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Primary aldosteronism — SCE Endocrinology MCQ

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HardAdrenalPrimary aldosteronismSCE Endocrinology

A 49-year-old man has resistant hypertension and spontaneous hypokalaemia. Plasma aldosterone is elevated, renin is suppressed and the aldosterone:renin ratio is repeatedly high. CT shows a 9 mm left adrenal nodule and a normal right adrenal. What is the most appropriate next investigation?

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Correct answer: C — Adrenal venous sampling

Adrenal venous sampling is usually required to distinguish unilateral aldosterone production from bilateral disease before adrenalectomy, because non-functioning nodules are common. CT alone can misclassify laterality. The pearl is that biochemical lateralisation matters more than nodule appearance.

Reference: Endocrine Society primary aldosteronism guideline