hyperaldosteronism
HYPERALDOSTERONISM
Hyperaldosteronism is a group of disorders in which aldosterone production is inappropriately high, relatively autonomous & non-suppressible by sodium loading.
Signs & symptoms are nonspecific.
Symptoms are caused by hypertension (eg headache), hypokalemia (eg polyuria, nocturia, muscle cramps & weakness, tetany, paralysis, etc) & metabolic alkalosis.

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
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Endocrinology - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Pearl Toh, 20 Jul 2018
Women with pre-eclampsia or gestational hypertension during their first pregnancy had an increased risk of developing chronic hypertension, type 2 diabetes (T2D), and hypercholesterolaemia than those who were normotensive during pregnancy, according to a study. The risk persisted for several decades later, signalling these hypertensive disorders of pregnancy (HDP) as red flags for cardiovascular (CV) health for life.
Roshini Claire Anthony, 30 Jul 2018

Canagliflozin may provide a renoprotective effect in individuals with type 2 diabetes (T2D) and a history of cardiovascular disease (CVD), according to results from the CANVAS* Program.

Stephen Padilla, 31 Jul 2018
Patients with type 2 diabetes (T2D) treated with sulphonylureas as second-line drugs are at an increased risk of myocardial infarction (MI), all-cause mortality and severe hypoglycaemia compared with those who remained on metformin monotherapy, a recent study has found.
22 Jul 2018
There appears to be a nonlinear relationship between total oestradiol and free oestradiol and all-cause mortality among older men, according to data from the Three-City cohort study. Specifically, the association is stronger for cardiovascular disease mortality and nonexistent for cancer mortality.