USMLE (United States Medical Licensing Examination) Step 1 Practice Exam

Which condition is associated with hypertension, hypokalemia, decreased renin, and decreased aldosterone?

1. CAH

2. Adrenal tumor

3. Cushing Syndrome

4. Exogenous mineralocorticoid

The correct answer is: CAH

The correct condition associated with hypertension, hypokalemia, decreased renin, and decreased aldosterone is adrenal tumor. In the case of an adrenal tumor, particularly one producing excess cortisol (such as an adrenal adenoma), there can be a decrease in renin activity due to the feedback regulation on the juxtaglomerular cells of the kidney. This results in decreased renin and subsequently decreased aldosterone levels despite the presence of hypertension and hypokalemia due to the effects of cortisol leading to mineralocorticoid activity. In contrast, congenital adrenal hyperplasia (CAH) most commonly leads to an increase in renin due to low circulating aldosterone levels from adrenal insufficiency. Cushing Syndrome typically causes hypertension and hypokalemia, but it would be associated with increased aldosterone levels due to the high cortisol that is acting at the mineralocorticoid receptors. Exogenous mineralocorticoids would also lead to increased blood pressure and potassium levels but usually would not cause decreased renin and aldosterone. Overall, adrenal tumors can produce excess hormone without regulatory feedback, leading to the metabolic state presented in the question.