GuidelinesEML (Adult Hospital STG)
Primary Aldosteronism
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2019 Edition
ICD-10 Code: E26.0
DESCRIPTION
- Increased aldosterone production usually due to an adrenal adenoma (Conn's syndrome) or idiopathic bilateral adrenal hyperplasia (the majority of cases).
Clinical
- Suspect in a patient with resistant hypertension or hypertension with hypokalaemia.
Diagnosis
- Elevated serum aldosterone with a suppressed renin level and elevated aldosterone/renin ratio.
- ACE-inhibitors, angiotensin receptor blockers (ARBs), and diuretics can give falsely elevated or lowered results. Stop all these drugs for a minimum of 2 weeks before testing. Stop spironolactone for 6 weeks before testing.
- Because of limited specificity, a positive screening test result should be followed by a confirmatory test. A negative random ratio test does not necessarily exclude the diagnosis.
MEDICINE TREATMENT
Adrenal adenoma
- A surgical resection/ removal of adenoma.
Bilateral hyperplasia
- Standard anti-hypertensive therapy, including spironolactone.
- Spironolactone, oral, 100–200 mg daily.
REFERRAL
- All patients to an endocrinologist or a hypertension centre for confirmation of the diagnosis and further treatment.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2024 Edition