Primary hyperaldosteronism medical therapy: Difference between revisions

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Revision as of 16:31, 10 July 2017

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	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).^[1]
	Potassium canrenoate	Aldosterone antagonist
	Eplerenone	Selective aldosterone antagonist	50 mg OD^[2]	Hyperkalaemia Hypotension Dizziness Altered renal function Increased creatinine concentration
Potassium-sparing diuretics	Amiloride Triamterene	Acts on distal renal tubule where it selectively blocks sodium transport, leading to inhibition of sodium-potassium exchange^[3]
Calcium channel blockers
ACE inhibitors
Angiotensin receptor blockers

↑ "www.accessdata.fda.gov" (PDF).
↑ Craft J (2004). "Eplerenone (Inspra), a new aldosterone antagonist for the treatment of systemic hypertension and heart failure". Proc (Bayl Univ Med Cent). 17 (2): 217–20. PMC 1200656. PMID 16200104.
↑ Vidt DG (1981). "Mechanism of action, pharmacokinetics, adverse effects, and therapeutic uses of amiloride hydrochloride, a new potassium-sparing diuretic". Pharmacotherapy. 1 (3): 179–87. PMID 6927605.

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[urlwww.accessdata.fda.gov-1] "www.accessdata.fda.gov" (PDF).

[pmid16200104-2] Craft J (2004). "Eplerenone (Inspra), a new aldosterone antagonist for the treatment of systemic hypertension and heart failure". Proc (Bayl Univ Med Cent). 17 (2): 217–20. PMC 1200656. PMID 16200104.

[pmid6927605-3] Vidt DG (1981). "Mechanism of action, pharmacokinetics, adverse effects, and therapeutic uses of amiloride hydrochloride, a new potassium-sparing diuretic". Pharmacotherapy. 1 (3): 179–87. PMID 6927605.

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-*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.
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Primary hyperaldosteronism medical therapy: Difference between revisions

Revision as of 16:31, 10 July 2017

Overview

Medical Therapy

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