Primary aldosteronism — ESENeph MCQ

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ModerateHypertension and Renovascular DiseasePrimary aldosteronismESENeph

A 39-year-old man has persistent hypertension despite amlodipine, indapamide and doxazosin. Potassium is 3.1 mmol/L and bicarbonate is 31 mmol/L. Plasma aldosterone is high and renin is suppressed on repeated testing. What is the most likely diagnosis?

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Correct answer: E — Primary aldosteronism

Resistant hypertension with hypokalaemic metabolic alkalosis, high aldosterone and suppressed renin is primary aldosteronism. Renal artery stenosis usually raises renin. Gitelman syndrome causes low blood pressure or normotension rather than resistant hypertension. The pearl is that primary aldosteronism is underdiagnosed and should be sought in resistant hypertension or hypertension with spontaneous hypokalaemia.

Reference: NICE Hypertension Guideline NG136; Endocrine Society Primary Aldosteronism Guideline