Overview
Aldosterone disorders involve the dysregulation of aldosterone, a hormone produced by the adrenal glands that regulates blood pressure and electrolyte balance. Conditions such as primary aldosteronism are characterized by excessive aldosterone production, leading to hypertension and hypokalemia.Diagnosis
Diagnostic evaluation for primary aldosteronism typically involves screening tests to assess for autonomous aldosterone production in patients with hypertension, especially those with hypokalemia, resistant hypertension, or early-onset hypertension 3.
Screening tests may include the aldosterone-to-renin ratio (ARR) 3.
Confirmatory tests, such as saline suppression testing or oral salt loading, are used to confirm autonomous aldosterone production 3.
Adrenal vein sampling may be performed to lateralize aldosterone hypersecretion in cases of confirmed primary aldosteronism 3.Management
Treatment for primary aldosteronism aims to control blood pressure and electrolyte imbalances 3.
Mineralocorticoid receptor antagonists, such as spironolactone, are a cornerstone of medical management for primary aldosteronism 3.
Surgical adrenalectomy may be considered for patients with unilateral aldosterone-producing adenomas 3.
For adult female acne, oral spironolactone (50 mg/day, increasing to 100 mg/day) compared with routine topical treatment alone was evaluated for cost-effectiveness over 24 weeks 1. Spironolactone did not appear cost-effective in this specific context 1.Key Recommendations
Mineralocorticoid receptor antagonists are a primary medical treatment for primary aldosteronism 3. (Evidence: Moderate)
Surgical adrenalectomy is an option for patients with unilateral aldosterone-producing adenomas 3. (Evidence: Moderate)
Spironolactone was not found to be cost-effective for persistent acne in adult women when added to routine topical treatment over 24 weeks 1. (Evidence: Strong)References
1 Pyne S, Sach TH, Lawrence M, Renz S, Eminton Z, Stuart B et al.. Cost-effectiveness of Spironolactone for Adult Female Acne (SAFA): economic evaluation alongside a randomised controlled trial. BMJ open 2023. link