Clinics in diagnostic imaging (113).

Primary hyperaldosteronism is described in a 27-year-old Brazilian woman from an endemic area of schistosomiasis. She presented with hypokalaemia, cramps and polyuria, refractory hypertension, plasma aldosterone of 40.7 ng/dL and aldosterone/renin activity ratio higher than 100, due to an associated long-standing unsuspected aldosteronoma. Computed tomography showed a well-defined ovoid right adrenal mass, which was subsequently resected and confirmed to be an aldosteronoma. During subsequent follow-up visits, she remained asymptomatic, normokalaemic, and required no antihypertensive drugs. The differential diagnoses of refractory hypertension are discussed.