The value of adrenal venous sampling in unveiling the conundrum of double unilateral adrenal adenomas in a case of primary hyperaldosteronism.

Primary hyperaldosteronism (PHA) is a cause of secondary hypertension, often due to adrenal adenoma. The diagnosis and management of multiple unilateral adrenal adenomas in PHA represent a unique challenge. Adrenal venous sampling (AVS) has become a pivotal diagnostic tool in these cases, providing critical information for accurate localization of aldosterone production. Here, we describe a rare case of a 52-year-old female with a history of resistant essential hypertension who presented with multiple unilateral adrenal adenomas concomitant with adrenal hyperplasia in a case of primary hyperaldosteronism. The use of AVS in localization of aldosterone production was the determining factor in deciding the ultimate management of the patient, leading to successful follow-up on medical therapy with spironolactone.