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Adrenal Incidentaloma — RACP Adult Medicine MCQ

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HardEndocrinologyAdrenal IncidentalomaRACP Adult Medicine

A 46-year-old has resistant hypertension, spontaneous potassium 2.9 mmol/L and an adrenal nodule. He takes spironolactone, ramipril, amlodipine and indapamide. What is the best approach to aldosterone-renin testing?

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Correct answer: B — Correct potassium and substitute interfering medicines before repeat testing

Explanation lettering: B = shown as A · A = shown as B · D = shown as C · C = shown as D

A is correct. Hypokalaemia and mineralocorticoid antagonism can invalidate screening; correction and planned substitution permit interpretable testing without unsafe total withdrawal. B risks hypertensive emergency. C ignores marked renin distortion. D CT cannot establish functional laterality. E ACE inhibition does not exclude autonomous secretion.

Reference: Australian Prescriber, Approach to diagnosis of secondary hypertension in adults: https://australianprescriber.tg.org.au/articles/approach-to-the-diagnosis-of-secondary-hypertension-in-adults.html