Abstract

Spironolactone is a mineralocorticoid receptor antagonist widely used due to its mortality-reducing effect in heart failure. However, due to its non-selective nature, hormonal side effects may occur. In this case, we present a patient who developed hoarseness after starting spironolactone as part of heart failure treatment, with complete resolution of symptoms after discontinuation of the drug. The symptoms recurred with the combination of spironolactone and a thiazide, but did not reappear with eplerenone, a selective mineralocorticoid receptor antagonist. This finding indicates a rare but reversible adverse effect of spironolactone. Spironolactone is one of the key drugs that improves long-term survival in the treatment of congestive heart failure. In the randomized aldactone evaluation study trial, spironolactone was shown to significantly reduce mortality. However, because spironolactone affects not only mineralocorticoid receptors but also androgen and progesterone receptors, it may be associated with hormonal side effects. These include gynecomastia, decreased libido, and menstrual irregularities. Another possible but rarely reported side effect in the literature that may impact quality of life is hoarseness.