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Primary hyperaldosteronism — RCPSC IM MCQ

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HardEndocrinologyPrimary hyperaldosteronismRCPSC IM

A 45-year-old has confirmed resistant hypertension despite perindopril, amlodipine and chlorthalidone. Potassium is 3.0 mmol/L and bicarbonate 31 mmol/L. After correcting potassium and reviewing interfering medication, which screening test is most appropriate?

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Correct answer: A — Measure plasma aldosterone and renin to calculate an aldosterone-to-renin ratio

The best answer is “Measure plasma aldosterone and renin to calculate an aldosterone-to-renin ratio”. Resistant hypertension with hypokalemic alkalosis is a classic primary-aldosteronism phenotype. Screening uses aldosterone and renin under appropriate conditions; imaging and adrenal venous sampling are localization steps after biochemical confirmation, while renal biopsy does not diagnose the syndrome.

Reference: Hypertension Canada, assessment for endocrine hypertension: https://hypertension.ca/guidelines/diagnosis-assessment/xviii-assessment-for-endocrine-hypertension/