title: Mineralocorticoid Receptor Antagonists and Clinical Outcomes in Primary Aldosteronism: As Good as Surgery?
abstract: Primary aldosteronism (PA) is detected with increasing frequency in hypertensive patients and is associated with excess cardiovascular, renal, and metabolic complications. For these reasons, appropriate choices for treatment of this endocrine condition are mandatory. Adrenalectomy is safely performed in PA patients when adrenal venous sampling (AVS) demonstrates lateralized aldosterone secretion. AVS, however, is a complex procedure and even among worldwide referral centers there are substantial discrepancies for interpretation of results. Also, in the majority of PA patients with lateralized aldosterone secretion, hypertension may persist after adrenalectomy requiring use of additional antihypertensive agents. Treatment with mineralocorticoid receptor antagonists (MRAs) is currently recommended for PA patients with bilateral adrenal disease, but these agents effectively decrease blood pressure also in patients with unilateral disease, although concern remains for possible sex-related side effects. Prospective studies indicate that MRAs have therapeutic values comparable to surgery in the long-term, inasmuch as they effectively correct metabolic abnormalities and subclinical organ damage and reduce the risk of cardiovascular events and renal disease progression. This article overviews the clinical outcomes obtained in patients with PA with use of MRAs.
authors.affiliation: Internal Medicine, Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy.
authors.forename: L A
authors.initials: LA
authors.lastname: Sechi
authors.affiliation: Internal Medicine, Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy.
authors.forename: G L
authors.initials: GL
authors.lastname: Colussi
authors.affiliation: Internal Medicine, Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Novello
authors.affiliation: General Surgery, Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Uzzau
authors.affiliation: Internal Medicine, Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Catena
mesh_terms: D000450:Aldosterone / Q000378:metabolism; D001794:Blood Pressure; D006801:Humans; D006929:Hyperaldosteronism / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery*; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D011788:Quality of Life; D016896:Treatment Outcome
chemical_list: D000451:Mineralocorticoid Receptor Antagonists; D000450:Aldosterone