A 35-year-old woman presents with hypertension, hypokalaemia, metabolic alkalosis, low renin, and elevated aldosterone. CT abdomen shows a 2 cm adrenal cortical adenoma. The zona of the adrenal cortex that is hyperplastic/neoplastic in primary hyperaldosteronism (Conn syndrome) is:

• A Zona fasciculata — produces glucocorticoids (cortisol)
• B Zona reticularis — produces androgens (DHEA, androstenedione)
• C Adrenal medulla — produces catecholamines (epinephrine, norepinephrine)
• D Zona glomerulosa — produces mineralocorticoids (aldosterone) ✓

Explanation

The zona glomerulosa is the outermost cortical zone and the exclusive site of aldosterone synthesis (regulated by the renin-angiotensin-aldosterone system and hyperkalemia). In Conn syndrome, an aldosterone-secreting adenoma or bilateral zona glomerulosa hyperplasia autonomously produces excess aldosterone, causing sodium retention, hypokalaemia, metabolic alkalosis, and hypertension with suppressed renin.

Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.

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