Primary hyperaldosteronism typically presents with which of the following combinations?

• A. Hypertension, metabolic acidosis, hyperkalemia, increased renin
• B. Hypotension with metabolic alkalosis and hyperkalemia
• C. Hypertension, metabolic alkalosis, hypokalemia, increased aldosterone and decreased renin
• D. Normotension with metabolic acidosis

Answer: (C)

Excess aldosterone drives sodium retention and volume expansion, which raises blood pressure. At the same time, aldosterone increases potassium and hydrogen ion secretion in the distal nephron, causing hypokalemia and metabolic alkalosis. Because the overproduction of aldosterone is autonomous, renin secretion is suppressed via feedback, so renin levels are decreased. This combination—hypertension with metabolic alkalosis and hypokalemia, plus high aldosterone and low renin—is characteristic of primary hyperaldosteronism. Other patterns like hypotension, metabolic acidosis, or hyperkalemia with high renin do not fit this condition.