Primary hyperaldosteronism—also known as Conn’s syndrome—is a condition in which one or both adrenal glands produce excess aldosterone, a hormone that helps regulate blood pressure and potassium levels. This hormone imbalance can lead to difficult-to-control high blood pressure, low potassium, and increased cardiovascular risk if left untreated.
At Saint John’s Health Center in Santa Monica, our Endocrine Center of Excellence provides advanced diagnostic testing and personalized treatment—including minimally invasive adrenal surgery and long-term medical management—designed to restore hormonal balance and protect long-term heart and kidney health.
What Is Primary Hyperaldosteronism?
Primary hyperaldosteronism occurs when excess aldosterone is produced due to a disorder within the adrenal glands themselves. Aldosterone normally helps regulate sodium, water, and potassium levels, playing a key role in maintaining healthy blood pressure.
When too much aldosterone is present, the body retains sodium and water while losing potassium. Over time, this imbalance can strain the cardiovascular system, increase the risk of stroke or heart disease, and contribute to persistent hypertension that may not respond to standard medications.
Causes of Primary Hyperaldosteronism
Identifying the underlying cause of Conn’s syndrome is essential, as treatment strategies and outcomes differ depending on whether one or both adrenal glands are involved. Advanced diagnostic testing helps determine the exact source of hormone overproduction.
Solitary Adrenal Nodule (Aldosteronoma)
The most common cause of primary hyperaldosteronism is a small, benign tumor—called an aldosteronoma—affecting one adrenal gland. These nodules are typically less than 2 centimeters in size and produce aldosterone independently of the body’s normal regulatory signals.
When properly identified, this form of the condition is often highly treatable and may be curable with minimally invasive surgery that removes the over-producing adrenal gland.
Bilateral Adrenal Hyperplasia
In some patients, both adrenal glands become overactive due to diffuse enlargement, a condition known as bilateral adrenal hyperplasia. Rather than a single tumor, hormone excess results from continuous aldosterone production across both glands.
This form is typically managed with medication rather than surgery and requires ongoing follow-up to optimize blood pressure and potassium levels.
Signs and Symptoms of Conn’s Syndrome
Symptoms of primary hyperaldosteronism can vary widely and may develop gradually over time. Many patients are diagnosed during evaluation for high blood pressure that remains uncontrolled despite multiple medications.
- Difficult-to-control high blood pressure
- Low potassium levels (sometimes without symptoms)
- Muscle weakness, cramping, or fatigue
- Frequent urination or increased thirst
- Headaches, palpitations, or flushing related to hypertension
- Occasionally few noticeable symptoms despite increased cardiovascular risk
Diagnosis of Primary Hyperaldosteronism
Diagnosis typically occurs in two stages and is designed to both confirm hormone excess and identify its source. Accurate diagnosis is critical for guiding the most effective treatment plan.
Hormonal Testing
Initial evaluation includes blood tests measuring aldosterone, renin, potassium, and related markers. A hallmark of Conn’s syndrome is elevated aldosterone with suppressed renin activity, indicating hormone production that is not properly regulated by the body.
Your care team may recommend additional confirmatory testing to ensure results are accurate before moving forward with imaging and localization.
Imaging and Localization
After biochemical testing confirms the diagnosis, imaging studies such as CT or MRI are used to evaluate the adrenal glands. In many cases, adrenal vein sampling is performed to determine whether excess aldosterone is coming from one gland or both.
Needle biopsy of adrenal tumors is generally not recommended because it does not reliably guide treatment decisions and may introduce avoidable risk.
Risk Factors for Conn’s Syndrome
Certain factors increase the likelihood of developing primary hyperaldosteronism. Awareness of these risk factors can help prompt earlier testing and diagnosis—especially for patients with resistant hypertension.
- Long-standing or resistant high blood pressure
- Family history of primary hyperaldosteronism or early-onset hypertension
- Stroke at a young age in the setting of hypertension
- Genetic forms of aldosterone excess (such as glucocorticoid-remediable aldosteronism)
Treatment and Management at Saint John’s
Treatment is individualized based on whether aldosterone excess originates from one adrenal gland or both. Our multidisciplinary team collaborates across endocrinology, imaging, and minimally invasive surgery to create a clear, coordinated plan of care.
Unilateral Disease – Surgical Treatment
For patients with a solitary aldosterone-producing adrenal nodule, laparoscopic adrenalectomy is often the preferred treatment. This minimally invasive procedure removes the overactive adrenal gland through small incisions, helping reduce recovery time and postoperative discomfort.
Many patients experience meaningful improvement in blood pressure control and may be able to reduce the number of blood pressure medications after surgery.
Bilateral Disease – Medical Management
When both adrenal glands are involved, treatment usually focuses on medical therapy rather than surgery. Aldosterone-blocking medications can help counteract hormone effects, and nutrition and lifestyle changes can further support blood pressure control.
- Aldosterone antagonists (such as spironolactone or eplerenone)
- Lower-sodium diet and heart-healthy lifestyle changes
- Regular monitoring of potassium, aldosterone, renin, and cardiovascular risk
Follow-Up and Prognosis
Long-term outlook is highly favorable when Conn’s syndrome is properly treated. Surgical patients typically receive follow-up lab testing and cardiovascular assessment to confirm hormone normalization and monitor blood pressure trends.
For patients managed with medication, ongoing follow-up helps stabilize potassium levels, adjust therapy over time, and reduce long-term complications. Our team provides personalized follow-up plans that reflect your health goals and overall risk profile.
Why Choose Saint John’s Endocrine Tumor Program?
Our Endocrine Tumor Program combines clinical expertise with advanced diagnostics and a coordinated, patient-centered approach. Patients benefit from specialty care that supports them from diagnosis through treatment and long-term follow-up.
- Fellowship-trained endocrine and adrenal surgeons
- On-site hormone testing and adrenal vein sampling
- Access to minimally invasive and robotic adrenal surgery
- Close coordination with cardiology, nephrology, and hypertension specialists
- Multidisciplinary support to ensure continuity of care
If you have questions regarding Hyperaldosteronism (Conn’s Syndrome) or other endocrine-related conditions, please call today. Request an appointment
