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Primary Aldosteronism Lateralisation — ESENeph MCQ

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HardHypertensionPrimary Aldosteronism LateralisationESENeph

A 52-year-old man with CKD G3a and resistant hypertension (on 4 agents including Doxazosin) has a plasma aldosterone of 850 pmol/L and renin of 2.5 mU/L. The aldosterone:renin ratio is significantly elevated. After confirmatory testing, CT adrenals shows a 1.5 cm left adrenal adenoma. He has a normal right adrenal. What is the next step to determine lateralisation?

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Correct answer: C — Adrenal venous sampling to confirm lateralisation before considering surgery

Adrenal venous sampling (AVS) is the gold standard for determining whether aldosterone secretion is unilateral (adenoma – amenable to surgery) or bilateral (hyperplasia – treated medically). CT alone cannot reliably distinguish functional from non-functional adenomas, especially as incidentalomas are common. Endocrine Society 2016 recommends AVS for most patients unless the patient is young (<40) with a clear unilateral adenoma and normal contralateral gland, where surgery can proceed without AVS.

Reference: Endocrine Society 2016 – Primary Aldosteronism Guideline