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Treatments and drugs
By Mayo Clinic staffTreatment for primary aldosteronism depends on the underlying cause.
Bilateral adrenal hyperplasia
A combination of medications and lifestyle modifications can effectively treat primary aldosteronism caused by overactivity of both adrenal glands.
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Medications. Mineralocorticoid receptor antagonists block the action of aldosterone in your body. Your doctor may first prescribe spironolactone (Aldactone). This medication helps correct high blood pressure and low potassium, but it may cause problems. In addition to blocking aldosterone receptors, spironolactone blocks androgen and progesterone receptors and may inhibit the action of these hormones. Side effects can include male breast enlargement (gynecomastia), decreased sexual desire (libido), impotence, menstrual irregularities and gastrointestinal distress.
A newer, more expensive mineralocorticoid receptor antagonist called eplerenone acts just on aldosterone receptors, eliminating the sex-hormone side effects associated with spironolactone. Your doctor may recommend eplerenone if you experience serious side effects with spironolactone. In addition to spironolactone or eplerenone, you may need further treatment for high blood pressure.
- Lifestyle changes. High blood pressure medications are more effective when combined with a healthy diet and lifestyle. Work with your doctor to create a plan to reduce the sodium in your diet and maintain a healthy body weight. Getting regular exercise, limiting your alcohol intake and stopping smoking also may improve your response to medications.
Aldosteronoma
Primary aldosteronism caused by a benign tumor on your adrenal gland also can be effectively treated with mineralocorticoid receptor antagonists and lifestyle changes, but high blood pressure and low potassium will return if you stop taking your medications.
Surgical removal of the adrenal gland containing the aldosteronoma (adrenalectomy) is usually recommended because it may permanently resolve both high blood pressure and potassium deficiency. Blood pressure usually drops gradually after a unilateral adrenalectomy. Your doctor will follow you closely after surgery and progressively adjust or eliminate your high blood pressure medications.
- Funder JW, et al. Case detection, diagnosis and treatment of patients with primary aldosteronism: An Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology & Metabolism. 2008;(93):3266-3281.
- Gomez-Sanchez CE, et al. Three perspectives on aldosterone's role in cardiovascular disease: Salt's not the only bad guy. The Endocrine Society. http://www.endo-society.org/endo_news/tri_point/upload/Tri-Point-Series-June-2005-EN.pdf. Accessed Sept. 25, 2008.
- Young WF, et al. Clinical features of primary aldosteronism. http://www.uptodate.com/home/index.html. Accessed Sept. 25, 2008.
- Hyperaldosteronism. The Merck Manuals Online Medical Library: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec12/ch153/ch153f.html. Accessed Sept. 25, 2008.
- Sechi LA. Long-term renal outcomes in patients with primary aldosteronism. Journal of the American Medical Association. 2006;295(22):2638-2645.
- Young WF, et al. Treatment of primary aldosteronism. http://www.uptodate.com/home/index.html. Accessed Sept. 25, 2008.
- Aldosterone and renin. Lab Tests Online. http://www.labtestsonline.org/understanding/analytes/aldosterone/test.html. Accessed Sept. 28, 2008.
- Young WF, et al. Clinical features of primary aldosteronism. http://www.uptodate.com/online/content/topic.do?topicKey=adrenal/19130&selectedTitle=3~56&source=search_result. Accessed Nov. 28, 2008.
- Young WF, et al. Treatment of primary aldosteronism. http://www.uptodate.com/online/content/topic.do?topicKey=adrenal/19430&selectedTitle=2~56&source=search_result. Accessed Nov. 28, 2008.
