What are the main complications of primary hyperaldosteronism?

Updated: Sep 08, 2020
  • Author: George P Chrousos, MD, FAAP, MACP, MACE, FRCP(London); Chief Editor: Robert P Hoffman, MD  more...
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The main complications of primary hyperaldosteronism are hypertension and hypokalemia.

Hypertension due to hyperaldosteronism can damage many organs and organ systems, including the heart (hypertrophy and myocardial fibrosis), the blood vessels (vascular remodeling with medial and intimal hypertrophy and acceleration of atherogenesis), the eyes (arterial narrowing, retinal ischemia, and papilledema), the kidneys (progressive deterioration with nephrosclerosis), and the brain (hemorrhage).

When patients with untreated PA are compared with patients who have essential hypertension, the risk of previous myocardial infarction or acute coronary syndrome is increased approximately 2.5-fold, cerebrovascular event or transient ischemic attack is increased approximately 3–4-fold, sustained cardiac arrhythmia is increased approximately 5-fold, and peripheral arterial disease is increased approximately 3-fold. [26] Renal disease is also increased in patients with PA. The frequency of 24-hour microalbuminuria in patients with PA (both APA and IHA) is twice that of patients with essential hypertension. Renal insufficiency has been reported to occur in 7-29% of patients with PA, and proteinuria has been reported in 8-24%. [30]

Aggressive blood pressure control and early diagnosis and treatment of the underlying hyperaldosteronism minimize the risk.

Hypokalemia initially results in weakness, constipation, and polyuria; when it is more severe, it may cause cardiac arrhythmias. Patients receiving cardiac drugs are at greater risk for this complication. Hypokalemia also impairs insulin secretion and can promote the development of diabetes mellitus. Of note, hypokalemia should not be considered a diagnostic feature of primary hyperaldosteronism. In some studies, only a minority of patients with PA (9-37%) had hypokalemia. [27] Thus, normokalemic hypertension constitutes the most common presentation of the disease; hypokalemia is probably present in only the more severe cases.

Patients with adenomas are more likely to develop this complication, as are patients who have milder disease but receive treatment with diuretics for their hypertension before the hyperaldosteronism is diagnosed.

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