Primary Aldosteronism Screening — RACP Adult Medicine MCQ

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EasyEndocrinologyPrimary Aldosteronism ScreeningRACP Adult Medicine

A 35-year-old woman with resistant hypertension (BP 160/100 on triple therapy) has unprovoked hypokalaemia (K⁺ 3.0 mmol/L) and metabolic alkalosis. Which screening test is most appropriate?

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Correct answer: C — Aldosterone:renin ratio

Resistant hypertension with unprovoked hypokalaemia and metabolic alkalosis should prompt screening for primary aldosteronism (the most common endocrine cause of secondary hypertension, ~10% of hypertensives). The aldosterone:renin ratio (ARR) is the screening test. It should be performed under standardised conditions. Confirmatory testing (saline infusion test or fludrocortisone suppression test) follows a positive screen.

Reference: Endocrine Society – 2016 – Primary Aldosteronism; NHFA 2016 Hypertension