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Introduction A clinical scenario characterized by hydrocortisone therapy (20 mg), a urine pH of 6.5, and severe hypertension reaching 170 mmHg raises concern for an underlying endocrine disorder, particularly primary aldosteronism (PA).  As one of the most common yet frequently overlooked causes of secondary hypertension, PA is associated with substantial cardiovascular and renal morbidity when not promptly identified and treated. In addition to resistant hypertension and hypokalemia, adrenal disorders such as Conn’s syndrome may also present with excessive or frequent urination due to aldosterone-mediated potassium loss and impaired renal concentrating ability. Physiology of Aldosterone Aldosterone , a mineralocorticoid synthesized in the zona glomerulosa of the adrenal cortex, acts on the distal nephron to enhance sodium reabsorption and potassium excretion . Through its regulation of extracellular fluid volume, aldosterone directly modulates systemic blood pressure . Patho...