Primary hyperaldosteronism presents with all of the following except-
**Core Concept**
Primary hyperaldosteronism is a condition characterized by excessive production of aldosterone, leading to hypertension, hypokalemia, and metabolic alkalosis. The underlying pathophysiology involves the renin-angiotensin-aldosterone system (RAAS), with aldosterone stimulating sodium retention and potassium excretion.
**Why the Correct Answer is Right**
Primary hyperaldosteronism typically presents with hypertension, hypokalemia, and metabolic alkalosis. The excessive aldosterone production leads to increased sodium reabsorption in the collecting duct, resulting in volume expansion and hypertension. Additionally, the increased potassium excretion leads to hypokalemia, and the metabolic alkalosis is a consequence of the increased hydrogen ion excretion in the urine.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect as primary hyperaldosteronism can present with hypertension, which is a hallmark of the condition.
**Option B:** This option is incorrect as hypokalemia is a common finding in primary hyperaldosteronism due to the increased potassium excretion.
**Option C:** This option is incorrect as metabolic alkalosis is a common consequence of the increased hydrogen ion excretion in the urine due to the excessive aldosterone production.
**Clinical Pearl / High-Yield Fact**
Primary hyperaldosteronism can be caused by either unilateral adrenal adenoma or bilateral adrenal hyperplasia, and the diagnosis can be confirmed by the presence of an aldosterone-producing adenoma on imaging studies or by the failure of the plasma aldosterone concentration to suppress with high-dose dexamethasone suppression test.
**Correct Answer:** D