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* Abdominal pain
* Abdominal pain
* Somnolence<ref name="urlwww.accessdata.fda.gov3">{{cite web |url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2007/019787s042lbl.pdf |title=www.accessdata.fda.gov |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref>
* Somnolence<ref name="urlwww.accessdata.fda.gov3">{{cite web |url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2007/019787s042lbl.pdf |title=www.accessdata.fda.gov |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref>
* May mask diagnosis of Conn's syndrome
|-
|-
|ACE inhibitors
|ACE inhibitors
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|
* Lisinopril
* Captopril
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|
* Inhibits angiotensin-converting enzyme (ACE) thereby decreasing levels of angiotensin II and blocking the release of aldosterone.<ref name="urlwww.accessdata.fda.gov6">{{cite web |url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/019777s054lbl.pdf |title=www.accessdata.fda.gov |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref>
|
|
* 20mg-40mg OD<ref name="urlwww.accessdata.fda.gov4">{{cite web |url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/019777s054lbl.pdf |title=www.accessdata.fda.gov |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref>
|
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* Cough
* Increased creatinine concentration
* Angioedema
* Hyperkalemia
* Renal impairment if given in bilateral renal artery stenosis
* Agranulocytosis<ref name="urlwww.accessdata.fda.gov5">{{cite web |url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/019777s054lbl.pdf |title=www.accessdata.fda.gov |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref>
|-
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|Angiotensin receptor blockers
|Angiotensin receptor blockers

Revision as of 17:29, 10 July 2017


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The optimal therapy for primary hyperladosteronism depends on the etiology of hyperaldosteronism.

Medical Therapy

Medical therapy is indicated for bilateral adrenal hyperplasia and all ambiguous causes of primary hyperaldosteronism. The following agents may be used to medical management of primary hyperaldosteronism:

Drug Class Agents Mechanism of action Dosage Side effects
Mineralocorticoid receptor antagonists Spironolactone
  • Competitive binding of receptors at the aldosterone-dependent sodium-potassium exchange site in the distal convoluted renal tubule
  • 12.5 – 25 mg BID
  • Max of 400 mg OD
  • Digestive: Gastric bleeding, ulceration, gastritis, diarrhea and cramping, nausea, vomiting.
  • Endocrine: Gynecomastia, irregular menses or amenorrhea, postmenopausal bleeding, carcinoma of the breast
  • Hematologic: Agranulocytosis.
  • Hypersensitivity: Fever, urticaria, maculopapular or erythematous cutaneous eruptions, anaphylactic reactions, vasculitis.
  • Hyperkalemia
  • Nervous system /psychiatric: Mental confusion, ataxia, headache, drowsiness, lethargy.
  • Liver / biliary: cholestatic/hepatocellular toxicity
  • Renal: Renal dysfunction (including renal failure).[1]
Potassium canrenoate
  • Aldosterone antagonist
Eplerenone
  • Selective aldosterone antagonist
 50 mg OD[2]
  • Hyperkalaemia
  • Hypotension
  • Dizziness
  • Altered renal function
  • Increased creatinine concentration
Potassium-sparing diuretics
  • Amiloride
  • Triamterene
  • Acts on distal renal tubule where it selectively blocks sodium transport, leading to inhibition of sodium-potassium exchange[3]
  • Initial dose: 5 mg OD
  • Maintenance dose: 5-10 mg OD[4]
    • Nausea,
    • Vomiting
    • stomach or abdominal pain
    • Anorexia
    • Bloating,
    • Diarrhea
    • Headache
    • Dizziness
    • Skin rash
    • Weakness
    • Fatigue
    • Constipation
    • Muscle cramps
    • Cough
    • Dyspnea
Calcium channel blockers
  • Amlodipine
  • Nifedipine
  • Prevent calcium from entering cells of the blood vessel walls, resulting in lower blood pressure[5]
  • 5 mg OD
  • Max of 10 mg OD[6]
  • Edema
  • Flushing
  • Diziness
  • Palpitations
  • Headache
  • Abdominal pain
  • Somnolence[7]
  • May mask diagnosis of Conn's syndrome
ACE inhibitors
  • Lisinopril
  • Captopril
  • Inhibits angiotensin-converting enzyme (ACE) thereby decreasing levels of angiotensin II and blocking the release of aldosterone.[8]
  • 20mg-40mg OD[9]
  • Cough
  • Increased creatinine concentration
  • Angioedema
  • Hyperkalemia
  • Renal impairment if given in bilateral renal artery stenosis
  • Agranulocytosis[10]
Angiotensin receptor blockers
Dexamethasone therapy(For familial hyperaldosteronism type I)
  • 0.5mg-0.75mg OD
  1. ↑ "www.accessdata.fda.gov" (PDF).
  2. ↑ Craft J (2004). "Eplerenone (Inspra), a new aldosterone antagonist for the treatment of systemic hypertension and heart failure". Proc (Bayl Univ Med Cent). 17 (2): 217–20. PMC 1200656. PMID 16200104.
  3. ↑ Vidt DG (1981). "Mechanism of action, pharmacokinetics, adverse effects, and therapeutic uses of amiloride hydrochloride, a new potassium-sparing diuretic". Pharmacotherapy. 1 (3): 179–87. PMID 6927605.
  4. ↑ "Amiloride Dosage Guide with Precautions - Drugs.com".
  5. ↑ Katz AM (1986). "Pharmacology and mechanisms of action of calcium-channel blockers". J Clin Hypertens. 2 (3 Suppl): 28S–37S. PMID 3540226.
  6. ↑ "www.accessdata.fda.gov" (PDF).
  7. ↑ "www.accessdata.fda.gov" (PDF).
  8. ↑ "www.accessdata.fda.gov" (PDF).
  9. ↑ "www.accessdata.fda.gov" (PDF).
  10. ↑ "www.accessdata.fda.gov" (PDF).

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