Primary aldosteronism unmasked during pregnancy: a case report

Primary aldosteronism during pregnancy is a rare but significant cause of secondary hypertension with potentially serious implications for maternal-fetal outcomes. This case adds to our understanding of how pregnancy can unmask previously compensated disease. A 37-year-old woman with pre-existing hypertension developed severe treatment-resistant hypertension at 36 weeks’ gestation, despite normal pre-pregnancy aldosterone-to-renin screening. Emergency cesarean section was required. Postpartum evaluation revealed hypokalemia, elevated aldosterone, suppressed renin, and a left adrenal adenoma. Complete resolution followed laparoscopic adrenalectomy. This case demonstrates the importance of maintaining clinical suspicion for primary aldosteronism in pregnancy-associated resistant hypertension, regardless of pre-pregnancy screening results, and highlights the value of a comprehensive postpartum evaluation.