A 55-year-old man presents with hypertension (BP 178/104 mmHg), hypokalemia (K⁺ 2.9 mEq/L), and metabolic alkalosis. 24-hour urinary aldosterone is elevated and plasma renin activity is suppressed. CT abdomen shows a 1.8 cm left adrenal adenoma. The most appropriate definitive treatment is:

• A Long-term spironolactone therapy
• B Bilateral adrenal venous sampling followed by eplerenone
• C High-dose fludrocortisone suppression test
• D Laparoscopic left adrenalectomy ✓

Explanation

Primary hyperaldosteronism due to a unilateral aldosterone-producing adenoma (Conn syndrome) is confirmed here by the suppressed renin and elevated aldosterone with a discrete adenoma on CT. Adrenal venous sampling is performed when lateralization is uncertain; in a young patient with a clear unilateral adenoma, laparoscopic adrenalectomy is curative. Medical therapy with mineralocorticoid antagonists is used for bilateral hyperplasia or when surgery is not feasible.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.