Ace the PANCE Endocrinology Challenge 2026 – Unleash Your Hormone Hero Powers!

Key idea: how renin-angiotensin-aldosterone activity differs between primary adrenal problems and secondary ones.

In primary hyperaldosteronism, the adrenal gland makes excess aldosterone on its own. That elevated aldosterone suppresses renin through negative feedback, so renin is low, while aldosterone activity remains high, leading to potassium loss (hypokalemia) and often hypertension.

In secondary hyperaldosteronism, something outside the adrenal gland reduces effective renal perfusion or stimulates the renin-angiotensin system. This raises renin, which increases angiotensin II and, in turn, stimulates more aldosterone release. Aldosterone activity is high as well, producing potassium wasting and hypokalemia, though other factors can modulate the exact potassium level.

Thus, the statement that best describes the difference is that secondary disease features high renin with high aldosterone activity and hypokalemia. Renin levels are a key discriminator between primary and secondary adrenal disorders, since primary disease suppresses renin while secondary disease elevates it.