Primary hyperaldosteronism medical therapy: Difference between revisions
No edit summary |
No edit summary |
||
| Line 1: | Line 1: | ||
__NOTOC__ | __NOTOC__ | ||
{{Conn syndrome}} | {{Conn syndrome}} | ||
{{CMG}} | {{CMG}} | ||
| Line 19: | Line 20: | ||
* Competitive binding of receptors at the aldosterone-dependent sodium-potassium exchange site in the distal convoluted renal tubule | * Competitive binding of receptors at the aldosterone-dependent sodium-potassium exchange site in the distal convoluted renal tubule | ||
| | | | ||
* 12.5 – 25 mg BID | |||
* Max of 400 mg OD | |||
| | | | ||
* Digestive: Gastric bleeding, ulceration, gastritis, diarrhea and cramping, nausea, vomiting. | |||
* Endocrine: Gynecomastia, irregular menses or amenorrhea, postmenopausal bleeding, carcinoma of the breast | |||
* Hematologic: Agranulocytosis. | |||
* Hypersensitivity: Fever, urticaria, maculopapular or erythematous cutaneous eruptions, anaphylactic reactions, vasculitis. | |||
* Hyperkalemia | |||
* Nervous system /psychiatric: Mental confusion, ataxia, headache, drowsiness, lethargy. | |||
* Liver / biliary: cholestatic/hepatocellular toxicity | |||
* Renal: Renal dysfunction (including renal failure). | |||
|- | |- | ||
|Potassium canrenoate | |Potassium canrenoate | ||
| Line 37: | Line 48: | ||
*Potassium canrenoate | *Potassium canrenoate | ||
*Eplerenone | *Eplerenone | ||
The first two have affinity for androgen and progesterone receptors, causing side effects such as, gynecomastia (6.9% at dose < 50 mg / day and 52% at dose > 150 mg / day),[108] | The first two have affinity for androgen and progesterone receptors, causing side effects such as, gynecomastia (6.9% at dose < 50 mg / day and 52% at dose > 150 mg / day),[108] . Spironolacone is used at a starting dose of 12.5 – 25 mg twice daily and increased gradually to a maximum of 400 mg per day. Eplerenone is a selective mineralcorticoid receptor antagonist without antiandrogen and progesterone agonist activity. It is 60% as potent as spironolactone and should be administered twice daily because of its short half life. It has been shown to be as effective as spironolactone. | ||
Potassium-sparing diuretics — amiloride, triamterene. Potassium-sparing diuretics, such as triamterene or amiloride, have been used, although they are usually not as effective as spironolactone | Potassium-sparing diuretics — amiloride, triamterene. Potassium-sparing diuretics, such as triamterene or amiloride, have been used, although they are usually not as effective as spironolactone | ||
Other anti-hypertensives — calcium channel blockers, ACE inhibitors, angiotensin receptor blockers, and low doses of thiadzides diuretics. | Other anti-hypertensives — calcium channel blockers, ACE inhibitors, angiotensin receptor blockers, and low doses of thiadzides diuretics. | ||
Revision as of 15:32, 10 July 2017
Template:Conn syndrome
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The optimal therapy for primary hyperladosteronism depends on the etiology of hyperaldosteronism.
Medical Therapy
Medical therapy is indicated for bilateral adrenal hyperplasia and all ambiguous causes of primary hyperaldosteronism. The following agents may be used to medical management of primary hyperaldosteronism:
| Drug Class | Agents | Mechanism of action | Dosage | Side effects |
|---|---|---|---|---|
| Mineralocorticoid receptor antagonists | Spironolactone |
|
|
|
| Potassium canrenoate |
|
|||
| Eplerenone |
|
- Spironolactone
- Potassium canrenoate
- Eplerenone
The first two have affinity for androgen and progesterone receptors, causing side effects such as, gynecomastia (6.9% at dose < 50 mg / day and 52% at dose > 150 mg / day),[108] . Spironolacone is used at a starting dose of 12.5 – 25 mg twice daily and increased gradually to a maximum of 400 mg per day. Eplerenone is a selective mineralcorticoid receptor antagonist without antiandrogen and progesterone agonist activity. It is 60% as potent as spironolactone and should be administered twice daily because of its short half life. It has been shown to be as effective as spironolactone. Potassium-sparing diuretics — amiloride, triamterene. Potassium-sparing diuretics, such as triamterene or amiloride, have been used, although they are usually not as effective as spironolactone Other anti-hypertensives — calcium channel blockers, ACE inhibitors, angiotensin receptor blockers, and low doses of thiadzides diuretics.