A 22-year-old man has early onset hypertension, hypokalemia, and metabolic alkalosis. Renin and aldosterone levels are both suppressed. His mother had similar findings. Which drug is the specific treatment of choice?
- A Spironolactone
- B Hydrochlorothiazide
- C Amiloride ✓
- D Eplerenone
Correct answer: C. Amiloride
Explanation
Liddle syndrome is an autosomal dominant gain of function mutation of epithelial sodium channels (ENaC) causing excess distal sodium reabsorption with potassium wasting, giving low renin and low aldosterone hypertension. Amiloride directly blocks ENaC and is definitive therapy. Spironolactone and eplerenone act on the mineralocorticoid receptor, which is not activated here since aldosterone is suppressed, so they are ineffective. Thiazides would worsen hypokalemia.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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