Secondary Hyperaldosteronism

By | June 10, 2022

Secondary hyperaldosteronism occurs when aldosterone levels are high. The phenomenon accompanies organ diseases such as liver cirrhosis, heart failure or chronic kidney disease. Treatment depends on the primary cause in each individual case.

What is Secondary Hyperaldosteronism?

Aldosterone is a steroid hormone produced by the adrenal cortex. In addition to increasing blood pressure, the hormone increases the reabsorption rate for sodium and water within the distal renal tubule. Hyperaldosteronism refers to disease states with increased aldosterone secretion. For slang insulinoma, please visit

The elevated level of the hormone manifests itself in symptoms such as hypertension, hypokalemia, and metabolic alkalosis. As a result, the patients suffer from an increase in blood pressure, potassium deficiency and an increase in the pH value in the blood. Many forms of hyperaldoteronism are caused by disorders of the adrenal cortex.

Secondary hyperaldosteronism is independent of adrenal dysfunction. Instead, this variant is based on pathologically increased stimulation of the renin-angiotensin-aldosterone system. This system is a regulatory cycle that controls the fluid and electrolyte balance in the human body and thus has a decisive impact on blood pressure.


Secondary hyperaldosteronism is not a disease in its own right. Rather, it is a symptom of another underlying disease. In this context, chronic kidney diseases such as renal artery stenosis, nephrosclerosis or chronic glomerulonephritis are possible primary causative diseases.

Significantly more angiotensin II is reactively formed as a result of a reduction in renal blood flow. In addition, secondary hyperaldosteronism can occur in all other diseases that are associated with a reduction in the currently circulating blood volume. In this case, the renin-angiotensin-aldosterone system is activated via the hypovolemia.

These processes are characteristic of diseases such as heart failure and cirrhosis of the liver. In addition, diarrheal diseases, states with vomiting and the administration of laxatives can cause an electrolyte shift and thus stimulate an increase in the activity of the renin-angiotensin-aldosterone system.

Symptoms, Ailments & Signs

Classically, secondary hyperaldosteronism is characterized by a symptomatic triad of hypertension, potassium deficiency, and metabolic alkalosis. All additional symptoms provide important information about the primary cause in individual cases. For example, a symptomatic increase in blood pressure does not occur in all forms of secondary hyperaldosteronism.

If there is an increase in blood pressure, chronic kidney diseases such as renal hypertension and renin-producing tumors are possible triggers. In addition, there may be drug abuse, such as lacancy abuse. If edema accompanies the symptoms, this speaks more for causal cardiac insufficiency, liver cirrhosis or, more rarely, a nephrotic syndrome.

All forms of secondary hyperaldosteronism that occur without hypertension or edema are almost always due to laxative abuse or prolonged diarrhea and vomiting symptoms. In the case of diarrhea or vomiting in particular, other symptoms such as weight loss or malnutrition appear. Symptoms of the skin, hair and nails can indicate deficiency symptoms.

Diagnosis & course of disease

Secondary hyperaldosteronism must always be differentiated from the primary form of hyperaldosteronism in the context of diagnostics. This demarcation primarily includes the exclusion of disorders of the adrenal cortex. In this context, imaging can exclude tumors of the adrenal cortex, for example.

In principle, evidence of hyperaldosteronism is provided by diagnostic parameters such as increased aldosterone and renin concentrations in the serum. Subsequent fine-tuning consists of systematic cause research. In addition to anamnesis and medical history of the patient, imaging of the organs can be an important step, especially imaging of the kidneys, liver and heart.

Further laboratory diagnostics may also be necessary in individual cases. In the case of drug abuse, for example, proof of the abused active ingredient must be provided. In most abuse cases, the patients themselves cannot be persuaded to confess. Family and friends are often accomplices, but are often ashamed of not having intervened.


As with primary hyperaldosteronism, secondary hyperaldosteronism is also complicated by the classic triad of metabolic alkalosis, hypertension, and hypokalemia. However, secondary hyperaldosteronism can have additional complications caused by the underlying diseases. Here, hyperaldosteronism is only one symptom of the respective disease.

The metabolic alkalosis resulting from hyperaldosteronism leads to reduced ventilation of the lungs. At the same time, hypokalemia occurs due to the exchange of intracellular hydrogen ions for extracellular potassium ions. Depending on the severity, hypokalemia can lead to muscle weakness, paralysis of the smooth muscles, cardiac arrhythmias through to ventricular fibrillation, muscle fiber breakdown or kidney failure.

At the same time, the constantly high blood pressure causes chronic cardiovascular problems that can promote a heart attack or stroke. Particularly when the secondary hyperaldosteronism is caused by kidney disease, blood pressure can constantly increase as part of a self-reinforcing process. The high blood pressure impairs kidney function, which in turn increases secondary hyperaldosteronism.

When edema occurs as part of secondary hyperaldosteronism, the underlying disease is often liver cirrhosis, heart failure, or nephrotic syndrome. Depending on the severity, cardiac insufficiency can lead to severe respiratory problems and impaired consciousness, to states of confusion and even coma. Liver cirrhosis can only be completely cured with the help of a liver transplant. Left untreated, it leads to death in the long term. As part of the nephrotic syndrome, complete renal failure is possible.

When should you go to the doctor?

This disease should always be treated by a doctor. Only proper medical treatment can prevent further complications. In the worst case, the affected person dies untreated from the symptoms of this disease. For this reason, early diagnosis with early treatment is very important in hyperaldosteronism.

A doctor should be consulted for hyperaldosteronism if the affected person suffers from severely elevated blood pressure. This complaint appears for no particular reason and does not go away on its own. A permanent lack of potassium can also indicate the disease and should also be examined by a doctor. Most sufferers of hyperaldosteronism also show weight loss and various other deficiency symptoms. The nails, skin or hair can also be negatively affected by this disease.

The disease can be diagnosed by a general practitioner. However, the further course and further treatment depend heavily on the exact cause of the disease, so that no general prognosis can be given.

Treatment & Therapy

For patients with secondary hyperaldosteronism, therapy depends on the primary cause. As far as possible, the medical team strives for a causal treatment of the primary disease. This is a treatment approach that tries to eliminate the root cause.

In the case of heart failure, the treatment options range, for example, from conservative drug approaches to lifestyle changes and invasive procedures. In addition to implantable devices, invasive approaches include transplants. In the case of renal insufficiency due to chronic kidney disease, dietary changes are used as supportive treatment steps.

A diet low in protein and salt inhibits any accumulation of fluid in the kidney area. Drug interventions focus on the administration of draining diuretics to increase fluid excretion. The patient must keep a kind of diary about the fluid intake. Advanced kidney damage requires additional detoxification measures.

As a rule, long-term dialysis treatment is used in the later course of renal failure. Complete healing of chronic kidney disease is only possible through transplantation of a donor organ. The same applies to patients with causative liver cirrhosis.

Abstinence from substances that are toxic to the liver, such as alcohol, is just as important in the context of liver cirrhosis as is a balanced diet and the compensation of deficiencies, such as folic acid deficiency or vitamin deficiency. If necessary, the protein intake is reduced. Ultimately, however, the supportive treatment measures can at best delay liver cirrhosis that has already started.

Therefore, the only chance of a cure for this disease is a liver transplant. When drug abuse is responsible for secondary hyperaldosteronism, treatment is usually easier. In the future, abstinence from the respective medication will apply, if necessary in the form of supervised withdrawal. Diuretics can be administered to flush out the causative substances.


Secondary hyperaldosteronism can only be prevented to the extent that its causes can be prevented. In the broadest sense, a balanced diet, exercise and abstinence from toxins can be counted among the preventive measures.


For aftercare of secondary hyperaldosteronism, the causes of the disease must be permanently combated. If liver cirrhosis was the cause of secondary hyperaldosteronism, it should be treated sustainably. The therapy consists of renouncing the supply of toxins that damage the liver (alcohol, medicines) and compensating for existing vitamin deficiency diseases.

If a kidney disease was the cause of secondary hyperaldosteronism, it must be treated for life. This can be done surgically or with medication. If a tumor has caused the secondary hyperaldosteronism, regular examinations of the tumor markers in the blood and imaging methods (MRI, CT, ultrasound) should be used in order to be able to identify and treat a recurring tumor as quickly as possible.

If cardiac insufficiency was the cause of the secondary hyperaldosteronism, it must be treated permanently by cardiology. If the cause was a pregnancy, regular tests of the aldosterone levels in the blood only have to be carried out in the case of renewed pregnancies. In all other cases, the potassium and aldosterone levels in the blood should be checked regularly in order to detect the recurrence of hyperaldosteronism at an early stage.

If the potassium level in the blood is too low, artificial potassium should also be taken as a dietary supplement. In addition, a long-term low-sodium diet can support the healing process and prevent hyperaldossteronism from recurring.

You can do that yourself

Depending on the cause of the disease, secondary hyperaldosteronism can often be combated by changing your lifestyle. For example, changes in the daily diet lower blood pressure, which increases the chances of recovery. In addition, patients should follow the doctor’s advice and take the medication as prescribed.

Self-help primarily relates to healthy eating. A low-salt diet with little protein can prevent kidney problems and also increase fluid excretion. If necessary, the affected persons take diuretics at the same time. In many cases, patients keep accurate records of how much fluid they take. This helps them keep track of things when they have kidney failure. The recordings serve as self-monitoring and are also useful for the doctor. Harmful substances such as alcohol should be taboo for those affected. In addition, foods containing folic acid and vitamins compensate for any deficiencies that may exist.

When the condition is caused by drug abuse, the principles of healing are relatively simple. Patients should refrain from medication and instead rely on a nutritious diet. Those affected need a certain discipline to do this.

Secondary Hyperaldosteronism