Aldosterone Excess ∞ Area

Aldosterone Excess

Meaning

Aldosterone excess describes abnormally high aldosterone production, primarily from the adrenal glands. This hormonal imbalance causes electrolyte disturbances—sodium retention and potassium excretion—often resulting in hypertension. Understanding this condition is crucial for precise clinical management.

Context

Aldosterone, a key component of the Renin-Angiotensin-Aldosterone System, regulates blood pressure and fluid-electrolyte homeostasis. In excess, its feedback loops disrupt, leading to dysregulation of fluid volume and electrolyte concentrations. This imbalance significantly impacts cardiovascular and renal health.

Significance

Recognizing aldosterone excess is paramount in clinical practice, representing a common, often overlooked cause of secondary hypertension, particularly resistant hypertension. Accurate identification allows targeted interventions, significantly improving blood pressure control, mitigating hypokalemia, and reducing long-term cardiovascular and renal complications. Prompt diagnosis enhances patient prognosis.

Mechanism

Aldosterone acts on renal collecting ducts and distal tubules, activating mineralocorticoid receptors. This promotes increased sodium and water reabsorption, enhancing potassium and hydrogen ion excretion. In excess, this sustained activity leads to chronic volume expansion, systemic hypertension, and persistent potassium depletion. Primary excess often stems from adrenal adenomas or bilateral adrenal hyperplasia.

Application

Clinical suspicion arises in patients with resistant hypertension, spontaneous hypokalemia, or hypertension with adrenal incidentalomas. Diagnostic protocols involve initial screening with the aldosterone-to-renin ratio, followed by confirmatory tests. Management strategies vary, from mineralocorticoid receptor antagonists for bilateral adrenal hyperplasia to unilateral adrenalectomy for aldosterone-producing adenomas. Personalized treatment is crucial.

Metric

Assessment involves precise measurement of plasma aldosterone concentration (PAC) and plasma renin activity (PRA). The aldosterone-to-renin ratio (ARR) serves as a primary screening tool; elevated ratios suggest potential excess. Confirmatory dynamic tests like saline infusion or oral sodium loading validate the diagnosis. Serum potassium, renal function, and adrenal imaging provide crucial supporting information.

Risk

Unaddressed aldosterone excess poses substantial health risks, including severe, often refractory hypertension, leading to elevated cardiovascular risk. Chronic potassium depletion causes muscle weakness, cardiac arrhythmias, and metabolic alkalosis. Prolonged high aldosterone levels directly damage target organs. Early detection and appropriate management are crucial.

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HRTioJuly 22, 2025