Primary Aldosteronism in a Young Woman: Diagnostic and Therapeutic Challenges

Abstract Primary aldosteronism is a frequently overlooked cause of secondary hypertension, despite its association with significant cardiovascular morbidity. Spontaneous or diuretic-induced hypokalemia can serve as an important clinical clue, particularly in younger individuals with resistant hypertension. This case report describes a 39-year-old female who was admitted with high blood pressure (160–180/100 mmHg) and severe hypokalemia (serum potassium: 2.4 mmol/L), requiring frequent potassium supplementation. Biochemical evaluation revealed suppressed renin levels and significantly elevated plasma aldosterone concentration, with an aldosterone-to-renin ratio diagnostic for primary aldosteronism. Adrenal computed tomography identified an unilateral adrenal nodule consistent with an aldosterone-producing adenoma. The patient underwent laparoscopic adrenalectomy, with histopathological confirmation of a benign aldosterone-producing adenoma. After surgery, her blood pressure improved significantly, hypokalemia was corrected, and her antihypertensive medication requirements decreased. Early recognition and targeted treatment, including adrenalectomy for unilateral lesions, can lead to improved long-term outcomes by reducing hypertension severity, cardiovascular risk, and medication burden. This case underscores the need for increased awareness and systematic screening in hypertensive patients, particularly those with hypokalemia or resistant hypertension, to ensure timely diagnosis and optimal management.