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Unilateral primary aldosteronism — SCE Endocrinology MCQ

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HardAdrenalUnilateral primary aldosteronismSCE Endocrinology

A 32-year-old man has severe hypertension and hypokalaemia. Aldosterone-renin ratio is high. Confirmatory testing supports primary aldosteronism and adrenal venous sampling lateralises secretion to the left adrenal. CT shows a 9 mm left adrenal nodule. What is the most appropriate management?

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Correct answer: D — Laparoscopic left adrenalectomy after blood pressure and potassium optimisation

Laparoscopic left adrenalectomy after blood pressure and potassium optimisation is best because unilateral aldosterone secretion confirmed by adrenal venous sampling is treated surgically when the patient is suitable. The alternatives are less appropriate because bilateral adrenalectomy causes unnecessary adrenal failure; hydrocortisone does not treat aldosterone excess; small nodule size does not overrule lateralisation; radioiodine does not ablate adrenal cortex. 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