Suspected Primary Aldosteronism in Post-Oncologic Patient with Resistant Hypertension and Normal Adrenal CT: A Case Report

Resistant hypertension warrants evaluation for secondary causes, particularly when blood pressure remains difficult to control despite multidrug therapy or when screening studies suggest a specific endocrine etiology. Primary aldosteronism is especially important because it is both common and potentially treatable. However, diagnosis may be delayed when patients present with overlapping cardiopulmonary, neurologic, or oncologic histories that appear to offer alternate explanations for symptoms. This report describes a patient with a complex post-oncologic thoracic history, chronic singultus, diaphragmatic dysfunction, and persistent hypertensive symptoms who was found to have a markedly elevated aldosterone-renin ratio with suppressed renin despite normal adrenal imaging. The case emphasizes the need to recognize biochemical screening patterns suggestive of primary aldosteronism even in the absence of classic hypokalemia or a visible adrenal mass on computed tomography.