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Aldosterone-producing adenoma

Aldosterone-producing adenoma



Overview

An aldosterone-producing adenoma (also called Conn's adenoma or aldosteronoma) is a benign tumor in an adrenal gland that overproduces the hormone aldosterone. This excess hormone causes primary hyperaldosteronism, leading to high blood pressure, low potassium levels, muscle weakness, and increased risk of heart problems.

Symptoms

People with an aldosteronoma typically have high blood pressure, but most don’t have any other symptoms.

When low potassium levels result, however, people may experience one or more of the following symptoms related to their aldosteronoma:

Muscle weakness or, rarely, episodes of muscle paralysis

Muscle spasms and/or cramps

Fatigue

Headache

Excessive thirst

Excessive or frequent urination

Waking up at night to urinate

Numbness and/or tingling of hands and feet

Causes

Effects and Body Changes

High blood pressure: Extra salt and water stay in the body, which raises blood pressure.

Low potassium (hypokalemia): The kidneys flush out too much potassium.

Muscle issues: Weakness, cramps, and spasms can happen due to low potassium.

Frequent bathroom trips: Excessive thirst and passing urine often.

Underlying Genetic Mutations

KCNJ5 gene: The most common genetic change found inside these tumors.

CACNA1D, ATP1A1, and ATP2B3 genes: Other less frequent changes that alter ion channels in adrenal cells.

Diagnosis

To diagnosis an aldosteronoma, your doctor will review your medical history, conduct a physical exam, and order one or more diagnostic tests.

The first step in making a diagnosis is to determine if you have primary aldosteronism. You should tell your doctor when you started experiencing symptoms. You may also be asked whether you have any risk factors for primary hyperaldosteronism, including whether you have a family history of the condition, high blood pressure, or have had a hemorrhagic stroke before age 40. During a physical exam, your doctor will check your blood pressure and look for signs and symptoms of low potassium levels, including muscle weakness and irregular heart rate.

Even if you don’t have symptoms, you may be given a blood test to screen for the condition if you meet any of the following criteria:

Sustained high blood pressure

High blood pressure and low potassium levels

High blood pressure that doesn’t improve with medications

High blood pressure and sleep apnea

High blood pressure with an adrenal incidentaloma (an adrenal tumor that has been found incidentally, during an imaging test done for another medical problem)

High blood pressure and a family history of primary hyperaldosteronism, early-onset high blood pressure, or stroke before age 40

Blood and urine tests are used to diagnose primary aldosteronism—they measure the levels of sodium, potassium, aldosterone, and other substances in your blood and urine. They cannot, however, determine whether the condition is caused by an aldosteronoma or adrenal hyperplasia.

To determine if an aldosteronoma is present, you doctor may order a computed tomography (CT) scan of the adrenal glands. If the CT scan shows the presence of a mass in one or both adrenal glands and you’re considering surgery to treat the condition, an additional test called adrenal vein sampling (AVS) may be necessary. In this test, blood is collected from veins of the left and right adrenal glands. The level of aldosterone is then measured to determine if one or both of the adrenal glands is producing excessive levels of aldosterone.

Treatment

An aldosteronoma is treated by endocrine surgeons and endocrinologists who specialize in the treatment of adrenal disorders and other endocrine conditions. Treatments for aldosteronomas include:

Surgery. If only one adrenal gland is affected, adrenalectomy, the surgical removal of the affected adrenal gland, is the first-line treatment for an aldosteronoma. In some cases, the surgeon may remove only part of the affected adrenal gland. In most cases, adrenalectomies are done using a minimally invasive surgical technique. In these procedures, the surgeon makes three or four small incisions, either on the abdomen or the back, then inserts a laparoscope—a thin tube equipped with a camera and light—into the incisions. The laparoscope allows the surgeon to examine and remove the adrenal gland.

Adrenalectomy improves blood pressure and returns potassium levels to normal in nearly all patients. In about 30% of cases, adrenalectomy also cures high blood pressure completely. Most people, however, will need to take some medications to control blood pressure even after having the affected adrenal gland removed.

After surgery, patients should see their doctor regularly to monitor their blood pressure and potassium levels and to determine the appropriate doses of any necessary medications

Medications. For people who cannot or do not want to undergo adrenalectomy—and for those who have hyperplasia of both adrenal glands—medications can help control blood pressure and normalize potassium levels. Before undergoing surgery, people may also need to take these medications to control their blood pressure and potassium levels.

Aldosterone receptor antagonists. These drugs cause the body to excrete excess salt and water, though not potassium, during urination. This helps lower blood pressure and increase potassium levels.

Potassium-sparing diuretics. These may be used to help lower blood pressure in people who do not tolerate aldosterone receptor antagonists. Diuretics, or water pills, work by increasing the amount of water and salt that gets excreted during urination. Potassium-sparing diuretics increase urination without potassium loss.

Type of Doctor Department : An endocrinologist

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