Treatment of primary aldosteronism

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• 作者：Marcus Quinkler ; Paul M. Stewart
• 关键词：primary aldosteronism ; mineralocorticoid receptor ; adrenalectomy ; spironolactone ; eplerenone ; conn´ ; s adenoma
• 刊名：Best Practice Research Clinical Endocrinology Metabolism
• 出版年：2010
• 出版时间：December 2010
• 年：2010
• 卷：24
• 期：6
• 页码：923-932
• 全文大小：156 K

文摘

The prevalence of primary hyperaldosteronism approaches 10 % of all hypertensive patients, and besides efficient diagnostic procedures, effective treatment is of increasing importance to reverse increased morbidity and mortality. Aldosterone-producing adenoma and unilateral adrenal hyperplasia are amenable to cure by endoscopic adrenalectomy. Bilateral adrenal hyperplasia (micro- or macronodular), which comprises two-thirds of primary hyperaldosteronism, is treated primarily by mineralocorticoid receptor antagonists (starting dose 12.5–25 mg/day spironolactone with titration up to 100 mg/day, alternatively 50–100 mg/day eplerenone). If blood pressure is not normalised by this first-line treatment, additional treatment with potassium-sparing diuretics (amiloride or triamterene) or calcium channel antagonists is necessary. The start of medication should be closely monitored by serum electrolyte and creatinine controls.