Primary hyperaldosteronism medical therapy

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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).
	Potassium canrenoate	Aldosterone antagonist
	Eplerenone	Selective aldosterone antagonist	50 mg OD	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	Initial dose: 5 mg OD Maintenance dose: 5-10 mg OD	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 mg OD Max of 10 mg OD	Edema Flushing Diziness Palpitations Headache Abdominal pain Somnolence 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.	20mg-40mg OD	Cough Increased creatinine concentration Angioedema Hyperkalemia Renal impairment if given in bilateral renal artery stenosis Agranulocytosis
Angiotensin receptor blockers	Losartan Candesartan Valsartan	Angiotensin II inhibition by interacting selectively with the receptor site and blocking it		Diziness Fatigue Diarrhea Dyspepsia Abdominal pain Arthralgia Sinusitis
Dexamethasone therapy(For familial hyperaldosteronism type I)			0.5mg-0.75mg OD