Abstract
Primary aldosteronism (PA) is detected with increasing frequency in hypertensive
patients and is associated with excess cardiovascular, renal, and metabolic
complications. For these reasons, appropriate choices for treatment of this
endocrine condition are mandatory. Adrenalectomy is safely performed in PA
patients when adrenal venous sampling (AVS) demonstrates lateralized aldosterone
secretion. AVS, however, is a complex procedure and even among worldwide
referral centers there are substantial discrepancies for interpretation of
results. Also, in the majority of PA patients with lateralized aldosterone
secretion, hypertension may persist after adrenalectomy requiring use of
additional antihypertensive agents. Treatment with mineralocorticoid receptor
antagonists (MRAs) is currently recommended for PA patients with bilateral
adrenal disease, but these agents effectively decrease blood pressure also in
patients with unilateral disease, although concern remains for possible
sex-related side effects. Prospective studies indicate that MRAs have
therapeutic values comparable to surgery in the long-term, inasmuch as they
effectively correct metabolic abnormalities and subclinical organ damage and
reduce the risk of cardiovascular events and renal disease progression. This
article overviews the clinical outcomes obtained in patients with PA with use of
MRAs.
Key words
adrenal venous sampling - adrenalectomy - spironolactone - eplerenone - blood pressure
- organ damage
