Medical treatment of low-renin aldosteronism

Among the subsets of LRA, IHA and GSA should always be treated medically. APA and APC should be treated surgically if possible, with unilateral adrenalectomy. First-line treatment of IHA and for preoperative preparation of APA and APC patients is the aldosterone antagonist spironolactone. If this agent cannot be used because of side effects, sodium transport inhibitors are appropriate alternatives. Patients with IHA and APA can also be treated with calcium channel blockers, but only nifedipine has been tested in these conditions. IHA can probably also be treated with the converting enzyme inhibitor enalapril, but the experience with this agent is very limited. The same is true for steroidogenesis inhibitors, of which ketoconazole seems to be the most promising. GSA is usually treated with dexamethasone. Spironolactone and amiloride can be used as alternatives. The only proven auxiliary medication for treatment of APC is o,p'-DDD.