Aldosterone/renin ratio is optional in the initial workup when which condition is present?

• A. If hypertension or hypokalemia
• B. If age over 60
• C. If imaging shows bilateral involvement
• D. If suspicion of pheochromocytoma

Answer: (A)

Aldosterone/renin ratio is used as a screening test for primary aldosteronism because excess aldosterone typically causes high blood pressure and can drive potassium down, while renin is suppressed. When a patient has hypertension or spontaneous hypokalemia, checking the ARR helps detect autonomous aldosterone production early, making it a sensible initial screen in those scenarios. If the patient only has age over 60, imaging suggesting bilateral involvement, or a suspicion of pheochromocytoma, ARR isn’t the primary initial test because these situations do not specifically point to primary aldosteronism and would lead you to pursue other diagnostic avenues (catecholamine testing for pheochromocytoma, or different imaging/assessments). In practice, ARR interpretation requires attention to medications and potassium status, and a positive screen is followed by confirmatory testing.