A Syndrome of High Blood Pressure - Research Paper Example

? Aldosteronism Aldostereonism “is a syndrome of high blood pressure and low blood potassium levels caused by an excess of the mineral corticoid called aldosterone.” (“Aldosteronism”, APMA para.1). An alternate name for this condition is Hyperaldosteronism. There are two types of Aldosteronism: Primary Aldosteronism and Secondary Aldosteronism. Aldosteronism is associated with other health problems such as heart disease and kidney disease. However most cases are caused by a tumor in the adrenal glands. Treatments for the disease include surgery, medications and certain lifestyle changes. Generally prognosis for treatment is positive but complications such as persistent high blood pressure may occur. Aldosterone is “a hormone produced by the outer portion (cortex) of the adrenal gland.” (“Aldosterone”) Aldosterone balances sodium and potassium levels in the blood. If excess aldosterone is produced in the body it may result in low potassium levels, under acidity of the body (alkalosis), muscle weakness, excessive thirst and urination, and high blood pressure. (“Aldosteronism, APMA)When physicians diagnose patients with low sodium levels and high blood pressure they may have them undergo additional testing to find out if they have Aldosteronism because of aldosterone’s normal function of increasing sodium and fluid in the bloodstream and to increase potassium excretion in the kidney. Blood tests or urine tests can be used to measure high levels of aldosterone. A special blood test known as the plasma rennin activity can be used to determine whether a patient has Primary Aldosteronism or Secondary Aldosteronism. If patients are determined to have Primary Aldosteronism further testing is needed by an endocrinologist to distinguish an adenoma from bilateral hyperplasia.”Both diseases can cause an over secretion of the salt retaining hormone aldosterone.” (“Primary Hyperaldosteronism (Conn’s Syndrome, para.3) After this testing a CT scan of the stomach may be performed to pinpoint the area of the body that the disease originated from. (“Aldosteronism”, APMA) Primary Aldosteronism occurs when the human’s body adrenal glands produce excess amounts of aldosterone leading to the decrease of potassium levels resulting in high blood pressure. This form of Aldosteronism generally results from a tumor in the adrenal glands. (Primary Aldosteronism) Primary Aldosteronism has been considered to be rare, but recent evidence shows it can occur in approximately one in ten patients with high blood pressure. “If we consider that hypertension is present in about 20% of the adult population, primary aldosteronism can no longer be considered a rare disease. Patients with primary aldosteronism have a high incidence of cardiovascular, cerebrovascular and kidney complications. ” (Fagugli & Taglioni, 1) Females are more likely to contract this condition than males and it commonly occurs when people are in their 30’s and 40’s. (Primary Hyperaldosteronism (Conn’s Syndrome)) Primary Aldosteronism is more common in people who have severe hypertension that cannot be treated through medication. “Primary Aldosteronism resulting from adrenocortical adenoma is a common cause of secondary hypertension.” (Chaudry and Said43)Aside from a tumor found in the adrenal glands another common cause of Primary Aldosteronism is the over activity of both adrenal glands. Adrenal adenomas are “benign, tumors of the outer adrenal gland, which often produce aldosterone in an unregulated manner. These tumors affect women more frequently than men.” (Andrews, para.4). Usually the affected adrenal glands need to be surgically removed. In rare cases, primary aldosteronism may be caused by cancerous growths found on the outside of adrenal glands. There is also a rare type of primary aldosteronism called glucocorticoid-remediable aldosteronism (GRA) which is hereditary and can result in high blood pressure in children and young adults. (“Primary Aldosteronism”) Primary Aldosteronism puts individuals with high blood pressure at a greater risk for stroke and heart disease and stroke than those who have high blood pressure alone. However in some cases people who have high blood pressure as a result of Primary Aldosteronism may be cured through medications, and lifestyle modifications. (Primary Aldosteronism: A Curable Cause of Hypertension) The World Health Organization has estimated that approximately 600 million people suffer from high blood pressure. “Based on Hypertension statistics from the American Heart Association, there may be 7 to 11 million people with Primary Aldosteronism in the US alone.” (Primary Aldosteronism: A Curable Cause of Hypertension, para.4)Primary Aldosteronism can be distinguished from hypertension through blood tests. Some conditions associated with excess aldosterone are Mild hypernatremia (high blood sodium), hypokalemia (low blood potassium), hyperkaluria (high urine potassium) and high levels of alkalinity. The symptoms indicating these conditions include muscle weakness, frequent urination, nighttime urination, headache, excessive thirst, pins and needles sensation, visual disturbances, temporary paralysis, muscle twitching and cramps. (Primary Hyperaldosteornism (Conn’s Syndrome)) Primary Aldosteronism only increases the various risks associated with high blood pressure. High aldosterone levels which result from PA can cause heart and blood vessel damage. Other areas of the body may be at risk as well. “Recent experimental studies, however, suggest that long-term exposure to increased aldosterone levels might result in cardiovascular and renal structural damage, independent of the blood pressure level.” (Sechi, Novello, Lapenna, Baroselli, Nadalini, Colussi, and Catena 2638)Some tests that may be used to diagnose PA include an initial screening test where the doctor measures the levels of aldosterone and ludro in the patient’s blood. “The combination of a very low ludro level with a high aldosterone level indicates that primary aldosteronism may be the cause of the patient’s high blood pressure.” (“Primary aldosteronism”, Test and diagnosis section) After this initial test the patient may need to undergo a test to confirm the initial diagnosis. One example of this type of test is an IV saline load test where the patient’s aldosterone levels are tested after sodium mixed with saline is introduced into the bloodstream for several hours. A CT scan of the abdomen may also be performed to help identify a tumor on the adrenal gland which may indicate over activity. The CT scan would have to show an adrenal mass in order for physicians to make a diagnosis of Aldosteronism. Certain urinary tests may be administered to determine whether or not they are high levels of aldosterone to determine presence of the disease. In some cases a physician may also perform an ECG on a patient to test for Primary Aldosteronism. If the ECG shows high heart rhythm abnormalities associated with low potassium levels then the patient has Aldosteronism. (“Hyperaldosteronism”, Endocrine Surgery Encyclopedia) The primary goal of treatment for Primary Aldosteronism is to block the effect of high aldosterone levels and prevent the possible consequences of high blood pressure and low potassium levels. The affected adrenal gland may be surgically removed in order to help regulate blood pressure levels and increase potassium levels. If a patient continues to have high blood pressure after surgery the doctor may prescribe blood pressure medication but they can eventually be weaned off it. Primary Aldosteronism may also be treated with Aldosterone blocking drugs. Spironolactone, a diuretic may be prescribed.If both adrenal glands have become overactive as a result of Primary Aldosteronism a combination of medicines and lifestyle changes can effectively treat the condition. For example a doctor may prescribe a mineral corticoid receptor antagonist called Inspra that acts on aldosterone receptors. People can adhere to a healthy diet, exercise, consume caffeinated and alcoholic beverages in moderation and not smoke. (“Primary Aldosteronism”) Secondary Aldosteronism “is increased adrenal production of aldosterone in response to nonpituitary, extra-adrenal stimuli, including renal artery stenosis and hypovolemia.” (“Secondary Aldosteronism”) According to the Merck Manual for Healthcare Professionals Some conditions that may cause Secondary Aldosteronism include narrowing of the arteries that supply blood to the kidneys, advanced cirrhosis of the liver, heart failure and certain types of kidney disease as well as kidney tumors. (Andrews, 2010). Obstructive renal artery disease such as atheroma and stenosis and accelerated hypertension can result in reduced renal blood flow causing aldostrone to be overly secreted. “Secondary hyperaldosteronism occurs as a consequence of activation of the normal physiologic mechanisms that maintain salt and water balance, blood volume, and blood flow to the kidneys.” (“Hyperaldosteronism”, Brittanica.com, para.6) For example the body loses salt and water after diarrhea, constant vommittimg, or excessive perspiration. During these situations the production of rennin is increased followed by an increase in aldosterone and angiotensin production. As aldosterone production increases, the kidneys reabsorb salt and water from the urine to equalize concentrations in electrolytes and in blood volume. There may be an underlying condition causing Aldosteronism in some patients. Certain tests would have to be conducted in order to make this determination. If a patient is diagnosed with conditions which cause reduced blood flow to a kidney or a drastic decrease in blood pressure, the underlying condition is the primary condition and the doctor would diagnose the Aldosteronism as secondary. Congestive heart failure and cirrhosis of the liver are examples of two conditions that can cause a drastic decrease in blood pressure, and can cause less blood flow to a kidney. Surgery would not necessarily be an option for treating Secondary Aldosteronism. (Hyperaldosteronism, Endocrine Encyclopedia) If treatment is successful rennin, angiotenism and aldsterone production is restored. Drugs that block the prevent overproduction of aldosterone can be given as an alternate if treatment of the main disease is unsuccessful. Only patients with renal artery disease and secondary hyperaldosteronism generally have hypertension or low serum potassium concentrations. Primary and secondary Aldosteronism are the same in the sense that both conditions can result in high blood pressure that cannot be treated with blood pressure medications if left untreated. Muscle weakness, headaches and numbness are possible physical symptoms that are common to Primary and Secondary Aldosteronism. Patients who have been tested for these conditions show evidence of an unusually low blood potassium level because the kidneys excrete large amounts of potassium under the influence of aldosterone. (Andrews) Unlike Primary Aldosteronism, secondary aldosteronism results from a problem outside the adrenal glands. If treated and diagnosed early the prognosis for Primary Aldosteronism is generally positive. However there may be some complications. Approximately “50% of patients will continue to be hypertensive and require lifelong antihypertensive therapy. Risk factors for long-term hypertension include older age at diagnosis.”(Hyperaldosteronism, Patient.co.Uk, Prognosis section) The outlook for Secondary Aldosteronism depends on the primary condition causing it. In rare cases impotence and enlarged breasts may occur in men as a result of long-term spironolactone treatment in men. (“Hyperaldosteronism - primary and secondary”) In general, patients experience rapid and uneventful postoperative recovery. In many cases approximately 80-90 percent of patients who undergo unilateral adrenalectomy for Primary Aldosteronism their blood pressure is lowered. In order to help mitigate the effects of this condition blood pressure and serum electrolytes should be monitored after surgery and/or after the start of medical therapy. It is not entirely clear why approximately five percent of patients may continue to suffer from high blood pressure following surgery for Primary and Secondary Aldosteronism. Up to 5 percent of patients may suffer from ongoing high blood pressure. In the case of Primary Aldosteronism, some experts believe this may be the result of chronic, irreversible kidney damage. (“Primary Hyperaldosteronism (Conn’s Syndrome”) in these cases the blood pressure may need to be monitored by the doctor and the patient. In conclusion there are several ways for physicians to diagnose and treat Primary and Secondary Aldosteronism. Many patients who are treated for these conditions are likely to respond successfully to treatment. However in some cases complications such as continuing high blood pressure may occur. These complications can be overcome through certain lifestyle changes. Works Cited Andrews, Tina. "Causes of Aldosteronism"www.Livestrong.com. 26 Sept.2010. Demand Media Inc. April 30, 2012 . Chaudry, M. Usman, and Sufyan Said. "A Patient with Primary Aldosteronism" Hospital Physician (April 2004): 43. Fagugli, Riccardo, and Taglioni, Chiara. "Changes in the Perceived Epidemiology of Primary Hyperaldosteronism" International Journal of Hypertension Vol. 2011. (2011): 1-7. May 1, 2012 . Rull, Gurvinder. "Hyperaldosteronism” Patient.co.uk. January 28, 2011. May 1, 2012 . Sechi M.D., Leonardo , Marileda Novello, MD, Roberta Lapenna, MD, Sara Baroselli, MD, Elisa Nadalini, MD,Colussi, GianLuca M.D & Catena, Christiana M.D.. "Long-term Renal Outcomes in Patients with Primary Aldosteronism" Journal of the American Medical Association Vol. 22. (2006): 2638. May 1, 2012 . "Hyperaldosteronism".  Encyclopedia Britannica. Encyclopedia Britannica Online. Encyclopedia Britannica Inc., 2012. Web. 30 Apr. 2012 . "Primary Aldosteronism” Mayo Clinic.com. Jan.6, 2011. Mayo Foundation for Medical Education and Research. April 30, 2012 . "Aldosteronism". New Book of Popular Science. 2008. Scholastic Publishing Inc. "Aldosteronism" APMA. Ablemarie Pulmonary Medical Associates. April 30, 2012 . "Hyperaldosteronism-Primary and Secondary Overview" NYTimes.com. May 1, 2012 . “Secondary Aldossteronism.” (n.d.) retrieved April 30, 2012, from The Merck Manual for Health Care Professionals Web Site: http://www.merckmanuals.com/professional/endocrine_and_metabolic_disorders/adrenal_disorders/secondary_aldosteronism.html "Primary Aldosteronism: A Curable Cause of Hypertension" Aldosteronism.com. April 30, 2012 . "Hyperaldosteronism” UCLA Endocrine Surgery Encyclopedia. Feb.27, 2006. May 1, 2012 . "Primary Hyperaldosteronism: Conn's Syndrome" AUAF Foundation. The Official Foundation of the American Urologic Association. May 1, 2012 . “Aldosterone”. New Book of Popular Science. 2008. Scholastic Publishing Inc. . Read More