Hypertensive crisis due to secondary aldosteronism from polyarteritis nodosa

Primary aldosteronism is common in those diagnosed with hypertension and distinguishing primary aldosteronism from its mimics allows tailored management. A woman in her 30s presented to an Australian hospital with hypertensive crisis (209/100 mm Hg) and spontaneous hypokalaemia (2.9 mmol/L). Laboratory tests revealed hyperreninaemic hyperaldosteronism with a normal aldosterone-renin ratio. CT imaging showed focal areas of soft tissue encasement and enhancement surrounding multiple arteries, including the left renal artery, raising suspicion of a medium-vessel vasculitis. Further investigation led to a final diagnosis of polyarteritis nodosa with secondary aldosteronism.