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Primary aldosteronism — ABIM Board MCQ

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HardCardiovascularPrimary aldosteronismABIM Board

A 45-year-old has resistant hypertension, potassium 3.1 mEq/L, suppressed renin and elevated aldosterone. Chlorthalidone can be held safely, potassium can be corrected and there is no renal failure. What is the next diagnostic step?

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Correct answer: E — Repeat aldosterone and renin under standardized conditions before confirmatory testing

The best answer is “Repeat aldosterone and renin under standardized conditions before confirmatory testing”. Hypokalemia and interfering medicines can distort aldosterone-renin testing. Repeating the screen after potassium correction and medication adjustment improves interpretability before confirmatory testing. Imaging and adrenal venous sampling classify anatomy and laterality after biochemical diagnosis; treatment response does not establish autonomous secretion.

Reference: 2025 Endocrine Society Primary Aldosteronism Guideline: https://www.endocrine.org/clinical-practice-guidelines/primary-aldosteronism-2