Adrenal: aldosterone excess: practice question

A Physiology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Physiology · Adrenal: aldosterone excess

Sample item

A 45-year-old man has blood pressure 168/102 mmHg, serum potassium 2.9 mmol/L, a raised aldosterone and a low plasma renin. Which acid-base disturbance is expected?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Metabolic alkalosis

In primary aldosteronism, aldosterone stimulates sodium reabsorption and potassium and hydrogen ion secretion in the collecting duct, causing hypokalaemia and metabolic alkalosis. Hypokalaemia further promotes hydrogen ion secretion. Renin is suppressed because the expanded volume feeds back on the juxtaglomerular apparatus.

Option by option

  • A. Normal anion gap metabolic acidosis

    Normal anion gap acidosis occurs in aldosterone deficiency, such as hypoaldosteronism, with hyperkalaemia.

  • B. High anion gap metabolic acidosis

    High anion gap acidosis results from organic acid accumulation, not aldosterone excess.

  • C. Metabolic alkalosis (correct)

    Correct. Increased renal hydrogen ion loss produces metabolic alkalosis.

  • D. Respiratory alkalosis

    Respiratory alkalosis is a primary hyperventilation state and is not caused by aldosterone.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Physiology question

What is the answer to this Physiology question?

The best answer is C, Metabolic alkalosis. In primary aldosteronism, aldosterone stimulates sodium reabsorption and potassium and hydrogen ion secretion in the collecting duct, causing hypokalaemia and metabolic alkalosis.

Why is "Normal anion gap metabolic acidosis" not the answer?

Normal anion gap acidosis occurs in aldosterone deficiency, such as hypoaldosteronism, with hyperkalaemia.

Why is "High anion gap metabolic acidosis" not the answer?

High anion gap acidosis results from organic acid accumulation, not aldosterone excess.

Why is "Respiratory alkalosis" not the answer?

Respiratory alkalosis is a primary hyperventilation state and is not caused by aldosterone.

What concept does this question test?

It tests Adrenal: aldosterone excess in Physiology. Hypokalaemia further promotes hydrogen ion secretion. Renin is suppressed because the expanded volume feeds back on the juxtaglomerular apparatus.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Adrenal: aldosterone excess?

For each system, sketch the key graph (pressure–volume loop, oxygen dissociation curve, nephron handling) and explain it aloud. Then use the flashcards and the other Physiology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.