Hepatocellular adenoma (HCA) is a rare, benign neoplasm of uncertain origin. It occurs predominantly in young adult women using long-term oral contraceptives. Spironolactone is a widely used diuretic agent. Despite the frequent use of spironolactone, there have been very few cases of hepatocellular toxicity reported. Furthermore, there are no reports to date in the English literature about HCA associated with spironolactone treatment for hyperaldosteronism. Herein, we present a HCA patient with hyperaldosteronism, who received spironolactone treatment for an extended period of time. The patient's HCA was enlarged and underwent hemorrhagic change. Therefore, eplerenone or surgical intervention may be superior to spironolactone in this patient.