Primary Hyperaldosteronism Guideline Quiz

A 55-year-old female patient presents to the clinic with uncontrolled hypertension. Laboratory tests reveal a PAC of 18 ng/dL and PRA of 0.2 ng/mL/h. The patient is started on verapamil slow-release, but her blood pressure remains elevated. Which confirmatory test should be ordered to definitively confirm or exclude the diagnosis of PA?

A 50-year-old male presents with hypertension that is controlled with lisinopril. The patient has a history of renal insufficiency with an estimated glomerular filtration rate (eGFR) of 30 ml/min/1.73m2. What is the most appropriate next step in management?

A 30-year-old female presents with hypertension that is controlled with amlodipine. The patient is interested in pursuing testing for primary aldosteronism. What is the most appropriate next step in management?

A 45-year-old male presents with hypertension that is resistant to multiple antihypertensive medications. The patient’s serum potassium is 2.8 mmol/L. What is the most appropriate next step in management?

A 50-year-old man with hypertension is scheduled for an ARR test. He is also taking a beta-blocker medication. When should the beta-blocker medication be stopped before performing the ARR test?

A 60-year-old woman with hypertension is on a diuretic medication and has hypokalemia. When should the diuretic medication be stopped before performing an ARR test?

A 55-year-old man with hypertension is scheduled for an ARR test. What is the best time of day to collect the blood sample?

A 45-year-old woman with hypertension has been taking spironolactone for the past year. What should be done before performing an ARR test?

A 60-year-old woman with a history of hypertension presents with obstructive sleep apnea. What is the recommended next step in management?

A 35-year-old man presents with hypertension and hypokalemia. What is the most likely cause of his symptoms?

A 55-year-old woman is found to have an adrenal incidentaloma on imaging performed for an unrelated condition. She has a history of hypertension that is well-controlled with one antihypertensive medication. What is the recommended next step in management?

A 45-year-old man presents with persistent hypertension despite treatment with three different antihypertensive medications, including a diuretic. His blood pressure is consistently above 150/100 mm Hg on multiple measurements. What is the next step in management?

A 30-year-old male with primary adrenal insufficiency presents for genetic counseling. What type of PAI is inherited in an autosomal recessive pattern?

A 45-year-old female with primary adrenal insufficiency is diagnosed with autoimmune gastritis with vitamin B12 deficiency. What additional testing should be done during her annual evaluation?

A 10-year-old male with primary adrenal insufficiency presents for his annual follow-up appointment. What should be evaluated during this visit?

A 35-year-old female with a history of primary adrenal insufficiency presents to the emergency department with severe abdominal pain and vomiting. What is the appropriate management in this situation?

What is the recommended best practice statement for the prevention of adrenal crisis in patients with primary adrenal insufficiency?

What is the recommended duration of oral glucocorticoid dose at double or triple the usual daily dose for patients with primary adrenal insufficiency during febrile illness?

In the absence of hydrocortisone, what glucocorticoid is suggested as an alternative for the treatment of adrenal crisis?

A patient with known primary adrenal insufficiency presents to the emergency department with symptoms of an adrenal crisis. What is the recommended immediate parenteral injection dose of hydrocortisone for adults?

According to the revised 2015 guidelines, what is the current recommendation for referral by primary care physicians of patients with suspected PA?

A 55-year-old hypertensive patient presents to their primary care physician with sustained blood pressure readings of 160/100 mm Hg. According to the revised 2015 guidelines for the management of PA, what is the current recommendation for screening?

In patients with GRA, what is the first-line treatment recommended to lower ACTH and normalize BP and potassium levels?

Which of the following is a potential advantage of using amiloride as a mode of treatment for PA?

A 30-year-old child with GRA is being treated with a glucocorticoid to suppress ACTH secretion. What is the recommended approach for determining treatment targets for BP?

A 40-year-old patient with glucocorticoid-remediable aldosteronism (GRA) is being treated with a synthetic glucocorticoid to suppress ACTH secretion. What is the recommended time of administration for the glucocorticoid?

A 35-year-old female patient with primary aldosteronism is being treated with spironolactone but is experiencing side effects such as menstrual irregularities. What is the alternative treatment option?

A 55-year-old male patient with hypertension is diagnosed with primary aldosteronism. Which of the following is the first-line treatment recommended?

A 55-year-old male presents with refractory hypertension despite treatment with multiple antihypertensive medications. Lab results reveal elevated aldosterone levels and low renin activity. CT scan shows a unilateral adrenal nodule. Which of the following is the most appropriate initial treatment for this patient?

A 50-year-old female with known bilateral adrenal nodules presents with persistent hypertension despite treatment with multiple antihypertensive medications. Lab results reveal elevated aldosterone levels and low renin activity. CT scan shows bilateral adrenal nodules. Which of the following is the most appropriate next step in management for this patient?

A 45-year-old male presents with refractory hypertension despite treatment with multiple antihypertensive medications. Lab results reveal elevated aldosterone levels and low renin activity. CT scan shows bilateral adrenal nodules. Which of the following is the most appropriate initial treatment for this patient?

What is the recommended treatment for patients with bilateral adrenal disease due to primary aldosteronism?

What is the most common reason for persistently increased blood pressure after adrenalectomy for unilateral aldosterone-producing adenoma?

A patient with documented unilateral aldosterone-producing adenoma (APA) is recommended to undergo which of the following treatments?

What is the effect of adrenalectomy on left ventricular mass index?

What is the cure rate for hypertension after unilateral adrenalectomy in patients with APA?

A 35-year-old woman presents with hypertension and hypokalemia. Genetic testing shows a somatic mutation in the CACNA1D gene. What is the likely mechanism of action of this mutation?

A 50-year-old man presents with hypertension and hypokalemia. Genetic testing shows a somatic heterozygous gain-of-function mutation in the ATP1A1 gene. What is the likely mechanism of action of this mutation?

A 42-year-old woman presents with hypertension, hypokalemia, and elevated aldosterone levels. Genetic testing shows a mutation in the KCNJ5 gene. What is the likely diagnosis?

A 40-year-old male presents with hypertension and elevated aldosterone levels. He has no family history of hypertension. Which of the following genetic tests should be performed in this patient?