Conn's syndrome · Resistant hypertension · Low potassium
High blood pressure with a fixable cause.
Primary aldosteronism is the most common curable cause of high blood pressure, found in 5 to 10 percent of people with hypertension and in 1 in 5 with resistant hypertension. Yet fewer than 1 in 50 are ever tested. Excess aldosterone makes the kidneys hold salt and lose potassium, and it damages the heart, kidneys and blood vessels beyond what the blood pressure number alone would predict. Dr. Hasan is experienced in finding it and treating it.
Who should be tested
The Endocrine Society and, since 2025, the American Heart Association recommend screening for primary aldosteronism in anyone with resistant hypertension, hypertension with low potassium, hypertension with an adrenal nodule, sleep apnea, onset before 40, or a family history of early stroke.
Confirmation is skipped when aldosterone is clearly high with suppressed renin and spontaneous low potassium.
Signs and findings
What excess aldosterone does
- 1High blood pressure, often needing 3 or more medications; atrial fibrillation; left ventricular thickening
- 2Higher stroke risk than blood pressure alone predicts
- 3Salt retention, potassium loss, kidney damage over time
- 4Aldosterone-producing adenoma (one side) or hyperplasia (both sides)
- 5Muscle weakness and cramps when potassium is low
- 6Thirst and frequent urination
- 7Bone loss from urinary calcium wasting
Potassium is normal in more than half of cases, so a normal potassium does not rule it out.
Treatment
- One-sided disease (an aldosterone-producing adenoma, about one third of cases): laparoscopic removal of that adrenal gland cures the aldosterone excess in nearly everyone and cures or markedly improves blood pressure in most.
- Both-sided disease (bilateral hyperplasia): a mineralocorticoid receptor antagonist, spironolactone or eplerenone, blocks aldosterone, normalizes potassium and protects the heart and kidneys. Doses are adjusted until renin is no longer suppressed.
- Everyone: sodium restriction to under 2 grams per day makes every treatment work better and may be enough alone in mild cases.
- Medication interference: ACE inhibitors, ARBs, diuretics and especially spironolactone distort the screening test. A supervised plan swaps them for verapamil, hydralazine or doxazosin for a few weeks when needed.
Dr. Hasan is experienced in screening for and confirming primary aldosteronism, managing antihypertensive medications around testing, coordinating adrenal vein sampling and surgery, and long-term medical therapy for bilateral disease.
Common questions
Can I be tested while on my blood pressure medications?
Often, yes. Most medications only reduce the test's sensitivity. A positive result on treatment is meaningful. If the result is borderline, a few medications are temporarily swapped and the test repeated.
Do I need adrenal vein sampling?
Only if you would consider surgery. It determines whether one or both glands are responsible, because CT alone is misleading in a substantial minority of people over 35.
Will my blood pressure be normal after surgery?
Complete clinical cure occurs in roughly 40 to 50 percent; most of the rest need fewer medications. Younger age, shorter duration of hypertension and fewer medications beforehand predict cure.
Is spironolactone safe long-term?
Yes, with potassium and kidney function monitoring. Breast tenderness or menstrual changes at higher doses can be avoided by switching to eplerenone.
Related conditions
In Wexford or by telehealth in PA and OH