علاج الألدوستيرونية الأولية عندما يكون المرض ثنائياً أو يكون التوطين الجانبي مجهولاً أو لا يتوفر خيار الجراحة

References

DOI: 10.1210/clinem/dgaf284

• Lifelong medical therapy that includes an MRA is usually offered to individuals with bilateral PA or lateralization status unknown (refer to Question 6 for definition of lateralization) and to those who decline the surgical option or who are not surgical candidates.
• In individuals with primary aldosteronism (PA) receiving PA-specific medical therapy, we suggest spironolactone over other mineralocorticoid receptor antagonists (MRAs) due to its low cost and widespread availability.
• Clinicians may start at a relatively low dose MRA (spironolactone 12.5-25 mg/d or eplerenone 25 mg daily or twice daily).
• For individuals with more severe PA, especially if profound hypokalemia is present, a higher initial dose could be considered (spironolactone 50 mg/d or eplerenone 50 mg twice daily).
• The primary goal of therapy is control of BP.
• The secondary goal of therapy is achievement of normokalemia.
• Normalization of serum potassium usually occurs, even with lower-dose MRAs, in the first 3 to 5 days, so it is reasonable to reduce or discontinue any potassium supplements at day 2 to 4 of MRA initiation in all but the most severe hypokalemic cases.