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Primary Aldosteronism Workup — EECC MCQ

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HardHypertension & Preventive CardiologyPrimary Aldosteronism WorkupEECC

A 50-year-old woman with hypertension has bilateral adrenal incidentalomas, spontaneous hypokalaemia and a markedly raised aldosterone-to-renin ratio. The aldosterone concentration is not sufficiently high to bypass suppression testing. What is the next diagnostic step?

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Correct answer: D — Confirmatory aldosterone-suppression testing before adrenal vein sampling

Biochemical confirmation is required when the phenotype does not meet criteria for omitting suppression testing. If primary aldosteronism is confirmed and surgery is contemplated, adrenal vein sampling—not nodule size—distinguishes unilateral secretion from bilateral disease because non-functioning incidentalomas are common.

Reference: https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines