Primary aldosteronism (hyperaldosteronism) Quiz: Ace Your Exams

A 52-year-old woman is sent to the emergency department by her primary care physician for abnormal blood work that was drawn before her upcoming visit. She has a one-year history of poorly controlled hypertension despite being on a thiazide diuretic, beta-blocker, and ACE inhibitor. She has not had chest pain, palpitations, headaches, or excessive sweating. Her past medical history is significant for type 2 diabetes mellitus and obesity. She has a family history of hypertension. She does not smoke or drink alcohol. On physical examination, she appears well-nourished and in no acute distress. Her temperature is 37°C (98.6°F), blood pressure is 175/100 mmHg, pulse is 82/min, respiratory rate is 16/min, and oxygen saturation is 98% on room air. Cardiopulmonary exam is within normal limits. No bruits are heard on abdominal exam. There is no lower extremity edema. Laboratory results are shown below. Which of the following is the most likely diagnosis?  

Laboratory value	Result
Hemoglobin	12.4 g/dL
Leukocyte count	9,500/mm3
Platelet count	320,000/mm3
Sodium	143 mEq/L
Potassium	2.8 mEq/L
Bicarbonate	31 mEq/L
Blood urea nitrogen	15 mg/dL
Creatinine	0.9 mg/dL