Endocrinology Question 24 Instructor

Sarah Hughes is a 45-year old woman with new onset hypertension 180/110. Her blood pressure remains elevated despite the use of three antihypertensive agents.

List 5 lifestyle questions you would ask her.

  • Salt intake
  • Alcohol intake
  • Caffeine
  • Smoking adherence to medications
  • Licorice ingestion
  • Use of NSAIDS
  • Cocaine
  • Amphetamines
  • Cold medications
  • Oral contraception

Her potassium is low at 2.8 mmol/L, and you suspect hyperaldosteronism. How do you screen for hyperaldosteronism? How would you confirm the diagnosis of primary hyperaldosteronism?


  • Elevated serum aldosterone (>400 nmol/L);
  • Elevated ratio of aldosterone:renin >140 (100-140 “grey zone”) (using renin measured as mass not activity, beware of units!)

Confirm with saline suppression test: 2 L saline infused IV over 4 hours, plasma aldosterone afterwards elevated >280 nmol/L

CT image (hyperplasia vs adenoma)

Adrenal vein sampling if image is confusing, or patient is >45 years old

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