Adrenal: primary aldosteronism: practice question

A General Surgery 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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General Surgery · Adrenal: primary aldosteronism

Sample item

A 38-year-old woman has hypertension resistant to three drugs, serum potassium 2.9 mmol/L and metabolic alkalosis. Which is the best screening test for the suspected diagnosis?

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

The answer and the reasoning

B. Plasma aldosterone to renin ratio

Resistant hypertension with hypokalaemia suggests primary aldosteronism (Conn syndrome). The aldosterone to renin ratio is the screening test, with a high aldosterone and suppressed renin. After confirmation, adrenal vein sampling lateralises the source, and a unilateral adenoma is treated by laparoscopic adrenalectomy.

Option by option

  • A. Serum ACTH

    ACTH helps to localise the cause of Cushing syndrome, not primary aldosteronism.

  • B. Plasma aldosterone to renin ratio (correct)

    Correct. A high ratio with suppressed renin identifies autonomous aldosterone excess.

  • C. Overnight dexamethasone suppression test

    Dexamethasone suppression screens for Cushing syndrome.

  • D. 24-hour urinary metanephrines

    Metanephrines screen for phaeochromocytoma, which has episodic symptoms rather than persistent hypokalaemia.

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 General Surgery question

What is the answer to this General Surgery question?

The best answer is B, Plasma aldosterone to renin ratio. Resistant hypertension with hypokalaemia suggests primary aldosteronism (Conn syndrome).

Why is "Serum ACTH" not the answer?

ACTH helps to localise the cause of Cushing syndrome, not primary aldosteronism.

Why is "Overnight dexamethasone suppression test" not the answer?

Dexamethasone suppression screens for Cushing syndrome.

Why is "24-hour urinary metanephrines" not the answer?

Metanephrines screen for phaeochromocytoma, which has episodic symptoms rather than persistent hypokalaemia.

What concept does this question test?

It tests Adrenal: primary aldosteronism in General Surgery. The aldosterone to renin ratio is the screening test, with a high aldosterone and suppressed renin. After confirmation, adrenal vein sampling lateralises the source, and a unilateral adenoma is treated by laparoscopic adrenalectomy.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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: primary aldosteronism?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery 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.