A 45-year-old woman presents to the clinic with complaints of persistent high blood pressure that has been difficult to control despite using multiple antihypertensive medications over the past few years. She has a history of hypertension for the last 10 years, but recently it has become more challenging to manage. She reports frequent episodes of fatigue, headaches, and muscle cramps. Additionally, she mentions that she has been experiencing excessive thirst and urination, especially at night.

On physical examination, her blood pressure is 160/98 mmHg, despite being on two antihypertensive medications. She has no significant findings on a general examination except for mild hypokalemia. There is no history of excessive salt intake, and her renal function tests are within normal limits.

Laboratory tests reveal the following:

Serum potassium: 3.2 mEq/L (low)

Serum sodium: 140 mEq/L

Plasma renin activity: Low

Plasma aldosterone: High

Given the patient’s clinical presentation, high blood pressure that is difficult to control, hypokalemia, and laboratory results showing low renin and high aldosterone, primary aldosteronism is suspected.

A CT scan of the abdomen reveals a unilateral adrenal adenoma, which is confirmed to be the source of aldosterone excess.

The patient is referred to an endocrinologist for further evaluation and management, which may include either surgical removal of the adrenal adenoma or medical therapy with mineralocorticoid receptor antagonists