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Primary aldosteronism is the cause of secondary arterial hypertension in up to 10–12% of patients with elevated blood pressure. In approximately one-third of these cases, the excess aldosterone production is lateralised to either the right or left adrenal gland, often due to an aldosterone-secreting adenoma. However, identifying the precise source of aldosterone hyperproduction via cross-sectional imaging is challenging, as imaging cannot reliably distinguish between hormone-active and inactive adenomas. This is further complicated by the higher prevalence of inactive adenomas. To address this limitation, adrenal vein sampling is a reliable method for determining the lateralisation of pathological aldosterone production.In this report, we present the case of a male patient in his early 50s who was diagnosed with primary aldosteronism and underwent adrenal vein sampling under difficult circumstances due to a rare anatomical variant in the adrenal venous system. Specifically, we describe our approach to successful catheterisation of the central adrenal vein in the setting of an accessory hepatic vein drainage, a condition present in about 10% of patients.This case underscores the need for accurate pre-interventional imaging and the use of appropriate interventional techniques during adrenal vein sampling to reliably localise the source of aldosterone hyperproduction.