This is the first published report describing the association between primary aldosteronism and chronic idiopathic orthostatic hypotension. The clinical history of a 57 year old man with incapacitating postural hypotension and severely symptomatic supine hypertension, is described. A possible occupational etiology of postural hypotension, with regard to a prolonged exposure to cutting oils, is considered. The intriguing pathophysiologic aspects of this unique association are discussed. The Authors suggest that, although supine hypertension is common in chronic idiopathic orthostatic hypotension, a careful examination of the adrenal glands is advisable in these patients, to rule out the presence of an associated adrenal adenoma.