A 28-year-old man has hypokalemia (K+ 2.8), hypertension, metabolic alkalosis, and suppressed plasma renin activity. Plasma aldosterone-to-renin ratio (ARR) is markedly elevated. Adrenal CT shows bilateral adrenal hyperplasia. The FIRST-LINE medical treatment for this subtype of primary hyperaldosteronism is:
- A Fludrocortisone
- B Amiloride
- C Spironolactone or eplerenone ✓
- D Dexamethasone
Correct answer: C. Spironolactone or eplerenone
Explanation
Bilateral adrenal hyperplasia causing primary aldosteronism is treated medically with mineralocorticoid receptor antagonists — spironolactone (first-line) or eplerenone (fewer anti-androgenic side-effects). Surgery is appropriate for unilateral aldosteronoma confirmed on adrenal venous sampling. Dexamethasone is reserved for glucocorticoid-remediable aldosteronism (familial type I). Amiloride is a second-line potassium-sparing alternative.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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