HIPOALDOSTERONISMO

 

TREATMENTAppropriate therapy for hypoaldosteronism varies with the cause of the hormone deficiency. Patients with primary adrenal insufficiency, for example, should receive mineralocorticoid replacement therapy (with fludrocortisone at a dose of 0.05 to 0.2 mg/day) to correct the hyperkalemia and with 0.9 percent saline to correct symptomatic hypovolemia. Primary adrenal insufficiency should also be treated with a glucocorticoid, such as hydrocortisone or prednisone, to correct the cortisol deficiency. (See "Treatment of adrenal insufficiency in adults".)

Fludrocortisone is also effective in patients with hyporeninemic hypoaldosteronism [1]. The typical dose required to normalize the serum potassium is 0.2 to 1 mg/day, substantially higher than the dose in primary adrenal insufficiency. It is therefore likely that these patients have some component of aldosterone resistance, presumably due to the underlying kidney disease.

Despite its efficacy, fludrocortisone is often not used in hyporeninemic hypoaldosteronism because many patients with this disorder have hypertension and/or edema, problems that can be exacerbated by mineralocorticoid replacement. In this setting, use of a low-potassium diet and, if necessary, a loop or thiazide-type diuretic will usually control the hyperkalemia [82,83]. (See "Patient education: Low-potassium diet (Beyond the Basics)".)