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Treatment of Primary Aldosteronism
Stéfanie Parisien-La Salle1,2, Gregory L Hundemer3, Matthew A Nehs4
1Division of Endocrinology, Diabetes, and Metabolism, Center for Adrenal Disorders (S.P.-L.S., A.V.), Mass General Brigham, Harvard Medical School, Boston, MA.
Hypertension (Dallas, Tex. : 1979)
|March 11, 2026
Summary
Primary aldosteronism (PA) management focuses on controlling hypertension and cardiorenal risks. Treatment involves surgery for lateralizing PA or mineralocorticoid receptor antagonists and dietary sodium restriction for most patients.
Area of Science:
- Endocrinology
- Cardiology
- Nephrology
Background:
- Primary aldosteronism (PA) is a frequent cause of hypertension.
- It involves excessive aldosterone production, leading to sodium retention, potassium loss, and cardiovascular issues.
- PA management aims to restore homeostasis and mitigate risks.
Purpose of the Study:
- To outline current management strategies for primary aldosteronism.
- To detail therapeutic approaches based on PA laterality and patient preference.
- To emphasize the goals of medical therapy intensification.
Main Methods:
- Review of therapeutic options including surgery and medical management.
- Discussion of steroidal mineralocorticoid receptor antagonists as cornerstone therapy.
- Highlighting the role of dietary sodium restriction and epithelial sodium channel inhibitors.
Main Results:
- Surgical adrenalectomy is highly effective for lateralizing PA.
- Mineralocorticoid receptor antagonists are the primary medical treatment for most PA patients.
- Dietary sodium restriction significantly aids blood pressure reduction, especially with medication.
Conclusions:
- Treatment is tailored to PA laterality and patient choice.
- Medical therapy intensification prioritizes blood pressure normalization, then potassium normalization, and finally renin level increase.
- Effective management of PA is crucial for reducing cardiorenal outcomes.
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