What are the treatment options for hyperaldosteronism?

Updated: Oct 19, 2018
  • Author: George P Chrousos, MD, FAAP, MACP, MACE, FRCP(London); Chief Editor: Robert P Hoffman, MD  more...
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Answer

Surgical excision of the affected adrenal gland is recommended for all patients with hyperaldosteronism who have a proven aldosterone-producing adenoma (APA). After surgical removal of an APA (aldosteronoma), a period of hypoadrenalism can occur. If this is not recognized, clinically significant hyponatremia and hyperkalemia may result.

Severe hypokalemia may require intravenous (IV) correction if the potassium concentration is less than 2.5 mmol/L or if the patient is clinically symptomatic. Once the potassium level is stable, sodium restriction and oral potassium supplements may be used as effectively as, or in addition to, potassium-sparing diuretics.

Spironolactone is the most effective drug for controlling the effects of hyperaldosteronism, though it may interfere with the progression of puberty. Newer drugs that possess greater specificity for the mineralocorticoid receptor than spironolactone does are becoming available.

Alternative medications for patients in whom aldosterone antagonists are contraindicated include amiloride and triamterene, as well as calcium channel antagonists and alpha-adrenergic antagonists (especially alpha1 -specific agents such as prazosin and doxazosin); in patients with angiotensin II–responsive disease, angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) are indicated.

Patients receiving medical treatment for hyperaldosteronism must be transferred to a physician with experience in managing such cases (eg, an endocrinologist, a cardiologist, or a nephrologist).


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