Hypertension affects up to 40% of the adult population and is a major risk factor for cardiovascular disease. About 15% of hypertension cases are secondary and may have a curable underlying cause, leading to improved blood pressure control or even complete resolution of hypertension. Among the causes of secondary hypertension, primary aldosteronism is the most common. We present a case of a 68-year-old man with long-standing poorly managed hypertension and ad-renal incidentalomas on an abdominal CT scan. Endocrine evaluation confirmed aldosterone excess, mild autonomous cortisol secretion (MACS), and elevated urinary normetanephrine. Therefore, he was referred to a urologist for laparo-scopic left adrenalectomy. Histopathological examination revealed an aldosterone-producing adenoma. After adrenalec-tomy, the patient’s primary aldosteronism was cured. His blood pressure was well-controlled with fewer antihypertensive medications. Concomitant MACS, which is present in one-third of patients with primary aldosteronism and represents an additional cardiovascular risk factor, was also resolved following adrenalectomy. Elevated normetanephrine in a 24-hour urine sample persisted after surgery, most probably due to obstructive sleep apnea. With this clinical case, we aim to high-light the importance of diagnosing secondary hypertension, as etiological treatment may improve or even cure high blood pressure and reduce the risk of target organ damage. We also emphasize the importance of rational endocrine diagnostics, including critical interpretation of hormonal test results.
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