How are hypokalemia and hypertension managed in idiopathic hyperaldosteronism (IHA)?

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

Although bilateral adrenalectomy (see below) corrects hypokalemia in patients with idiopathic hyperaldosteronism (IHA), it has not been shown to be effective at controlling blood pressure, with cure rates less than 20%. This may be because this condition is typically insidious in its onset, allowing time for chronic hypertension to cause secondary damage. Furthermore, bilateral adrenalectomy commits the patient to lifelong replacement therapy with glucocorticoids and mineralocorticoids.

Control of hypokalemia and hypertension in IHA can be achieved with sodium restriction (to < 2 g/day) and administration of spironolactone or amiloride, but additional antihypertensives are often needed to achieve good control in this patient group. Pediatric drug doses are outlined in the Table below.

Table 2. Drugs Used in the Management of Idiopathic Hyperaldosteronism in Children (Open Table in a new window)

Drug

Class

Pediatric Dose

Spironolactone

Aldosterone antagonist

0-10 kg: 6.25 mg/dose PO q12h

11-20 kg: 12.5 mg/dose PO q12h

21-40 kg: 25 mg/dose PO q12h

>40 kg: 25 mg PO q8h

Potassium canrenoate

Aldosterone antagonist

3-8 mg/kg IV qd; not to exceed 400 mg

Amiloride

Potassium-sparing diuretic

0.2 mg/kg q12h

Triamterene

Potassium-sparing diuretic

2 mg/kg/dose q8-24h

Nifedipine

Dihydropyridine calcium channel antagonist

0.25-0.5 mg/kg PO q6-8h

Amlodipine

Calcium channel antagonist

0.05-0.2 mg/ day PO

Doxazosin

Alpha1 -specific adrenergic antagonist

0.02-0.1 mg/day; not to exceed 4 mg

Prazosin

Alpha1 -specific adrenergic antagonist

0.005 mg/kg test dose, then 0.025-0.1 mg/kg/dose q6h; not to exceed 0.5 mg/dose


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