Treatment of primary aldosteronism
- William F Young, Jr, MD, MSc
William F Young, Jr, MD, MSc
- Professor of Medicine
- Mayo Clinic College of Medicine
- Norman M Kaplan, MD
Norman M Kaplan, MD
- Editor-in-Chief — Nephrology
- Section Editor — Hypertension
- Clinical Professor of Internal Medicine
- University of Texas Southwestern Medical Center
Nonsuppressible (primary) hypersecretion of aldosterone is an uncommon but underdiagnosed cause of hypertension. The classic presenting signs of primary aldosteronism are hypertension and hypokalemia.
Many subtypes of primary aldosteronism have been described since Conn's original report of the aldosterone-producing adenoma in 1954 [1-3]. The most common subtypes are:
●Bilateral idiopathic hyperaldosteronism
Less common forms include:
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- Zarnegar R, Young WF Jr, Lee J, et al. The aldosteronoma resolution score: predicting complete resolution of hypertension after adrenalectomy for aldosteronoma. Ann Surg 2008; 247:511.
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- Parthasarathy HK, Ménard J, White WB, et al. A double-blind, randomized study comparing the antihypertensive effect of eplerenone and spironolactone in patients with hypertension and evidence of primary aldosteronism. J Hypertens 2011; 29:980.
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- Sukor N, Gordon RD, Ku YK, et al. Role of unilateral adrenalectomy in bilateral primary aldosteronism: a 22-year single center experience. J Clin Endocrinol Metab 2009; 94:2437.
- Ahmed AH, Gordon RD, Sukor N, et al. Quality of life in patients with bilateral primary aldosteronism before and during treatment with spironolactone and/or amiloride, including a comparison with our previously published results in those with unilateral disease treated surgically. J Clin Endocrinol Metab 2011; 96:2904.
- GOALS OF THERAPY
- GENERAL PRINCIPLES
- Clinical Guidelines
- UNILATERAL ADRENAL ADENOMA OR HYPERPLASIA
- - Postoperative management
- - Effect on hypertension
- Ablative procedures
- Medical therapy
- - Mineralocorticoid receptor antagonists
- - Potassium-sparing diuretics
- - Suggested approach
- BILATERAL ADRENAL HYPERPLASIA
- Idiopathic adrenal hyperplasia
- Glucocorticoid-remediable aldosteronism
- SUMMARY AND RECOMMENDATIONS