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Primary aldosteronism — USMLE Step 3 MCQ

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ModerateAmbulatory Medicine / Primary CarePrimary aldosteronismUSMLE Step 3

A 54-year-old woman with hypertension and diabetes comes for follow-up. She takes lisinopril 40 mg and amlodipine 10 mg. Home blood pressures average 154/88 mm Hg. Potassium is 3.2 mEq/L, bicarbonate is 30 mEq/L, and creatinine is normal. She has no licorice use. Which of the following is the most likely explanation for this patient's findings?

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Correct answer: C — Primary aldosteronism

Resistant hypertension with spontaneous hypokalemia and metabolic alkalosis suggests primary aldosteronism. Screening is with a plasma aldosterone-to-renin ratio.

Reference: Endocrine Society primary aldosteronism guidance