Hyperaldosteronism and Cushing’s syndrome are not the same condition. They are two distinct disorders of the adrenal glands, each caused by the overproduction of a different hormone. Hyperaldosteronism (also called Conn’s syndrome) involves too much aldosterone, a hormone that controls salt and water balance. Cushing’s syndrome involves too much cortisol, a hormone that regulates metabolism, blood sugar, and the stress response. Despite sharing an origin in the adrenal glands, the two conditions look different, feel different, and require different treatments.
Different Hormones, Different Parts of the Gland
Your adrenal glands sit on top of each kidney and are organized in layers, each producing different hormones. Aldosterone is made in the outermost layer, while cortisol is produced in the middle layer. This matters because a growth or abnormality in one layer can leave the other functioning normally. An adrenal tumor causing hyperaldosteronism may have no effect on cortisol levels, and vice versa.
Aldosterone’s primary job is telling your kidneys to hold onto sodium and release potassium. This raises blood volume and blood pressure. Cortisol has a much broader role: it influences how your body uses sugar, fat, and protein, affects immune function, and helps you respond to physical stress. When either hormone is overproduced, it creates a cascade of problems, but those problems look quite different from each other.
How the Symptoms Compare
Hyperaldosteronism is primarily a blood pressure disease. Its hallmark is high blood pressure that resists treatment, often requiring three or more medications without reaching target levels. About 1 in 5 patients with resistant hypertension turn out to have primary aldosteronism. Because excess aldosterone pushes potassium out of the body, people may also experience muscle weakness, cramps, or fatigue from low potassium. Beyond that, the outward physical signs are subtle. You wouldn’t necessarily look different.
Cushing’s syndrome, by contrast, tends to reshape the body in visible ways. Excess cortisol causes fat to redistribute to the face (creating a rounded “moon face”), the upper back, and the abdomen, while the arms and legs may thin out. Skin becomes fragile, bruises easily, and may develop wide purple stretch marks. People often notice muscle weakness, slow wound healing, and thinning bones. Between 20% and 45% of people with Cushing’s syndrome develop diabetes, and up to 70% have some form of glucose abnormality. Cushing’s also raises blood pressure, but it does so through different mechanisms than hyperaldosteronism.
The emotional and cognitive effects differ too. Cushing’s syndrome frequently causes mood swings, anxiety, depression, and difficulty with memory and concentration. Hyperaldosteronism doesn’t typically produce these kinds of neuropsychiatric symptoms.
What Causes Each Condition
Primary hyperaldosteronism is most often caused by either a benign adrenal tumor (an adenoma) that pumps out aldosterone, or by overgrowth of both adrenal glands. Rarely, an adrenal cancer is responsible. The condition is far more common than once believed. Current Endocrine Society guidelines suggest screening all individuals with hypertension by measuring aldosterone, renin, and the ratio between them.
Cushing’s syndrome has a wider range of causes. The most common, by far, is long-term use of corticosteroid medications (prednisone, for example) prescribed for conditions like asthma, lupus, or rheumatoid arthritis. When the cause is internal, it’s usually a small tumor in the pituitary gland that sends excess signaling hormones to the adrenal glands, telling them to overproduce cortisol. This specific scenario is called Cushing’s disease. Less commonly, an adrenal tumor or a tumor elsewhere in the body drives the cortisol excess.
How Each Condition Is Diagnosed
The diagnostic workups are entirely separate. For hyperaldosteronism, the initial screening test measures the ratio of aldosterone to renin in the blood. An elevated ratio (for example, above 30) raises suspicion, and confirmatory testing follows. In some cases, a procedure called adrenal venous sampling is performed to determine whether one or both glands are overproducing aldosterone.
For Cushing’s syndrome, the screening process involves measuring cortisol in different ways: a 24-hour urine collection, a late-night saliva sample, or a blood test after taking a low dose of a medication called dexamethasone, which should normally suppress cortisol production. If cortisol remains elevated despite the medication, Cushing’s syndrome is likely. Imaging and additional hormone tests then help pinpoint the source.
When One Tumor Produces Both Hormones
There is a rare but important overlap. Some adrenal tumors produce both aldosterone and cortisol simultaneously. The exact prevalence isn’t well established, but clinicians are increasingly recognizing these co-secreting tumors. Patients with this overlap face a higher risk of cardiovascular events, including heart attacks, heart failure, and stroke, as well as metabolic complications like glucose intolerance and weakened bones.
This overlap can complicate diagnosis. Cortisol co-secretion can cause false results during adrenal venous sampling, making it harder to localize the problem. Doctors should consider the possibility of a co-secreting tumor when someone with primary aldosteronism also has cortisol that doesn’t suppress on testing, or when the adrenal tumor is larger than 2.5 centimeters. After surgical removal of a co-secreting tumor, patients need to be monitored for adrenal insufficiency, since the healthy adrenal gland may have been suppressed by the excess cortisol and needs time to recover.
Treatment Differences
Treatment for hyperaldosteronism depends on whether one or both glands are involved. If a single adrenal gland is responsible, surgical removal of that gland often cures or significantly improves the condition. If both glands are overactive, the standard approach is long-term use of medications that block aldosterone’s effects, which helps control blood pressure and restore potassium balance.
Cushing’s syndrome treatment targets the cortisol source. If the cause is corticosteroid medication, doctors gradually taper the dose while still managing the underlying condition that required the medication in the first place. If a pituitary tumor is responsible, surgery to remove it is the first-line approach. For adrenal tumors causing cortisol excess, removing the affected gland is standard. In cases where the source can’t be identified or fully removed, both adrenal glands may need to be taken out. This is a more significant intervention: without any adrenal glands, you need lifelong hormone replacement for both cortisol and aldosterone.
Recovery timelines also differ. After successful treatment for hyperaldosteronism, blood pressure often improves within weeks to months, though some patients still need reduced medication long-term. Recovery from Cushing’s syndrome can take longer. The body needs months to readjust to normal cortisol levels, and some symptoms like bone thinning and muscle weakness may improve gradually over a year or more.