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The optimal therapy for primary hyperladosteronism depends on the etiology of hyperaldosteronism.
The optimal therapy for primary hyperladosteronism depends on the etiology of hyperaldosteronism.
==Medical Therapy==
==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:
 
=== 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:
{| class="wikitable"
{| class="wikitable"
!Drug Class
!Drug Class
Line 119: Line 124:
* Angiotensin II inhibition by interacting selectively with the receptor site and blocking it<ref name="pmid10696996">{{cite journal |vauthors=Burnier M, Brunner HR |title=Angiotensin II receptor antagonists |journal=Lancet |volume=355 |issue=9204 |pages=637–45 |year=2000 |pmid=10696996 |doi= |url= |issn=}}</ref> <ref name="pmid162787272">{{cite journal |vauthors=Barreras A, Gurk-Turner C |title=Angiotensin II receptor blockers |journal=Proc (Bayl Univ Med Cent) |volume=16 |issue=1 |pages=123–6 |year=2003 |pmid=16278727 |pmc=1200815 |doi= |url= |issn=}}</ref>
* Angiotensin II inhibition by interacting selectively with the receptor site and blocking it<ref name="pmid10696996">{{cite journal |vauthors=Burnier M, Brunner HR |title=Angiotensin II receptor antagonists |journal=Lancet |volume=355 |issue=9204 |pages=637–45 |year=2000 |pmid=10696996 |doi= |url= |issn=}}</ref> <ref name="pmid162787272">{{cite journal |vauthors=Barreras A, Gurk-Turner C |title=Angiotensin II receptor blockers |journal=Proc (Bayl Univ Med Cent) |volume=16 |issue=1 |pages=123–6 |year=2003 |pmid=16278727 |pmc=1200815 |doi= |url= |issn=}}</ref>
|
|
* 50 mg OD (Losartan)<ref name="urlwww.accessdata.fda.gov7">{{cite web |url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/020386s049lbl.pdf |title=www.accessdata.fda.gov |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref>
* 16 mg OD (Candesartan)<ref name="urlwww.accessdata.fda.gov8">{{cite web |url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2005/020838s022lbl.pdf |title=www.accessdata.fda.gov |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref>
* 80mg-160mg OD (Valsartan)<ref name="urlwww.accessdata.fda.gov9">{{cite web |url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/021283s037lbl.pdf |title=www.accessdata.fda.gov |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref>
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* Diziness
* Diziness

Revision as of 17:50, 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

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 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
  • Losartan
  • Candesartan
  • Valsartan
  • Angiotensin II inhibition by interacting selectively with the receptor site and blocking it[11] [12]
  • 50 mg OD (Losartan)[13]
  • 16 mg OD (Candesartan)[14]
  • 80mg-160mg OD (Valsartan)[15]
  • Diziness
  • Fatigue
  • Diarrhea
  • Dyspepsia
  • Abdominal pain
  • Arthralgia
  • Sinusitis[16]
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).
  11. ↑ Burnier M, Brunner HR (2000). "Angiotensin II receptor antagonists". Lancet. 355 (9204): 637–45. PMID 10696996.
  12. ↑ Barreras A, Gurk-Turner C (2003). "Angiotensin II receptor blockers". Proc (Bayl Univ Med Cent). 16 (1): 123–6. PMC 1200815. PMID 16278727.
  13. ↑ "www.accessdata.fda.gov" (PDF).
  14. ↑ "www.accessdata.fda.gov" (PDF).
  15. ↑ "www.accessdata.fda.gov" (PDF).
  16. ↑ 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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