Endocrinology and diabetes: primary hyperaldosteronism: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Endocrinology and diabetes: primary hyperaldosteronism

Sample item

A 38-year-old woman has resistant hypertension and serum potassium of 3.0 mEq/L. Plasma aldosterone-to-renin ratio is raised. What is the next step to confirm the diagnosis?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Saline infusion suppression test

A raised aldosterone-to-renin ratio is a screening test for primary aldosteronism. A confirmatory suppression test, such as intravenous saline infusion, shows failure of aldosterone to fall. Imaging and adrenal vein sampling follow to separate adenoma from hyperplasia.

Option by option

  • A. Overnight dexamethasone suppression test

    Dexamethasone suppression tests investigate cortisol excess.

  • B. Oral glucose tolerance test with growth hormone

    A glucose suppression test of growth hormone is used for acromegaly.

  • C. Saline infusion suppression test (correct)

    Correct. Failure of aldosterone to suppress after saline confirms autonomous secretion.

  • D. 24-hour urine metanephrines

    Urinary metanephrines screen for phaeochromocytoma.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is C, Saline infusion suppression test. A raised aldosterone-to-renin ratio is a screening test for primary aldosteronism.

Why is "Overnight dexamethasone suppression test" not the answer?

Dexamethasone suppression tests investigate cortisol excess.

Why is "Oral glucose tolerance test with growth hormone" not the answer?

A glucose suppression test of growth hormone is used for acromegaly.

Why is "24-hour urine metanephrines" not the answer?

Urinary metanephrines screen for phaeochromocytoma.

What concept does this question test?

It tests Endocrinology and diabetes: primary hyperaldosteronism in General Medicine. A confirmatory suppression test, such as intravenous saline infusion, shows failure of aldosterone to fall. Imaging and adrenal vein sampling follow to separate adenoma from hyperplasia.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Endocrinology and diabetes: primary hyperaldosteronism?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.