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PLAB04-036

A 28 year old male presents to the GP with a 1 month history of fatigue, generalised pains and feeling thirsty. His blood pressure is 162/101 mmHg and physical examination findings are normal. He has no other past medical history and does not take any regular medications. Investigations are requested, which demonstrate the following:

Haemoglobin A1c 38 mmol/mol (normal <42 mmol/mol)
Haemoglobin 142 g/L (range 115-165 g/L)
Sodium 147 mmol/L (range 133-146 mmol/L)
Potassium 3.3 mmol/L (range 3.5-5.3 mmol/L)
Thyroid Stimulating Hormone 2.5 mU/L2 (range 0.4-4.0 mU/L2)
Random Cortisol 410 nmol/L (range 137-429 nmol/L)
Aldosterone to Renin ratio 60 ng/ml/h (range <30 ng/ml/h)
24-hour urinary metadrenaline 1.5 umol/L (range 0.0-3.0 umol/24 hours)

What is the most likely diagnosis?

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