Differential Diagnosis for High Aldosterone with Non-Suppressed Renin

• Single Most Likely Diagnosis
  • Primary Aldosteronism with Renin-Independent Aldosterone Secretion: This condition is characterized by high aldosterone levels, but unlike typical primary aldosteronism where renin is suppressed, in some cases, renin can be non-suppressed due to the heterogeneity of the disease or the presence of a renin-producing tumor.
• Other Likely Diagnoses
  • Renin-Dependent Aldosteronism: This includes conditions where aldosterone secretion is driven by high renin levels, such as renal artery stenosis or renin-producing tumors. The high renin stimulates the production of aldosterone.
  • Bilateral Adrenal Hyperplasia: Although less common, this condition can present with high aldosterone and non-suppressed renin levels, especially if there's a component of renin-dependent aldosterone secretion.
• Do Not Miss Diagnoses
  • Renin-Producing Tumor: A rare but critical diagnosis to consider, as these tumors can cause significant hypertension and are potentially curable with surgery.
  • Familial Hyperaldosteronism Type II: This genetic disorder can lead to variable presentations, including high aldosterone with non-suppressed renin, and is important to diagnose for family screening and potential targeted therapy.
• Rare Diagnoses
  • Ectopic Aldosterone-Producing Adenoma: Although rare, these tumors can produce aldosterone independently of renin-angiotensin system feedback, potentially leading to high aldosterone levels with non-suppressed renin.
  • Glucocorticoid-Remediable Aldosteronism (Familial Hyperaldosteronism Type I): This is a rare form of primary aldosteronism caused by a chimeric gene leading to aldosterone synthase being regulated by ACTH instead of renin-angiotensin. It might present with variable renin levels due to its unique pathophysiology.