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Primary aldosteronism — SCE Endocrinology MCQ

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ModerateAdrenalPrimary aldosteronismSCE Endocrinology

A 29-year-old woman has resistant hypertension and episodic weakness. Potassium is 2.8 mmol/L and bicarbonate 32 mmol/L; plasma aldosterone is high with suppressed renin on repeated testing. CT shows no clear adrenal mass. What is the most appropriate next investigation?

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Correct answer: B — Adrenal venous sampling

Adrenal venous sampling is best because confirmed primary aldosteronism needs subtype classification before surgery, and adrenal venous sampling distinguishes unilateral from bilateral secretion. The alternatives are less appropriate because dexamethasone tests cortisol autonomy; MIBG is for catecholamine tumours; pituitary MRI is unrelated; urinary calcium helps hypercalcaemia work-up. The SCE teaching point is to integrate the clinical pattern, biochemistry and context rather than treating an isolated result.

Reference: Endocrine Society primary aldosteronism guideline