原发性醛固酮增多症（PA）是低酉激素性高血压的典型例子，而肾动脉狭窄（RAS）是高酉激素性高血压的经典形式。一个患者同时患有PA和RAS是一个具有挑战性的诊断。我们报告了一个32岁的女性，患有12年的难治性高血压史。她被发现血浆醛固酮和酉激素水平升高，但醛固酮/酉激素比值（ARR）正常。影像检查发现双侧肾上腺增厚和左肾前分支的亚总阻塞。进行肾上腺静脉采样，结果显示单侧醛固酮过度分泌。这可能表明，即使RAS导致的酉激素不能被抑制，肾上腺静脉采样仍是一种适用的方法来确定醛固酮产生的腺瘤的诊断，尽管ARR的诊断价值可能会因酉激素水平不被抑制而受到影响。患者接受了两阶段治疗。首先，通过经皮肾动脉球囊成形术扩张左肾动脉狭窄。两个月后，进行全腹腔镜下左侧肾上腺全切除术。苏木精-伊红染色和CYP11B2免疫染色表明这个肿瘤是一种醛固酮产生腺瘤。在两阶段治疗后，她的血压降至正常水平，无需服用降压药物。这个案例报告提醒我们注意RAS和PA同时发生的情况。在这种情况下，ARR可能会导致PA的假阴性。肾上腺静脉采样是为了确诊而必要的。对于复杂的继发性高血压病因，可能需要多阶段治疗。

Primary aldosteronism (PA) is a typical example of low renin hypertension, whereas renal artery stenosis (RAS) is a classic form of high renin hypertension. PA and RAS occurring simultaneously in a patient is challenging to diagnose. We report a 32-year-old woman with a 12-year history of resistant hypertension. She was identified to have elevated plasma aldosterone and renin levels with normal aldosterone/renin ratio (ARR). Imaging examinations identified bilateral adrenal thickening and subtotal occlusion of the anterior segment of the left renal artery. Adrenal venous sampling was performed and indicated the existence of unilateral aldosterone over-secretion. It may suggest that even though RAS led to non-suppressed renin, adrenal venous sampling remains to be an applicable approach to establish the diagnosis of aldosterone-producing adenomas, although the diagnostic value of ARR may be compromised due to non-suppressed renin level. The patient underwent a two-stage treatment. First, stenosis of the left renal artery was dilated by percutaneous transluminal renal balloon angioplasty. Two months later, laparoscopic complete left adrenalectomy was performed. Hematoxylin-eosin staining and CYP11B2 immunostaining suggested that this tumor was an aldosterone-producing adenoma. After the two-stage treatment, her blood pressure decreased to a normal level without antihypertensive drugs. This case report raises our awareness of the simultaneous occurrence of RAS and PA. Under this condition, ARR could lead to a false-negative PA. Adrenal venous sampling is warranted to achieve a confirmed diagnosis. For subjects with complex etiologies of secondary hypertension, multi-stage treatment may be required.