[Therapy of primary aldosteronism with trilostane]

Trilostane is a competitive inhibitor of the 3 beta-hydroxysteroid dehydrogenase enzyme system localized in the adrenal cortex and in the gonads. This inhibitor reduces the production of cortisol, aldosterone and androstendione. Trilostane was used for the treatment of 3 male and 2 female patients with primary aldosteronism, two of whom had an adenoma of the adrenal cortex and three bilateral adrenal hyperplasia. After a 12 weeks' treatment with trilostane (average dosage 288 mg/day) normalization of plasma aldosterone (from 368 to 35.1 pg/ml) was achieved. Average blood pressure had almost normalized (147/98 mm Hg) after the treatment period. However, in one patient no, or only a minor, reduction in blood pressure was observed during trilostane and even during captopril and minoxidil administration. Except slight diarrhea in 2 cases, which did not require cessation of trilostane medication, there were no further side effects. After 12 weeks' treatment the average serum cortisol was in the lower normal range. It is concluded from these results that trilostane is an effective therapeutic agent in primary aldosteronism, especially where there is no indication for surgery.