Treatment of Primary Aldosteronism

The best treatment for primary hyperaldosteronism depends on the cause of the disease and the individual patient. Patients found to have evidence of excess aldosterone production from one gland (unilateral) are usually provided with several options for treatment. Most commonly, surgery (adrenalectomy of the affected side) is recommended. The operation is usually performed using minimally invasive techniques (i.e. laparoscopic surgery) but may require a traditional “open” operation in cases of large or difficult to remove tumors (patients who have undergone prior surgery in the area prohibiting easy access to the gland). The hospital stay for laparoscopic adrenalectomy is usually no more than 1-2 nights in the hospital. The other option for treatment in those patients who have other medical problems making surgery too high risk or for those patients who do not want to pursue surgery is medical treatment with medications, often including spironolactone or eplerenone. Medications will not cure patients of their disease. Medication may control the blood pressure to an adequate level, but in some cases will not. Even if the blood pressure and potassium level is able to be adequately treated, research suggests that continued high levels of aldosterone are still damaging to many organ systems in the body. Medication does not lower the aldosterone level. It simply treats the blood pressure.  Surgery is the only option in which cure is a possibility resulting in a normal aldosterone level, improved blood pressure and normal potassium level not requiring potassium supplements. 

If excess aldosterone production is the result of abnormal production from both adrenal glands, medication is generally offered as treatment. A low-salt diet is also recommended. Surgery is generally not offered except in special circumstances. Removal of both adrenal glands results in the need for supplemental steroids. A lack of steroids can be life-threatening. 

People with primary hyperaldosteronism who do nothing are at risk of developing the complications associated with untreated high blood pressure. These complications can include heart attack, heart failure, kidney damage, and stroke. If you have a suspected diagnosis of primary hyperaldosteronism, be sure to seek proper diagnosis and treatment to avoid these harmful complications.