin is an enzyme made by the kidneys that starts the chain of reactions leading to aldosterone production. [1]
How long does recovery from adrenal surgery take?
Many people return to normal activities within a few weeks after laparoscopic surgery, though recovery varies from person to person.
Can I live with only one adrenal gland?
Yes. The remaining adrenal gland usually takes over the work of both glands.
What is an adrenal “incidentaloma”?
It is an adrenal tumor found by accident during a scan done for an unrelated reason.
Why do I feel so tired?
Low potassium (hypokalemia) interferes with how muscles and nerves work, which can cause fatigue and weakness.
Is hyperaldosteronism more common in men or women?
It affects both sexes but occurs more often in women. [1]
Can children get hyperaldosteronism?
It is uncommon in children and is usually linked to specific genetic changes when it does occur.
What is the difference between an adenoma and hyperplasia?
An adenoma is a single tumor. Hyperplasia means the whole gland is enlarged and overactive.
Do I need potassium supplements?
Some people need them for a while until aldosterone is controlled with medicine or surgery. Your doctor will decide, because some medicines used for this condition raise potassium.
Can hyperaldosteronism cause anxiety?
High blood pressure and palpitations can feel like anxiety, but hyperaldosteronism is primarily a hormonal disorder.
What is an electrolyte panel?
It is a blood test that measures minerals such as sodium, potassium and magnesium.
Can pregnancy affect this condition?
Pregnancy can make diagnosis and management more complicated because of natural hormonal changes, so care should be planned with your doctor.
Is aldosterone a steroid?
Yes. It is a mineralocorticoid steroid hormone made in the outer layer (cortex) of the adrenal gland.
Can licorice cause similar symptoms?
Yes. Large amounts of real black licorice can cause high blood pressure and low potassium that look like hyperaldosteronism, although aldosterone levels are low in that situation.
What is the RAAS?
It stands for renin-angiotensin-aldosterone system, the body’s main hormone chain for controlling blood pressure.
How is aldosterone measured?
It is measured with a blood test or a 24-hour urine collection.
Can I stop my blood pressure medicines after surgery?
Many people can reduce or stop some medicines, but some still need treatment, especially if they have had high blood pressure for a long time.
What is renal artery stenosis?
It is a narrowing of the arteries that supply the kidneys and is a cause of secondary hyperaldosteronism.
Does hyperaldosteronism affect weight?
It can cause some water and sodium retention, but it is not a main cause of weight gain.
What is an endocrinologist?
A doctor who specializes in hormones and the glands that make them, including the adrenal glands.
Can hyperaldosteronism cause heart palpitations?
Yes. High blood pressure and low potassium can both make the heart feel as if it is skipping beats.
What is eplerenone?
It is a medicine similar to spironolactone that blocks the effects of aldosterone and is less likely to cause hormonal side effects such as breast tenderness.
How is the salt loading test done?
You take extra sodium by mouth or through an IV, and then blood or urine tests show whether aldosterone drops as it normally should. [1]
Can a CT scan miss an adrenal tumor?
Small tumors can be hard to see on standard scans, which is why adrenal venous sampling may be needed to find out which gland is overactive. [2] [3]
What is the adrenal cortex?
It is the outer layer of the adrenal gland, where aldosterone is made.
Can hyperaldosteronism cause headaches?
Yes. Severe or recurring headaches can be a symptom of the high blood pressure it causes.
Is hyperaldosteronism the same as Cushing’s syndrome?
No. Cushing’s syndrome involves too much cortisol, while hyperaldosteronism involves too much aldosterone.
Can I exercise with hyperaldosteronism?
Moderate exercise is generally encouraged, but check with your doctor first if your blood pressure is very high or your potassium is very low.
What is polydipsia?
It is the medical term for extreme thirst, which can occur when low potassium affects the kidneys. [1]
Can hyperaldosteronism cause numbness?
Yes. Low potassium can cause tingling or “pins and needles” sensations. [1]
Is it a form of cancer?
Most adrenal tumors that cause this condition are noncancerous. Adrenal cancer is a very rare cause.
What is an ACE inhibitor?
It is a common blood pressure medicine that acts on the same hormone system but is often not enough on its own to treat hyperaldosteronism.
How does the doctor know whether it is primary or secondary?
By measuring renin. Low renin points to primary hyperaldosteronism, and high renin points to secondary hyperaldosteronism.
Can hyperaldosteronism cause frequent urination at night?
Yes. Low potassium can affect the kidneys’ ability to concentrate urine, which can increase urination, including at night.
What is the adrenal medulla?
It is the inner part of the adrenal gland, which makes adrenaline (epinephrine). The outer cortex makes aldosterone.
Can I use salt substitutes?
Be careful. Many salt substitutes contain potassium, which can be dangerous if you take medicines such as spironolactone. Ask your doctor first.
What is a laparoscopic adrenalectomy?
It is a “keyhole” operation in which small incisions and a camera are used to remove an adrenal gland.
Is hyperaldosteronism permanent?
Primary hyperaldosteronism usually lasts long term unless the overactive tissue is removed. With appropriate surgical expertise, removing a single overactive gland can be curative. [3] Otherwise it is managed with lifelong medicine. [3]
Where are the adrenal glands?
They sit on top of each kidney in the upper abdomen.
Related Reading
References
Cleveland Clinic. Hyperaldosteronism: What It Is, Causes, Symptoms & Treatment. Cleveland Clinic. Last updated September 12, 2022. https://my.clevelandclinic.org/health/diseases/16448-hyperaldosteronism
Funder JW, Carey RM, Mantero F, et al. The management of primary aldosteronism: case detection, diagnosis, and treatment: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2016;101(5):1889-1916. PMID 26934393. https://doi.org/10.1210/jc.2015-4061
Young WF. Diagnosis and treatment of primary aldosteronism: practical clinical perspectives. J Intern Med. 2019;285(2):126-148. PMID 30255616. https://doi.org/10.1111/joim.12831
Huang WC, Chen YY, Lin YH, Chueh JS. Composite cardiovascular outcomes in patients with primary aldosteronism undergoing medical versus surgical treatment: a meta-analysis. Front Endocrinol (Lausanne). 2021;12:644260. PMID 34079522. https://doi.org/10.3389/fendo.2021.644260
Tsai CH, Chen YL, Pan CT, et al. New-onset atrial fibrillation in patients with primary aldosteronism receiving different treatment strategies: systematic review and pooled analysis of three studies. Front Endocrinol (Lausanne). 2021;12:646933. PMID 34108934. https://doi.org/10.3389/fendo.2021.646933
Monticone S, Sconfienza E, D’Ascenzo F, et al. Renal damage in primary aldosteronism: a systematic review and meta-analysis. J Hypertens. 2020;38(1):3-12. PMID 31385870. https://doi.org/10.1097/HJH.0000000000002216
Disclaimer
This article is for informational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
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