Do I Have PA?

You may have come to this website because you are concerned about your hypertension, and are searching for answers. Perhaps your hypertension has become difficult to control or you are “just not feeling quite right,” and are worried that something else might be going on. One in four patients with resistant hypertension actually have primary aldosteronism, so it is quite reasonable to ask: “Do I have PA?” For most patients, primary aldosteronism slowly develops over many years. Since excess aldosterone causes irreversible damage, it is critical to get a diagnosis, and start treatment as early as possible.

Primary Aldosteronism is Commonly Misdiagnosed

Nearly everyone with primary aldosteronism begins with a diagnosis of essential hypertension. That’s to be expected. Hypertension is a very common condition with some 3 million new cases each year in the US alone. In most cases, the exact cause of hypertension is not known, although there are many contributing factors, including:

  • Obesity,
  • Too much salt in the diet,
  • Lack of exercise,
  • Smoking,
  • Excess alcohol consumption, and
  • Older age.

Because essential hypertension — where the underlying cause of hypertension is unknown — is such a common condition, primary care physicians tend not to consider secondary causes, like primary aldosteronism, until patients develop serious problems. There is a mistaken belief throughout the medical community, and especially among primary care physicians, that primary aldosteronism is a rare condition. This “belief” is incorrect: 25% of those who have secondary hypertension actually have primary aldosteronism. More importantly, researchers have recently demonstrated that primary aldosteronism actually affects up to half of those who have essential hypertension.

The PA Foundation was created to advocate, on behalf of patients, for the recognition of the high prevalence of primary aldosteronism, and for its proper diagnosis and treatment. We invite you to join our effort by signing the Foundation’s Open Letter, sharing your story, and supporting our organization to make the paradigm shift needed to adequately address PA, a reality for every individual worldwide.

As the disease progresses, your blood tests may show elevated blood sugar when fasting (i.e., impaired fasting glucose), or other early signs of diabetes. You may have an abnormal EKG, or an echocardiogram may indicate Left Ventricular Hypertrophy (LVH). Your kidney functions may decline, and you may develop chronic kidney disease.

Since each of these conditions are relatively common and can have other causes, they are usually treated separately without any connection to primary aldosteronism. Patients are sent to separate specialists without team-based coordination of their care, and on the long road to a belated diagnosis of PA, they are unsuccessfully treated for widely differing disorders while primary aldosteronism remains ignored.

It is thus critical that patients advocate for themselves, and ask more questions of their physicians.

Symptoms of Primary Aldosteronism

Primary aldosteronism is considered a syndrome. Multiple symptoms are associated with it. Because patients develop primary aldosteronism over many years, the intensity of these symptoms usually increase as the disease progresses. Some patients may experience a wider range of symptoms than others.

In many patients, the following signs are indicative of primary aldosteronism:

  • Fatigue, which can be debilitating and does not improve with sleep,
  • “Brain fog” or cognitive impairment ranging from memory loss to difficulty focusing,
  • Polyuria,
  • Nocturia,
  • Edema,
  • Significant weight gain,
  • Reduced resistance to stress, and
  • Reduced physical endurance.

The sodium reabsorption caused by excess aldosterone is accompanied by potassium loss. The greater the loss, the more intense symptoms are:

  • Palpitations (i.e., irregular, strong or fast heartbeat),
  • Muscle fatigue,
  • Muscle cramps, or even spasms and paralysis.

Some patients report difficulty maintaining sufficient magnesium levels, and find that increasing their magnesium intake improves their potassium levels. In response to sodium reabsorption, the kidneys also release hydrogen. Because hydrogen must be tightly controlled to maintain optimal acid balance, the body compensates for the loss of hydrogen with an increase in bicarbonate. The mechanism is called alkalosis, and patients with PA who are subject to it often experience shallow breathing.

Since calcium channels are also involved in aldosterone production, primary aldosteronism is also found to cause calcium malabsorption. At the recommended daily allowance of 1,000 mg, some patients experience irregular heartbeat and palpitations. A lot of patients develop early onset and/or severe osteoporosis, others experience Vitamin D deficiency and kidney stones.

Since excess aldosterone is associated with cardiovascular and renal disease, patients with PA often experience some of the signs and symptoms of these diseases:

  • Headaches,
  • Dizziness,
  • Flushing which, in women, is nearly always mistaken for perimenopause and menopause,
  • Shortness of breath,
  • Lightheadedness,
  • Chest tightness, chest discomfort,
  • Pain, numbness, tingling in the extremities,
  • Fatigue,
  • Edema,
  • Polyuria,
  • Nocturia, and
  • Kidney stones.

Excess aldosterone is known to be associated with eye diseases — particularly those affecting the retina. In those instances, patients with PA will experience floating specks or webs, as well as blurred or distorted vision.

With primary aldosteronism, some patients develop sudden allergies (e.g. to drugs and foods, or seasonal), others frequently experience:

  • Dysgeusia (i.e. a metallic taste in the mouth),
  • Dry eyes,
  • Dry mouth,
  • Nasal congestion,
  • Hyperhidrosis (i.e. excessive sweating),
  • Thirst, and
  • Constipation and other digestive issues.

Overall, excess aldosterone triggers inflammation processes which, in most patients with PA, manifest as generalized pain and unwellness, and is usually mistaken for fibromyalgia. Similarly, patients with PA often experience sleep disorders and/or sleep apnea, anxiety and/or irritability, and are erroneously diagnosed with depression while the condition is in fact also caused by excess aldosterone.

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References

  • John W. Funder, Robert M. Carey, Franco Mantero, M. Hassan Murad, Martin Reincke, Hirotaka Shibata, Michael Stowasser, William F. Young, The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline, The Journal of Clinical Endocrinology & Metabolism, Volume 101, Issue 5, 1 May 2016, Pages 1889–1916, DOI: 10.1210/jc.2015-4061
  • William F. Young, Jr. Diagnosis and treatment of primary aldosteronism: practical clinical perspectives. The Journal of Internal Medicine, Volume 285, Issue 2, February 2019, DOI: 10.1111/joim.12831