Medical Management of Aldosterone-Producing Adenoma with Sequential Mineralocorticoid Receptor Antagonists: A Case Report
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Abstract
Primary aldosteronism (PA) is the most common cause of secondary hypertension, characterized by autonomous aldosterone overproduction leading to hypertension, hypokalemia, and increased cardiovascular risk. Mineralocorticoid receptor antagonists (MRAs) are the pharmacological cornerstone of treatment when surgery is not feasible. We describe a 34-year-old male with PA secondary to a right adrenal adenoma, who refused surgical treatment due to severe anxiety. After developing painful bilateral gynecomastia with spironolactone (50 mg/day), he was switched to eplerenone (50 mg twice daily), which normalized serum potassium (4.3 mEq/L), resolved gynecomastia, and maintained blood pressure control. Temporary replacement of eplerenone with finerenone because of drug unavailability resulted in recurrent hypokalemia, which resolved after eplerenone was resumed. Following psychotherapy, the patient subsequently underwent laparoscopic right adrenalectomy, achieving complete biochemical remission. This case highlights eplerenone as an effective, well-tolerated alternative MRA in patients who develop androgen-mediated adverse effects with spironolactone, reinforcing the importance of individualized therapeutic management in PA.
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