From the Guidelines
Patients with primary hyperaldosteronism should not restrict their salt intake because doing so can worsen their condition. In primary hyperaldosteronism, the adrenal glands produce excessive aldosterone, which causes sodium retention and potassium excretion. When salt intake is restricted, the body responds by further increasing aldosterone production to conserve sodium, exacerbating the underlying hormonal imbalance. This worsening aldosterone excess leads to more severe hypokalemia (low potassium levels), which can cause muscle weakness, cardiac arrhythmias, and other dangerous symptoms. Additionally, salt restriction can make diagnostic testing less accurate, potentially delaying proper diagnosis and treatment.
Key Points to Consider
- The most recent guidelines from the European Society of Cardiology (2024) recommend that patients with primary aldosteronism should have unrestricted salt intake before testing 1.
- The American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines (2018) also suggests that patients should have unrestricted salt intake, serum potassium in the normal range, and mineralocorticoid receptor antagonists withdrawn for at least 4 weeks before testing 1.
- Instead of restricting salt, patients should maintain a normal salt intake while receiving appropriate medical therapy, which typically includes mineralocorticoid receptor antagonists like spironolactone (25-100 mg daily) or eplerenone (50-100 mg daily) to block aldosterone's effects.
- These medications help normalize potassium levels and control blood pressure while diagnostic workup and definitive treatment planning proceed.
- The management of primary aldosteronism depends on its subtype, particularly on adrenal lesions being unilateral or bilateral, because the unilateral forms are amenable to surgical treatment while the latter require lifelong medical treatment 1.
From the Research
Reasons for Not Restricting Salt Intake
- There is no direct evidence in the provided studies that suggests patients with primary hyperaldosteronism should restrict their salt intake 2, 3, 4, 5, 6.
- The focus of treatment for primary hyperaldosteronism is on managing aldosterone excess, either through surgery or medication, rather than dietary restrictions 2, 4, 6.
- Medications such as spironolactone and eplerenone are used to treat primary hyperaldosteronism by blocking the effects of aldosterone, and there is no mention of salt restriction as a necessary adjunct to these treatments 2, 4, 6.
- The provided studies discuss the importance of screening, diagnosis, and management of primary hyperaldosteronism, but do not address the role of salt intake in treatment 3, 5.
Treatment Approaches
- Treatment for primary hyperaldosteronism typically involves either unilateral adrenalectomy for patients with aldosterone-producing adenomas or medical management with mineralocorticoid receptor antagonists for those with bilateral idiopathic hyperaldosteronism 2, 4, 5.
- Medical management may include the use of spironolactone or eplerenone, with the goal of reducing aldosterone's effects on the body 2, 4, 6.
- The development of new, more selective mineralocorticoid receptor antagonists and aldosterone synthase inhibitors may offer additional treatment options in the future 4, 6.