Primary aldosteronism is a clinical syndrome characterized by hypertension, hyperkalemia and hyporeninemia due to increased aldosterone production from the adrenal gland. It is caused by adenoma, bilateral hyperplasia or carcinoma. We experienced anesthetic management of a 49-year-old female with adrenal adenoma accompanied by aortic dissection for left adrenalectomy. To avoid undesirable hypertension which may exacerbate the aortic dissection during general anesthesia, we performed adjunctive continuous thoracic epidural anesthesia under careful hemodynamic monitoring. The patient recovered uneventfully without extension of aortic dissection.