Amiloride in primary hyperaldosteronism with chronic peptic ulceration.

Prolonged treatment with the aldosterone antagonist spironolactone is well-established in the syndrome of hypertension with aldosterone excess and low plasma renin ("primary" hyperaldosteronism) and is usually effective in lowering the blood pressure and correcting the electrolyte abnormalities in cases with adrenocortical adenoma or micronodular hyperplasia (Brown et al., 1965, 1969, 1971b, 1972; Spark and Melby, 1968; Crane and Harris, 1970). While serious side effects are in our experience rare, spironolactone may cause epigastric discomfort, and in one patient gastric ulceration developed during therapy and rapidly healed when the drug was withdrawn (Brown et al., 1971 b). We report the use of an alternative potassium-conserving diuretic, amiloride, in a patient with primary hyperaldosteronism in whom spironolactone could not be tolerated because of severe epigastric pain associated with peptic ulceration.