Primary hyperaldosteronism medical therapy: Difference between revisions

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* Max of 400 mg OD
* Max of 400 mg OD
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|
* Digestive: Gastric bleeding, ulceration, gastritis, diarrhea and cramping, nausea, vomiting.
* Digestive: Gastric bleeding, ulceration, gastritis, diarrhea and cramping, nausea, vomiting  
* Endocrine: Gynecomastia, irregular menses or amenorrhea, postmenopausal bleeding, carcinoma of the breast   
* Endocrine: Gynecomastia, irregular menses or amenorrhea, postmenopausal bleeding, carcinoma of the breast   
* Hematologic: Agranulocytosis.
* Hematologic: Agranulocytosis  
* Hypersensitivity: Fever, urticaria, maculopapular or erythematous cutaneous eruptions, anaphylactic reactions, vasculitis.
* Hypersensitivity: Fever, urticaria, maculopapular or erythematous cutaneous eruptions, anaphylactic reactions, vasculitis  
* Hyperkalemia  
* Hyperkalemia  
* Nervous system /psychiatric: Mental confusion, ataxia, headache, drowsiness, lethargy.
* Nervous system /psychiatric: Mental confusion, ataxia, headache, drowsiness, lethargy  
* Liver / biliary: cholestatic/hepatocellular toxicity
* Liver / biliary: cholestatic/hepatocellular toxicity
* Renal: Renal dysfunction (including renal failure).<ref name="urlwww.accessdata.fda.gov">{{cite web |url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/012151s062lbl.pdf |title=www.accessdata.fda.gov |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref>
* Renal: Renal dysfunction (including renal failure)<ref name="urlwww.accessdata.fda.gov">{{cite web |url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/012151s062lbl.pdf |title=www.accessdata.fda.gov |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref>
|-
|-
|Potassium canrenoate
|Potassium canrenoate
Line 73: Line 73:
* Maintenance dose: 5-10 mg OD<ref name="urlAmiloride Dosage Guide with Precautions - Drugs.com">{{cite web |url=https://www.drugs.com/dosage/amiloride.html |title=Amiloride Dosage Guide with Precautions - Drugs.com |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref>
* Maintenance dose: 5-10 mg OD<ref name="urlAmiloride Dosage Guide with Precautions - Drugs.com">{{cite web |url=https://www.drugs.com/dosage/amiloride.html |title=Amiloride Dosage Guide with Precautions - Drugs.com |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref>
|
|
** Nausea,
** Nausea
** Vomiting
** Vomiting
** stomach or abdominal pain
** stomach or abdominal pain
** Anorexia
** Anorexia
** Bloating,
** Bloating
** Diarrhea
** Diarrhea
** Headache
** Headache
Line 113: Line 113:
* Captopril
* 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>
* 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>
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* 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>
* 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>

Revision as of 13:56, 11 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

Indications

Medical therapy is indicated for:

  • Bilateral adrenal hyperplasia
  • All ambiguous causes of primary hyperaldosteronism.

The following agents may be used to medical management of primary hyperaldosteronism:

Drug Class[1] 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[2]
  • 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)[3]
Potassium canrenoate
  • Aldosterone antagonist
  • Parentral administration
  • 200 mg OD
  • Max of 800 mg OD
  • Hoarseness
  • Deepening of voice
  • Hyperkalemia
  • Nausea
  • Vomiting
Eplerenone
  • Selective aldosterone antagonist
 50 mg OD[4]
  • 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[5]
  • Initial dose: 5 mg OD
  • Maintenance dose: 5-10 mg OD[6]
    • 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[7]
  • 5 mg OD
  • Max of 10 mg OD[8]
  • Edema
  • Flushing
  • Diziness
  • Palpitations
  • Headache
  • Abdominal pain
  • Somnolence[9]
  • May mask diagnosis of Conn's syndrome[10]
ACE inhibitors
  • Lisinopril
  • Captopril
  • Inhibits angiotensin-converting enzyme (ACE) thereby decreasing levels of angiotensin II and blocking the release of aldosterone[11]
  • Cough
  • Increased creatinine concentration
  • Angioedema
  • Hyperkalemia
  • Renal impairment if given in bilateral renal artery stenosis
  • Agranulocytosis[13]
Angiotensin receptor blockers
  • Losartan
  • Candesartan
  • Valsartan
  • Angiotensin II inhibition by interacting selectively with the receptor site and blocking it[14] [15]
  • 50 mg OD (Losartan)[16]
  • 16 mg OD (Candesartan)[17]
  • 80mg-160mg OD (Valsartan)[18]
  • Diziness
  • Fatigue
  • Diarrhea
  • Dyspepsia
  • Abdominal pain
  • Arthralgia
  • Sinusitis[19]
Dexamethasone therapy(For familial hyperaldosteronism type I)
  • 0.5mg-0.75mg OD
  1. ↑ Horsley MG, Bailie GR (1988). "Effectiveness of theophylline monitoring by the use of serum assays". J Clin Pharm Ther. 13 (5): 359–64. PMID 3230101.
  2. ↑ Greiner JW, Kramer RE, Jarrell J, Colby HD (1976). "Mechanism of action of spironolactone on adrenocortical function in guinea pigs". J. Pharmacol. Exp. Ther. 198 (3): 709–15. PMID 978470.
  3. ↑ "www.accessdata.fda.gov" (PDF).
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ "Amiloride Dosage Guide with Precautions - Drugs.com".
  7. ↑ Katz AM (1986). "Pharmacology and mechanisms of action of calcium-channel blockers". J Clin Hypertens. 2 (3 Suppl): 28S–37S. PMID 3540226.
  8. ↑ "www.accessdata.fda.gov" (PDF).
  9. ↑ "www.accessdata.fda.gov" (PDF).
  10. ↑ Brown MJ, Hopper RV (1999). "Calcium-channel blockade can mask the diagnosis of Conn's syndrome". Postgrad Med J. 75 (882): 235–6. PMC 1741191. PMID 10715768.
  11. ↑ "www.accessdata.fda.gov" (PDF).
  12. ↑ "www.accessdata.fda.gov" (PDF).
  13. ↑ "www.accessdata.fda.gov" (PDF).
  14. ↑ Burnier M, Brunner HR (2000). "Angiotensin II receptor antagonists". Lancet. 355 (9204): 637–45. PMID 10696996.
  15. ↑ Barreras A, Gurk-Turner C (2003). "Angiotensin II receptor blockers". Proc (Bayl Univ Med Cent). 16 (1): 123–6. PMC 1200815. PMID 16278727.
  16. ↑ "www.accessdata.fda.gov" (PDF).
  17. ↑ "www.accessdata.fda.gov" (PDF).
  18. ↑ "www.accessdata.fda.gov" (PDF).
  19. ↑ Barreras A, Gurk-Turner C (2003). "Angiotensin II receptor blockers". Proc (Bayl Univ Med Cent). 16 (1): 123–6. PMC 1200815. PMID 16278727.

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