Which medications in the drug class Corticosteroids are used in the treatment of Primary Aldosteronism?

Updated: Mar 24, 2020
  • Author: Gabriel I Uwaifo, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

Corticosteroids

This class of agents are therapeutically appropriate only for the GRA subtype of primary aldosteronism. The treatment of choice in GRA is the administration of the lowest possible dose of glucocorticoid that can be used to achieve adequate blood pressure control. Because of the potential adverse effects that can result from even subtle glucocorticoid excess, using short-acting glucocorticoids, such as prednisone and hydrocortisone (rather than dexamethasone), is generally best.

Prednisone

Prednisone is a short-acting prodrug that exerts its effects after it undergoes metabolism and is converted to prednisolone. Prednisone mimics naturally occurring cortisol and is used in GRA to rapidly suppress aldosterone levels and resolve the volume expansion and hypertension in this disorder, being generally efficacious within 2 weeks of treatment initiation.

Hydrocortisone (Solu-Cortef, Cortef)

Hydrocortisone possesses a molecular similarity to aldosterone and therefore not only binds to the glucocorticoid receptor (thus resulting in resulting in lower aldosterone levels in GRA), but also the mineralocorticoid receptor (MR), thus also providing competitive inhibition of ambient aldosterone levels at the MR level (resulting in decreased physiologic effects of existing ambient aldosterone levels in GRA).


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