Treatments and drugsBy Mayo Clinic staff
Treatment for primary aldosteronism depends on the underlying cause but its basic goal is to normalize, or block the effect of, high aldosterone levels and prevent the potential complications of high blood pressure and low potassium levels.
Treatment for an adrenal gland tumor
An adrenal gland tumor may be treated with surgery or medications and lifestyle changes.
Surgical removal of the gland. Surgical removal of the adrenal gland containing the tumor (adrenalectomy) is usually recommended because it may permanently resolve high blood pressure and potassium deficiency, and it can bring aldosterone levels back to normal. 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.
An adrenalectomy carries the usual risks of abdominal surgery, including bleeding and infection. However, adrenal hormone replacement is not necessary after a unilateral adrenalectomy because the other adrenal gland is able to produce adequate amounts of all the hormones on its own.
- Aldosterone-blocking drugs. If you're unable to have surgery or prefer not to, primary aldosteronism caused by a benign tumor can also be effectively treated with aldosterone-blocking drugs (mineralocorticoid receptor antagonists) and lifestyle changes. But high blood pressure and low potassium will return if you stop taking your medications.
Treatment for overactivity of both adrenal glands
A combination of medications and lifestyle modifications can effectively treat primary aldosteronism caused by overactivity of both adrenal glands (bilateral adrenal hyperplasia).
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 (Inspra) 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 the amount of alcohol you drink and stopping smoking also may improve your response to 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.
- Young WF, et al. Clinical features of primary aldosteronism. http://www.uptodate.com/home/index.html. Accessed Oct. 25, 2010.
- Primary aldosteronism. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec12/ch153/ch153f.html. Accessed Oct. 25, 2010.
- Sechi LA, et al. Cardiovascular and renal damage in primary aldosteronism: Outcomes after treatment. American Journal of Hypertension. In press. Acessed Oct. 25, 2010.
- Giacchetti G, et al. Management of primary aldosteronism: Its complications and outcomes after treatment. Current Vascular Pharmacology. 2009;7:244.
- Young WF, et al. Treatment of primary aldosteronism. http://www.uptodate.com/home/index.html. Accessed Oct. 25, 2010.
- Aldosterone and renin. Lab Tests Online. http://www.labtestsonline.org/understanding/analytes/aldosterone/test.html. Accessed Oct. 25, 2010.
- High blood pressure. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/Hbp/HBP_All.html. Accessed Oct. 25, 2010.
- High blood pressure, factors that contribute to. American Heart Association. http://www.americanheart.org/presenter.jhtml?identifier=4650. Accessed Oct. 25, 2010.
- Young WF, et al. Approach to the patient with hypertension and hypokalemia. http://www.uptodate.com/home/index.html. Accessed Oct. 25, 2010.
- Rose BD. Clinical manifestations and treatment of hypokalemia. http://www.uptodate.com/home/index.html. Accessed Oct. 25, 2010.
- The seventh report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Bethesda, Md.: National Heart, Lung, Blood Institute. http://www.nhlbi.nih.gov/guidelines/hypertension/jnc7full.htm. Accessed Oct. 25, 2010.
- Nippoldt TB (expert opinion). Mayo Clinic, Rochester, Minn. Oct. 27, 2010.