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Primary aldosteronism (PA) is a common yet still underdiagnosed cause of secondary hypertension (HTN). We report two cases illustrating the variability of its clinical presentation: one revealed by left ventricular hypertrophy, the other by refractory hypertension. These observations highlight the importance of a structured diagnostic approach to determine the PA subtype and tailor management accordingly. Early diagnosis improves blood pressure control, corrects electrolyte disturbances, and prevents aldosterone-related visceral complications. These findings also support the need for more systematic screening of this common yet often overlooked condition.