We read the article by Lopes MNSC et al., published in this Journal focusing the clinical, physio pathological, and management aspects of a secondary arterial hypertension (AH) due to an adrenal adenoma causing primary aldosteronism (PA) in a 32-year-old male, who was evolving uncontrolled even with use of four classes of antihypertensive drugs.1 His evaluation revealed low plasma renin levels, and a high aldosterone-renin ratio, besides imaging of an adrenal nodule, and the histopathological pattern of an adenoma. Worthy of note, on the outpatient cardiological follow-up performed seven months after the surgical tumor removal, he was found normotensive without utilizing any medication. The authors highlighted the key points about the PA diagnosis and etiologies, which include the aldosteronoma in 60% and the bilateral adrenal hyperplasia in 40% of cases.1 Although spontaneous hypokalemia, low renin activity, and aldosterone over 20 ng/dl are the clues, they highlighted the normokalemic hypertension in people under 40 years, an age group with up to 30% of secondary hypertension, and 20-37% hyperaldosteronism.1 In this challenging setting, the aim of this letter is to add more recent literature data which support the well posed comments and the conclusions of the aforementioned case study.
