Primary hyperaldosteronism secondary to right adrenal hyperplasia with non-functioning left adrenal adenoma elucidated by adrenal vein sampling

Key Clinical MessagePrimary hyperaldosteronism includes two main subtypes namely idiopathic hyperaldosteronism (also termed bilateral adrenal hyperplasia) and unilateral aldosterone-producing adenoma, managed with aldosterone antagonists or adrenalectomy, respectively.Aldosterone renin ratio (ARR) has emerged as a significant parameter as compared to plasma aldosterone concentration (PAC), thus identifying need for adrenal vein sampling (AVS) or further exclusionary tests including imaging, the solitary utility of which without AVS may result in unwarranted adrenalectomy.Our case demonstrates the importance of AVS and elaborates the context that needs to be applied to plasma renin and aldosterone levels.