For nearly ten years, 49-year-old Shilpa Mhatre battled uncontrolled high blood pressure (BP). Despite consulting numerous doctors and taking three medications daily, her condition steadily worsened. She even began experiencing facial spasms that resembled paralysis.
“I believed it was genetic,” said Mhatre, whose father had a history of heart disease. With hypertension affecting 26% of Mumbai’s population, her assumption seemed reasonable. However, her true diagnosis came only last year at KEM Hospital: Primary Aldosteronism (PA).
Primary Aldosteronism: The Hidden Culprit Behind High BP
Primary Aldosteronism is a condition where the adrenal glands secrete excess aldosterone, a hormone that causes salt retention, potassium loss, and elevated blood pressure. For Mhatre, this underlying cause had gone undetected for years.
According to Dr. Tushar Bandgar, head of endocrinology at KEM Hospital, awareness about PA remains alarmingly low, even among medical professionals. “Most patients reach endocrinologists only after years of ineffective treatments,” he explained.
KEM and Nair: Mumbai’s Only Public Hospitals for PA Diagnosis
Only KEM and Nair Hospitals in Mumbai are equipped to diagnose and treat PA. KEM alone treats 800 to 1,000 hypertension patients annually, with endocrinologists estimating that 8-10% of them suffer from PA. Even conservative data indicates that 40 to 50 cases are treated at KEM each year. Hospital-based studies peg the prevalence at 10-15%.
At Nair Hospital, Dr. Girish Rajadhyaksha, head of the medicine unit, sees 50-60 hypertension patients per OPD session. While he believes PA remains rare, Dr. Nikhil Bhagwat, head of endocrinology at Nair, points out that wider screenings have revealed a significant rise in PA cases.
When to Suspect PA: Young Patients and Resistant Hypertension
Doctors emphasize that early-onset high BP can be a red flag for PA. At both KEM and Nair Hospitals, diagnosed patients range in age from 16 to 65.
“When standard BP medications fail, especially in younger individuals, clinicians should consider screening for PA,” said Dr. Bandgar.
Effective Treatment Offers New Hope
Fortunately, treatment for PA is often straightforward. If one adrenal gland is overactive, surgeons can remove it through minimally invasive surgery, often curing the patient entirely—as happened in Mhatre’s case.
When both glands are overactive, doctors remove the one producing more aldosterone, significantly reducing the patient’s dependence on medication.
Advanced Testing and the Role of AVS
As reported by TOI, diagnosis begins with an aldosterone-renin ratio test, followed by confirmatory diagnostics and Adrenal Venous Sampling (AVS). AVS pinpoints which gland is responsible for the excess hormone production.
Dr. Shehla Sheikh, consultant endocrinologist at Saifee Hospital and HN Reliance Hospital, highlighted the importance of precision in AVS. “KEM has become the leading center in the city for AVS due to its expertise and high patient volume,” she said. “Most private hospitals refer patients to KEM for AVS, and later perform the surgery at their own facilities.”
Looking Ahead: Raising Awareness Is Key
Mhatre’s story underscores the critical need for increased awareness and early diagnosis of primary aldosteronism. With the right screening and treatment, patients can avoid years of suffering and medication.