Hypertension is a frequent early manifestation of autosomal dominant polycystic kidney disease (ADPKD). Many mechanisms cause hypertension in ADPKD; however, primary aldosteronism (PA) as a possible manifestation of hypertension in ADPKD is extremely rare. The diagnosis of PA in ADPKD is extremely challenging because multiple renal cysts can mask the identification of adrenal adenomas, and ADPKD is associated with hypertension in majority of cases. Here, we report a unique case of a young lady with ADPKD with hypertension masquerading PA.