michigan hypertension core curriculum - State of Michigan

Figure 3; Endocrine Society
See text for details.
APA: aldosterone-producing adenoma; AVS: adrenal venous sampling; CT: computed
tomography; GRA: glucocorticoid-remediable aldosteronism; IHA: idiopathic
hyperaldosteronism; PAH: primary adrenal hyperplasia. Copyright 2008, The Endocrine
Society
Medical management with aldosterone antagonists is indicated prior to surgery as well as over
the long-term for those not undergoing surgery. Spironolactone, which has been available for over 40
years, has the side effects of breast tenderness/gynecomastia and sexual dysfunction, particularly with
doses of more than 50 mg/d. Recent studies have suggested that in patients with adrenal hyperplasia,
doses of 25-50 mg, combined with other medications such as CCBs and chlothalidone, may control BP
with fewer side effects. Higher doses may, however, be required in patients with adrenal adenomas.
Chlorthalidone, a thiazide-like diuretic, will also be an important drug in the therapeutic armamentarium
because of the high likelihood of plasma volume expansion despite the well established kaliuretic effect
of thiazide diuretics. Other antihypertensive agents such as calcium antagonists may be needed to
104 Hypertension Core Curriculum