A Trial of Finerenone in a Patient with Primary Aldosteronism

Primary aldosteronism (PA), a common secondary cause of arterial hypertension, is treated either surgically or pharmacologically with mineralocorticoid receptor antagonists (MRAs). These drugs, while effective, can cause allergic reactions and have side effects, including menstrual cycle disorders in women. Finerenone is a new, highly selective, nonsteroidal MRA with excellent side-effect profile, primarily intended to slow the progression of diabetic kidney disease and improve cardiovascular outcomes in these patients. No data are available so far on its effect on patients with PA.

A case of a female patient with confirmed primary aldosteronism, in whom adrenal vein sampling failed twice is presented. The patient developed a skin allergic reaction to spironolactone and experienced prolonged vaginal bleedings with eplerenone, which was attributed to the drug's affinity for progesterone receptors. A trial of finerenone was initiated, resulting in mild increase in plasma renin activity and serum potassium, and somewhat control of blood pressure, but far from optimal blood pressure control, normokalemia, or unsuppression of plasma renin activity.

This case highlights the challenges of managing PA and describes an attempt of treatment with finerenone to which this patient unfortunately did not adequately respond.