Primary aldosteronism (hyperaldosteronism) Quiz: Ace Your Exams

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A 48-year-old woman presents to the emergency department with a severe headache, blurred vision, and nausea. She has also been experiencing muscle weakness and cramps. She has a past medical history of obesity and hypertension for which she takes lisinopril and hydrochlorothiazide. Her blood pressure has been poorly controlled despite adherence to medications. Temperature is 36.9°C (98.4°F), blood pressure is 216/124 mmHg, pulse is 96/min, respiratory rate is 18 breaths/min, oxygen saturation is 95% on room air. Physical examination reveals bilateral retinal hemorrhages on fundoscopic examination. There are no focal neurologic deficits. Cardiopulmonary exam is within normal limits. The abdomen is soft and nontender with no masses or bruits, and there is no peripheral edema. ECG shows no ST segment changes or QT prolongation, but there is diminished amplitude of the T waves. Laboratory studies are listed below. Which of the following is the best next step in management?

 Laboratory study  Result  Reference
 Sodium  147 mEq/L  135-145 mEq/L 
 Potassium  2.1 mEq/L  3.5-5 mEq/L 
 Bicarbonate  28 mEq/L  22-28 mEq/L 
 Creatinine   1.3 mg/dL  0.6-1.2 mg/dL 

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