Hyperaldosteronism Treatment

Treatment

Principles of Therapy

Patients with bilateral adrenal hyperplasia or those unsuitable for surgery is recommended to be treated medically by mineralocorticoid receptor antagonists
- They appear to be effective in blood pressure control and protection for blood pressure-independent target organ

Pharmacotherapy

Spironolactone

First-line agent for the medical treatment of hyperaldosteronism
Mineralocorticoid receptor antagonist that acts on the distal portion of the renal tubule as a competitive antagonist of aldosterone and it also increases sodium and water excretion and reduces potassium excretion
An androgen receptor antagonist and progesterone agonist
Dose-related gynecomastia was observed
A small dose of thiazide diuretic, Triamterine, or Amiloride may be given to avoid the side effects of high dose Spironolactone

Eplerenone

Alternative to Spironolactone
Selective mineralocorticoid antagonist that has no anti-androgen and progesterone agonist effects
It should be given twice daily due to its shorter half-life

Amiloride

An epithelial sodium channel antagonist that can ameliorate blood pressure and hypokalemia
Less efficacious than Spironolactone but may be useful
It has no sex steroid-related side effects but no beneficial effects on endothelial function

Angiotensin-converting enzyme (ACE) inhibitor

Can be added if hypertension persists
For patients with angiotensin II sensitive adenoma or hyperplasia
Efficacy in the low plasma renin state may in part reflect the role of even low concentrations of angiotensin II as an aldosterone secretagogue in adrenal hyperplasia

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