Archive Of Standardized Exam Questions: Primary Hyperaldosteronism (Conn Syndrome)


This page is dedicated to organizing various examples of standardized exam questions whose answer is primary hyperaldosteronism (Conn syndrome). While this may seem a odd practice, it is useful to see multiple examples of how primary hyperaldosteronism (Conn syndrome) will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a traditional question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.


When it comes to standardized exams, each condition has its own “code” marked by key buzzwords, lab findings, clues, etc. If you are well versed in this code you will be able to more quickly identify the condition that is being discussed, and get the right answer on the exam you are taking. Below is the “code” for primary hyperaldosteronism (Conn syndrome)

  • Hypertension: often it is resistant to medial management 
  • Hypokalemia: a classic lab finding 
  • Lack of hypernatremia: while sodium resorption is increased, rarely does it cause hypernatremia
  • Metabolic alkalosis: increased bicarbonate produced by the distal nephron (due to the activity of aldosterone) 
  • Decreased renin/angiotensin: typically this condition is independent of the renin-angiotensin system. 

Question # 1

60 old man comes the clinic for follow-up visit regarding his hypertension. This patient was diagnosed with hypertension about four months ago after an episode of transient vision loss in his left eye. Currently he is taking aspirin, lisinopril, and hydrochlorothiazide. His blood pressure in the clinic is 160/100 mmHg, and his pulse is 70 bpm. The patient’s BMI is 27 kg/m². The cardiac exam is remarkable for the presence of an S4 heart sounds, There are no bruits in the carotids or the abdomen. His pulses are palpated everywhere in his extremities are 2+. Lab results are as follows:

  • Potassium: 3.0 mEq/L ***
  • Creatinine: 0.9 mg/dL ***
  • Plasma renin activity: undetectable ***

What is the likely diagnosis in this patient?

Explanation # 1

Hypertension (refractory to treatment) + low potassium + normal creatinine + undetectable renin activity = primary hyperaldosteronism

Question # 2

A 45 year old male is seen in the clinic for persistent hypertension. He has been treated for high blood pressure for the past 10 years but continues to struggle with it’s management. Today his blood pressure is 165/100 mmHg, and he is very insistent the he takes all of his medications religiously. He is currently on a thiazide diuretic, CCB, beta blocker, and an ACE inhibitor for blood pressure. He also takes potassium chloride daily for hypokalemia. Labs are conducted and show a normal CBC, and a BMP significant for a bicarbonate of 28, and a potassium of 3.1. What is the likely diagnosis? 

Explanation # 2

Hypertension (refractory to treatment) + low potassium (despite potassium supplementation)  = primary hyperaldosteronism


Many questions on standardized exams go beyond simply recognizing the underlying condition. Often there are specific testable facts regarding some aspect of the disease’s pathophysiology/management/clinical implications that are commonly asked. Some of these are listed below:

  • Causes: the two major causes are either a unilateral hyperfunctioning adrenal adenoma, or bilateral nodular hyperplasia. 



Page Updated: 04.09.2017