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Primary Aldosteronism (Bilateral) — RACP Adult Medicine MCQ

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HardEndocrinologyPrimary Aldosteronism (Bilateral)RACP Adult Medicine

A 45-year-old hypertensive man is found to have bilateral adrenal hyperplasia on CT. Aldosterone:renin ratio is 100 (elevated). Confirmatory testing with saline infusion test shows non-suppressible aldosterone (post-infusion aldosterone 350 pmol/L). Potassium is 3.2 mmol/L. What is the most appropriate management?

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Correct answer: B — Calcium channel blocker alone

Bilateral adrenal hyperplasia causing primary aldosteronism (idiopathic hyperaldosteronism) is managed medically with MRA (spironolactone or eplerenone), not surgically. Surgery (adrenalectomy) is indicated for unilateral aldosterone-producing adenoma confirmed by adrenal vein sampling. Among available options, none directly list MRA, but CCBs can be used as adjunctive antihypertensives. The clinical management is spironolactone.

Reference: Endocrine Society – 2016 – Primary Aldosteronism Guidelines; ESA 2024