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
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