Treatment

Treatment for primary aldosteronism depends on the underlying cause. The basic goal is get your aldosterone levels back to normal or to block the effect of high aldosterone to prevent complications.

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 with the tumor (adrenalectomy) is usually recommended. Surgical removal may bring blood pressure, potassium and aldosterone levels back to normal. Your doctor will follow you closely after surgery and progressively adjust or eliminate your high blood pressure medications.

  Risks of surgery include bleeding and infection. Adrenal hormone replacement isn't necessary because the other adrenal gland can make enough of all the hormones your body needs.

• Aldosterone-blocking drugs. If your primary aldosteronism is caused by a benign tumor and you can't have surgery or prefer not to, you can be treated with aldosterone-blocking drugs called mineralocorticoid receptor antagonists (spironolactone and eplerenone) and lifestyle changes. 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.

• 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 may cause other problems.

  In addition to blocking aldosterone receptors, spironolactone may inhibit the action of other hormones. Side effects can include male breast enlargement (gynecomastia) and menstrual irregularities in women.

  A newer, more-expensive mineralocorticoid receptor antagonist called eplerenone (Inspra) eliminates the sex hormone side effects associated with spironolactone. Your doctor may recommend eplerenone if you have serious side effects with spironolactone. You may also need other medications 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 lower the sodium in your diet and keep a healthy body weight. Getting regular exercise, limiting the amount of alcohol you drink and stopping smoking also may improve your response to medications.