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Primary Aldosteronism Diagnosis — ESENeph MCQ

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ModerateHypertensionPrimary Aldosteronism DiagnosisESENeph

A 60-year-old man with resistant hypertension (BP 162/98 on Ramipril, Amlodipine, and Indapamide at optimal doses) and CKD G3a has a plasma aldosterone:renin ratio (ARR) that is elevated. What is the next diagnostic step?

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Correct answer: C — Confirmatory testing for primary aldosteronism (e.g. saline suppression test or oral salt loading)

An elevated ARR is a screening test for primary aldosteronism. NICE and Endocrine Society guidelines recommend confirmatory testing before proceeding to localisation studies. Confirmatory tests include saline infusion test, oral salt loading test, or fludrocortisone suppression test. CT adrenals should only be performed after primary aldosteronism is confirmed, to localise the source (adenoma vs bilateral hyperplasia). Interfering medications (MRAs, beta-blockers) should ideally be stopped before ARR testing.

Reference: Endocrine Society 2016 – Primary Aldosteronism; NICE NG136 2019