27th May 2025

Management

Management will depend on whether PH is due to a unilateral issue e.g. adenoma or bilateral, and whether the patient is fit for surgery. In the instance of unilateral causes, laparoscopic adrenalectomy may be performed and can resolve hypertension in 70% of patients. Even for bilateral causes, unilateral laparoscopic adrenalectomy can be of benefit by reducing the amount of adrenal tissue capable of secreting aldosterone, and therefore reduce hypertension. If unfit for surgery, lifelong aldosterone antagonists may be prescribed (such as spironolactone, amiloride or eplerenone) and these can take weeks to months to improve hypertension. Treatment must be titrated to avoid excessive volume depletion that can result in pre-renal acute kidney injury and hyperkalaemia. Dietary sodium restriction is also of benefit.