Medical History Female, 30 years old, diagnosed with an 8-year story of persistent hypertension in use of four antihypertensive drugs, is admitted to the hospital due to a Hypertensive Urgency. Laboratorial findings included asymptomatic hypokalemia (K=1,7mEq/L). Other exams were requested: Plasma Aldosterone = 44ng/dL and Plasma Renin Activity = 0,1ng/mL/h, thus revealing an aldosterone-to-renin ratio (ARR) of 440. Primary Aldosteronism (PA) was then diagnosed and further imaging studies were requested. Image 1: Abdominal Computed Tomography, axial view at L2 level, after intravenous injection of contrast, venous phase. Round mass (red arrows) with regular shape, well-defined limits, slightly heterogeneous impregnation of contrast, located at right adrenal topography. Dimensions: 3,6 x 3,0 cm. Lesion density before intravenous contrast: 11,5 UH; absolute and relative washouts of 64% and 51%, respectively.Imagem 2: Abdominal Computed Tomography, coronal view, after injection of contrast, venous phase. Round mass (red arrows) with regular shape, well-defined limits, slightly heterogeneous impregnation of contrast, located at right adrenal topography. Dimensions: 3,6 x 3,0 cm. Lesion density before intravenous contrast: 11,5 UH; absolute and relative washouts of 64% and 51%, respectively. Question:Analyzing the patient's story and the given Computer Tomography (CT) images, the most probable etiologic diagnose for this patient's Primary Aldosteronism (PA) is: Bilateral Adrenal Hyperplasia Aldosterone-Producing Adenoma Adrenocortical Carcinoma Renal Artery Stenosis Test Question (TRT-RJ: Analista em Cardiologia - 2011) In a case of primary hyperaldosteronism, the most probable findings in blood examination and adrenal histology for POTASSIUM, RENIN, pH and HISTOLOGY are, respectively: Increased, decreased, increased, adenoma. Increased, increased, decreased, carcinoma. Decreased, increased, decreased, adenoma. Decreased, decreased, decreased, carcinoma. Decreased, decreased, increased, adenoma. Time is Up! Time's up
