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Introduction {#sec1-1} ============ Hypertension presents as a usual clinical symptom in 50%--75% of autosomal dominant polycystic kidney disease (ADPKD) patients.\[[@ref1]\] Primary aldosteronism (PA) occurs in approximately 10% of patients with mild to moderate hypertension and 20% of patients with resistant hypertension.\[[@ref2]\] The occurrence of PA in ADPKD patients is extremely rare. Here, we describe a unique case of ADPKD with adrenal mass. Case Report {#sec1-2} =========== A 33-year-old female, during routine visit to obstetrician at the time of her first pregnancy (in 2008), detected to have hypertension and on routine ultrasonography found to have multiple cysts in both the kidneys. Her mother and maternal uncle also had polycystic kidney disease. She was started on antihypertensive medications; however, there were no signs of preeclampsia and her blood pressure (BP) was well controlled. However, she lost her baby due to intrauterine fetal death at 5 months of gestation. Since then, she was on regular follow-up for her hypertension and on regular treatment with nifedipine 10 mg twice a day, her BP remaining around 130--140/80--90 mmHg. Her two-dimensional echo revealed concentric left ventricular hypertrophy. Her renal function at that time was normal (serum creatinine was 0.61 mg%). In October 2013, she had complaints of weakness, body ache with cramps and leg pain with feeling of easy fatigability; however, this was attributed to nutritional deficiency and treated with multivitamins. Her BP at that time was 140/80 mmHg. In 2016, during her workup for surrogacy, she was advised to consult nephrologist, so she came to Muljibhai Patel Urological Hospital, Nadiad. On investigation, her serum potassium was found to be 1.8--2 mg/dl and serum creatinine of 1.7 mg%. In view of hypertension and hypokalemia ( first time detected), she was advised computed tomography (CT) abdomen to rule out adrenal lesion. Her CT abdomen showed left adrenal cyst/adenoma of 2.3 cm × 2 cm \[[Figure 1](#F1){ref-type="fig"}\]. She was advised to undergo further investigations and removal of mass. She underwent magnetic resonance imaging of abdomen which showed left adrenal nodule of 2.7 × 2.5 cm in size. Her serum potassium was 2.4, she was supplemented with potassium, and spironolactone was started. Her BP was 120/80 mmHg (on nifedipine 20 mg and aldactone). ![Computed tomography scan showing adrenal adenoma](IJN-28-167-g001){#F1} On further investigation of the adrenal mass, her serum aldosterone was high - 69.8 ng/dl and plasma renin activity (PRA) was low - 0.68 ng/ml/h, aldosterone/PRA ratio being 102.6, thus favoring primary hyperaldosteronism. She underwent left adrenalectomy on July 5, 2016 \[[Table 1](#T1){ref-type="table"}\]. Intraoperative course was uneventful with her BP remaining around 140--150 mmHg systolic without antihypertensive medications. Her serum creatinine remained around 1.2--1.3 mg/dl with serum potassium of 2.5--2.7 mg/dl postsurgery \[[Table 1](#T1){ref-type="table"}\]. ###### Details of blood reports ![](IJN-28-167-g002) On postadrenalectomy (gross specimen) \[[Figure 2](#F2){ref-type="fig"}\], she needed antihypertensive medications for a month, gradually her BP reached normal range (120/80 mmHg) and her antihypertensives were stopped with well-controlled BP. Her serum potassium levels also reached normal range (3.5--5 mg%) without any supplementation. ![Gross specimen of adenoma removed](IJN-28-167-g003){#F2} Discussion {#sec1-3} ==========