We are always reminded that when a patient is diagnosed to have hypertension, the possibility of secondary hypertension must be entertained especially for young patients.
There are various clues that can lead us to suspect a patient might have secondary causes and one of them is hypokalemia.
Therefore, if you find a patient with hypertension and hypokalemia, always think of the following diagnosis,
1) Renal Artery stenosis or renin secreting tumor ( RAS)
2) Liddle's syndrome
3) Adrenal hyperfunction- can be due to adrenal ademona/carcinoma leading to hyperaldosteronism
4) Licorice usage or syndrome of apparent mineralcorticoid access ( SAME)
And one of the popular question in MRCP is how to differentiate these four conditions!!
It is quite easy if we know how renin angiotensin aldosterone ( RAA) system works. It is summarised as the following image,
For RAS or renin secreting tumour, you will have high renin and high aldosterone. For aldrenal hyperfunction, patients have high aldosterone level but normal renin.
As for Liddle's syndrome and SAME, I will try to explain a bit deeper next time!
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