Evaluation and Management of Primary Aldosteronism

Primary aldosteronism (PA) is now recognized as a prevalent disorder that contributes to hypertension and cardiovascular disease. Updated Endocrine Society guidelines recommend universal screening for primary aldosteronism among people with hypertension using a streamlined approach to diagnosis that emphasizes the recognition of renin-independent aldosterone production and de-emphasizes the use of aldosterone suppression tests. Emerging molecular imaging modalities may further transform PA subtyping. Treatment options and efficacy for primary aldosteronism continue to expand, with surgery remaining the gold standard for lateralizing PA, while adrenal or adrenal arterial ablation, steroidal and nonsteroidal mineralocorticoid receptor antagonists, and aldosterone synthase inhibitors offer promising alternatives.