Which statement about primary hyperaldosteronism is true?

• A. Hyperkalemia with high renin.
• B. Occurs independent of renin; most common cause is adrenal hyperplasia; Conn syndrome is an adenoma.
• C. Always presents with hypotension.
• D. Low aldosterone with high renin.

Answer: (B)

Primary hyperaldosteronism is caused by autonomous production of aldosterone by the adrenal cortex, unchecked by the renin–angiotensin system. That excess aldosterone expands the extracellular fluid, raises blood pressure, and increases potassium and hydrogen ion loss, leading to hypokalemia and metabolic alkalosis. Because the volume expansion suppresses renin, renin levels are typically low rather than high.

The statement is correct because this condition occurs independently of renin, the most common cause is bilateral adrenal hyperplasia, and Conn syndrome refers to an aldosterone-producing adenoma. In contrast, high renin with hyperaldosteronism isn’t characteristic of primary disease (that points to secondary causes), hypotension is not typical (hypertension is common), and low aldosterone with high renin describes a different situation such as hypoaldosteronism.