A 34-year-old woman presents with resistant hypertension, spontaneous hypokalaemia (K⁺ 2.9 mEq/L), and suppressed plasma renin activity. CT abdomen shows a 1.8 cm right adrenal adenoma. Adrenal vein sampling (AVS) confirms right-sided aldosterone excess. What is the definitive treatment?
- A Lifelong spironolactone
- B Laparoscopic right adrenalectomy ✓
- C Bilateral adrenal biopsy
- D Fludrocortisone suppression test
Correct answer: B. Laparoscopic right adrenalectomy
Explanation
In primary hyperaldosteronism (Conn's syndrome) due to a unilateral adenoma confirmed by AVS, laparoscopic adrenalectomy is the definitive treatment offering potential cure of hypertension and hypokalaemia. AVS is the gold-standard for lateralisation and must be performed before surgery. Bilateral hyperplasia is managed with mineralocorticoid antagonists (spironolactone/eplerenone). The fludrocortisone suppression test is used for diagnosis confirmation, not treatment.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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