Most such circumstances are distinguished by the presence of hypertension.7-13 Aldosterone receptor antagonism with spironolactone has also proved useful in treating adrenal hypertension, which was not responsive to 2 or more antihypertensive medications.14 The foundation for this kind of antihypertensive effect is just now starting to emerge. In fact, eplerenone reduces urine albumin excretion like what's observed with ACE inhibitors, also if given with an ACE inhibitor, there's an additive antiproteinuric effect.25 What this contraindication should have said was that type 2 diabetic patients with microalbuminuria would more frequently develop hyperkalemia with eplerenone therapy; there, lies the proviso for caution. For instance, it has been demonstrated by Schohn et al.15 that doses of spironolactone as low as 25 mg/d apply a marked inhibitory effect on cardiovascular reactivity to the adrenergic and the renin-angiotensin systems.15 The inhibitory effect achieved with spironolactone seems to be much more durable than that observed with angiotensin-converting enzyme (ACE) inhibitors. Therefore, tachyphylaxis or an escape from inhibition of this renin-angiotensin-aldosterone system may occur after long-term therapy with an ACE inhibitor, an occurrence that has not yet been observed with spironolactone. Risks of surgical treatment include reaction to anesthesia, infection, nerve injury, fatigue or lack of flexibility in the affected area or inability to straighten the arm.