Primary Aldosteronism due to a Sub Centimeter Unilateral Adrenal Adenoma

We have described a 44-year old man with past medical history of resistant hypertension on 4-antihypertensive medications including diuretic. He has not been investigated for secondary causes of hypertension despite having elevated blood pressure for 10-years and low normal Potassium level. We started the work up for secondary causes of his HTN and proved by assessing the aldosterone. To plasma renin activity ratio of more than 20 with elevate aldosterone in the blood, sodium load suppression test the existence of primary hyperaldosteronism. The cause as per the CT and MRI of the abdomen and following adrenalvein sampling was found to be right adrenal gland hypersecreting adenoma. We referred the patient for surgery and started treating the patient with mineralocorticoid antagonist with improvement of the blood pressure. Current recommendation about screening and diagnosing primary hyperaldosteronism were discussed as well as the deleterious effect of HTN due to hyperaldosteronism.