The goal of treatment is to prevent the harmful effects of high aldosterone by returning your aldosterone levels to normal or blocking the actions of aldosterone.
For patients whose disease is caused by aldosterone production from both adrenal glands, medication is the best form of treatment2.
In Australia, the most common medication (tablet) for treating primary aldosteronism is spironolactone which can be taken once a day. Spironolactone blocks the effects of aldosterone, not only in the kidneys but in all the organs where aldosterone may be causing harm. The main side effects are breast growth and pain (in both men and women), reduced libido or sex drive (in men and women) and irregular periods (in pre-menopausal women). These side effects are usually seen
at higher doses, and are reversible once the dose is reduced or you switch to another medication.
Another medication that does not have these side effects is eplerenone. This also blocks the effects of aldosterone, however, eplerenone is not subsidised by the government and is therefore more expensive. It usually needs to be taken twice a day.
Another option is amiloride, which blocks the effect of aldosterone in the kidneys.
Your doctor will discuss these options with you, and monitor your progress over time to ensure that your blood pressure is improving and to monitor for side effects. Sometimes more than one tablet is required to keep the blood pressure under control, especially if you have had high blood pressure
for many years.
It is important to keep taking the medication as instructed by your doctor. If you stop taking this medication suddenly, it can cause high blood pressure which increases the risk for heart attack, stroke and kidney disease.
For patients who have primary aldosteronism caused by aldosterone overproduction from only one adrenal gland, the best treatment is key-hole surgery to remove the affected gland2. Medication is given before surgery to get your blood pressure and potassium in the normal range ahead of surgery.
Keyhole surgery to remove an adrenal gland is performed in hospital under general anaesthetic, so you are completely asleep during the procedure. You will have four small incisions made in the side of your back. These allow the surgeons to view the adrenal gland using a tiny camera (called a laparoscope) through one incision, and then access and remove the adrenal gland through the other incisions. The procedure generally lasts for 2-4 hours and will require an overnight stay in hospital.
The response to surgery depends on your age and how long you have had primary aldosteronism. The earlier the diagnosis, the less injury caused by aldosterone and therefore surgery is likely to have the greatest blood-pressure lowering effect. Blood tests of aldosterone and renin around three months after surgery will indicate if you have had a cure of the disease. Blood pressure may take longer to return to normal, although you may still need blood pressure lowering tablets (usually much less than before) even after a cure of primary aldosteronism.