A 28-year-old man with new-onset hypertension has serum potassium of 2.9 mEq/L despite oral replacement. Aldosterone:renin ratio (ARR) is 42 (normal <20). CT adrenals shows bilateral adrenal hyperplasia. What is the next best step?
- A Unilateral adrenalectomy
- B Spironolactone therapy
- C Adrenal vein sampling ✓
- D Dexamethasone suppression test
Correct answer: C. Adrenal vein sampling
Explanation
When CT shows bilateral adrenal hyperplasia or equivocal findings in primary hyperaldosteronism, adrenal vein sampling (AVS) is the definitive test to distinguish unilateral (adenoma/hyperplasia) from bilateral disease before deciding on surgery versus medical management. If AVS confirms bilateral disease, medical treatment with spironolactone/eplerenone is preferred; unilateral disease would direct surgical intervention.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.