Primary aldosteronism — SCE Endocrinology MCQ

Correct answer: B — Potassium correction and medicine review before repeat aldosterone–renin testing

The best answer is “Potassium correction and medicine review before repeat aldosterone–renin testing”. Hypokalaemia and several antihypertensive classes can distort aldosterone and renin; preparation must balance diagnostic validity against blood-pressure safety, usually with specialist-supervised substitutions when feasible. “Proceed directly to unilateral adrenalectomy from the ratio alone” is less appropriate because surgery requires confirmation and lateralisation rather than a confounded screening result “Start fludrocortisone before repeating aldosterone and renin” is less appropriate because fludrocortisone alters the renin–aldosterone system and can worsen hypertension and hypokalaemia “Diagnose essential hypertension because the patient already takes three drugs” is less appropriate because resistance plus hypokalaemia strengthens rather than dismisses suspicion of primary aldosteronism “Replace the aldosterone-to-renin ratio with urinary catecholamines” is less appropriate because catecholamine testing evaluates phaeochromocytoma and does not resolve this confounded aldosterone screen

Reference: British and Irish Hypertension Society practical approach to primary aldosteronism. https://pmc.ncbi.nlm.nih.gov/articles/PMC10803267/