American Board of Surgery Qualifying Exam (ABS QE) Practice Test

Which of the following conditions can cause secondary hyperaldosteronism?

1. Adrenal adenoma

2. Renal artery stenosis

3. Adrenal carcinoma

4. Cushing's syndrome

The correct answer is: Renal artery stenosis

Secondary hyperaldosteronism occurs when the adrenal glands produce excess aldosterone as a response to external stimuli, primarily due to decreased blood flow to the kidneys. This can happen with conditions that lead to renal perfusion issues, such as renal artery stenosis. In this condition, the narrowing of the renal artery reduces blood flow to one kidney, prompting an increase in renin release from the juxtaglomerular cells. In turn, elevated renin leads to increased production of angiotensin II, which stimulates the adrenal glands to secrete more aldosterone. In contrast, adrenal adenoma, adrenal carcinoma, and Cushing's syndrome are associated with primary hyperaldosteronism or increased glucocorticoid levels, where the aldosterone is secreted independently of renin-angiotensin stimulation. These conditions originate from the adrenal glands themselves rather than from compensatory mechanisms related to renal function. Therefore, renal artery stenosis stands out as the condition that leads to secondary hyperaldosteronism due to its impact on renal blood flow and the subsequent hormonal response.