Spontaneous remission of idiopathic aldosteronism after long-term treatment with spironolactone: results from the German Conn's Registry

Abstract

Context: Primary aldosteronism (PA) is mainly caused by aldosterone-producing adenoma and idiopathic bilateral adrenal hyperplasia (IHA). Recently, spontaneous resolution of IHA has been described.

Objective: We aimed to determine the frequency of spontaneous remission of PA during long-term treatment with mineralocorticoid receptor (MR) antagonists.

Design, setting and patients: Thirty-seven patients of the Munich PA registry with IHA treated by MR antagonists were investigated. The patients were identified retrospectively by chart review and prospectively assessed by clinical and biochemical means.

Main outcome measures: Complete remission of IHA was defined as normal aldosterone to renin ratio (ARR), normal suppression test and normalization of hypokalaemia in the presence of normal blood pressure. Partial remission was defined as normalization of normal ARR, normal suppression test and normalization of hypokalaemia in the presence of persistent hypertension.

Results: The mean period of MR antagonist treatment was 5·8 ± 0·7 years in the patients. We identified two of 37 (5·4%) patients with spontaneous remission: one with complete remission and one with partial remission.

Conclusion: Remission of IHA in PA may occur in some patients after long-term mineralocorticoid antagonist treatment.