Figure 2: A 27-year-old woman (patient 15) who had stage 4 CKD presented with stage 1 hypertension alone due to bilateral adrenal hyperplasia, whose PAC was elevated, but whose serum potassium level was normal, whose PRA was nonsuppressive, whose ARR was negative, whose confirmatory testing was negative, whose bilateral adrenal lesions had normal appearing on CT (a) and faint uptakes on planar imaging (b) but true positive on SPECT (c) and coronal SPECT/CT (d) imaging. After treatment with 25 mg of spironolactone, her BP and PAC were normalized.