skip to main content

Primary aldosteronism — ABIM Board MCQ

Instant feedback + full explanation. One question, done properly.

HardCardiovascularPrimary aldosteronismABIM Board

A 49-year-old with resistant hypertension, spontaneous hypokalemia, suppressed renin and clearly elevated aldosterone has primary aldosteronism and wants curative surgery if disease is unilateral. Adrenal CT shows a 1.5-cm left adrenal nodule. What diagnostic study should guide lateralization?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Perform adrenal venous sampling before deciding on unilateral adrenalectomy

The best answer is “Perform adrenal venous sampling before deciding on unilateral adrenalectomy”. Adrenal nodules are common and CT anatomy alone cannot reliably identify the aldosterone-secreting side. In a surgical candidate, adrenal venous sampling distinguishes unilateral from bilateral secretion and guides adrenalectomy, except in narrowly defined young patients with a highly convincing unilateral phenotype. Renin and renal imaging do not lateralize adrenal secretion.

Reference: Endocrine Society 2025 Primary Aldosteronism Guideline: https://pubmed.ncbi.nlm.nih.gov/40658480/