Background A 51-year-old woman was referred to the Hypertension Clinic of L'Hotel-Dieu de Quebec Hospital, University of Quebec Hospital Centre, with hypertension. Her hypertension had been evolving for approximately 30 years and was refractory to maximum doses of four antihypertensive agents. Routine blood testing revealed mild hypokalemia Investigations Physical examination, urine and blood analyses including measurement of renin and aldosterone levels, echocardiography, fundoscopy abdominal-pelvis CT scan and histopathology studies. Diagnosis Juxtaglomerular cell tumor with vascular invasion. Management Radical nephrectomy, and follow-up visits to monitor blood pressure and renin levels.