Pursuing Investigations Establish the Challenging Diagnosis of Primary Aldosteronism.

Primary aldosteronism is one of the causes of secondary hypertension. The most sensitive screening test for primary aldosteronism is the measurement of the plasma aldosterone concentration and plasma renin activity to calculate the aldosterone/renin ratio. We report a case of hypertension and hypokalemia with a negative plasma aldosterone/renin ratio, inconclusive confirmatory saline infusion test. Subsequently, the patient was diagnosed with primary aldosteronism secondary to adrenal adenoma. If there is a high index of clinical suspicion of primary aldosteronism, it is important to evaluate further to establish the diagnosis for initiation of specific treatment because failure to identify primary aldosteronism can lead to aldosterone-specific adverse cardiovascular diseases and events.