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Feline primary hyperaldosteronism (often abbreviated PHA) is a disorder in which an adrenal gland produces too much aldosterone, a hormone that controls how the body handles sodium and potassium. The excess commonly causes potassium loss and can raise blood pressure. Early signs may be subtle, and the diagnosis rests on combining several findings rather than on one test. When the disease comes from a single adrenal gland, removing that gland is generally the preferred treatment once the cat has been stabilized. Medical management is the alternative when surgery is not suitable. This article is educational and does not replace a veterinary examination. Test interpretation, medications, and doses must be chosen and monitored by your veterinarian.
What aldosterone does and what goes wrong
Aldosterone tells the kidneys to hold on to sodium and let potassium go. In a healthy cat, its output rises and falls with the body’s needs. In primary hyperaldosteronism, the adrenal gland makes more of it than the body requires, and the regulation no longer follows normal feedback. The result is a tendency toward low potassium and high blood pressure, which are the two clues veterinarians look for first.
Why is my cat’s potassium low?
Low blood potassium, called hypokalemia, is one of the most common clues. The American Animal Hospital Association (AAHA) notes that in this condition hypokalemia is frequently below 3 mEq/L, while serum sodium is usually normal. A low potassium result is a reason to investigate, not a diagnosis on its own, because several other conditions can also lower potassium. A 2010 veterinary review by Rhonda L. Schulman, based on the evidence available at that time, cautioned that treating low potassium as the deciding screening criterion can lead to late diagnosis or missed cases. Its findings should not be read as a current estimate of how often the condition occurs.
Some findings should prompt a closer look, according to the AAHA guideline:
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- Unexplained hypokalemia, especially when it responds poorly to potassium supplementation.
- Hypertension in a cat without concurrent heart or thyroid disease.
- Nonspecific illness in a middle-aged or older cat, which is the point at which blood pressure should be measured.
Signs can be subtle in the early stages, so a cat may look well while these laboratory and blood pressure changes are already present.
Can an adrenal mass cause high blood pressure in a cat?
It can, but a mass on an ultrasound scan is not proof of primary hyperaldosteronism. The MSD Veterinary Manual notes that an adrenal mass may be nonfunctional or may secrete other hormones, including catecholamines, cortisol, or sex hormones. Only a mass that produces aldosterone fits this disease, and that has to be shown by the laboratory and clinical picture.
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The reverse is also true. AAHA reports that imaging may reveal a unilateral adrenal mass, sometimes up to 5 cm across, but that some affected cats have adrenal glands that look apparently normal. A normal scan therefore does not rule the disease out. Whether the change is on one side or both sides matters greatly for treatment planning, and it is the veterinary team that weighs these results together.
How is primary hyperaldosteronism diagnosed in cats?
There is no single decisive test. A typical work-up combines the following elements, with the veterinarian interpreting them together:
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- History and physical examination, including a search for other causes of the cat’s signs.
- Blood pressure measurement, which the AAHA guideline treats as part of routine care for adult cats.
- Serum biochemistry, to assess potassium, sodium, and kidney values.
- Plasma aldosterone concentration. AAHA describes this as the most readily available and reliable laboratory diagnostic tool. A single very high result may be confirmatory. Equivocal results may need more complex testing.
- Adrenal imaging, usually ultrasound, to look for a unilateral mass, with the understanding that a normal-looking gland does not exclude disease.
- Adrenal histopathology, the microscopic examination of adrenal tissue, which is available once a gland has been removed. The small case series described below used it to confirm diagnoses.
Some questions remain outside what this work-up can settle. Imaging alone cannot reliably tell whether the opposite gland is involved. Blood pressure can also be raised by chronic kidney disease, so a high reading does not identify its cause. And no single result predicts how a particular cat will fare.
Does a cat with hyperaldosteronism need surgery?
Not every cat does. The MSD Veterinary Manual and the AAHA guideline agree on the general approach. Removing the affected adrenal gland is the treatment of choice for confirmed unilateral disease when feasible, but the cat should first be medically stabilized. Where surgery is not suitable, medical management is the option. The two approaches are compared below.
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Medical management
Medical care targets low potassium and high blood pressure. AAHA identifies potassium supplementation, usually as potassium gluconate, as part of treatment. The same guideline lists spironolactone at 1–2 mg/kg twice daily as a regimen. These figures are published veterinary guideline information, not instructions for owners, and a veterinarian selects the formulation and dose and monitors the response. The American College of Veterinary Internal Medicine (ACVIM) notes that amlodipine is often also needed for adequate blood pressure control. In its guidance, facial dermatitis and excoriation associated with spironolactone are reported as rare.
Medication is only effective if it is given. In the small case series, one cat was euthanized 50 days after treatment began because the owner could not medicate it. If pill-giving is a problem at home, raise it with your veterinarian before the regimen is set.
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Adrenalectomy
Surgery removes the affected gland. The MSD Veterinary Manual describes adrenalectomy as an advanced procedure with considerable risk. It also reports long survival among cats without metastasis that survive to discharge, although such cats often ultimately die of comorbidities. Surgery does not guarantee a cure for high blood pressure. ACVIM notes that concurrent nonadrenal disease, such as chronic kidney disease, can contribute to hypertension, so a cat may still need blood pressure medication after the operation.
Medical and surgical options compared
| Factor | Medical management | Adrenalectomy |
|---|---|---|
| Best fit | Cats for whom surgery is not suitable, per the MSD Veterinary Manual and AAHA | Confirmed unilateral adrenal tumor disease when feasible, after medical stabilization |
| What it addresses | Potassium and systemic hypertension, using supplementation, spironolactone, and often amlodipine | Removes the affected gland; blood pressure may still need medication afterward |
| Key requirements | Reliable administration of medication and veterinary monitoring | Surgical candidacy and an anesthetic and perioperative plan |
| Main limits | Ongoing treatment; some cats cannot be medicated consistently | Considerable risk per the MSD Veterinary Manual; outcome depends on comorbidities |
| Long-term outcome | Not established as a current survival estimate; see the small case series below | Long survival reported for cats without metastasis that survive to discharge (MSD Veterinary Manual); a current percentage is not established |
Blood pressure, kidneys and what to expect
AAHA states: “Blood pressure measurement should be a standard of care for adult cats at least annually, and any time a middle-age to older cat presents with nonspecific clinical signs.” This is broad guidance for all adult cats, not a recommendation limited to primary hyperaldosteronism.
Prognosis depends on how extensive the disease is, on the surgery and the perioperative course where surgery is performed, and on comorbidities such as chronic kidney disease. The most detailed published information is a 2005 case series in the Journal of Feline Medicine and Surgery, which describes 13 diagnosed cats. Three were treated medically and ten underwent adrenalectomy after stabilization. In the medical group, two cats survived 304 and 984 days before being euthanized for chronic renal failure, and the third was euthanized at 50 days because the owner could not medicate it. This is a small, older series. It cannot provide a universal outcome, a current survival estimate, or a fair comparison of treatment effectiveness.
The evidence also does not establish a reliable population figure for how common feline primary hyperaldosteronism is, so the condition should not be judged rare or common from published numbers.
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- Did the aldosterone result, potassium, and blood pressure agree, and what would make the result equivocal?
- Does the imaging show a change on one side only, or is there a question about the other gland?
- Is there a sign of chronic kidney disease that could also be raising blood pressure?
- Has anyone checked my cat’s eyes for damage from high blood pressure?
- Is my cat a suitable candidate for adrenalectomy, and what would stabilization involve first?
- If medication is needed, what dose, formulation, and monitoring schedule are proposed, and what should I do if my cat will not take the tablets?
Further reading is available from the AAHA 2023 guideline on feline hyperaldosteronism, the MSD Veterinary Manual entry on feline primary hyperaldosteronism, the ACVIM guidelines on systemic hypertension in dogs and cats, and the 2005 case series of 13 cats.
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