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A Novel Method: Super-selective Adrenal Venous Sampling

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Electronic Health Record-Based Screening for Primary Aldosteronism in a Large Academic System.

Sang Ngo¹, Joshua C Chao², Jetesh Sahadeo¹

¹David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.

Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists

|May 22, 2026

Summary

Primary aldosteronism (PA) is underdiagnosed in hypertensive patients. Improving screening adherence can enhance detection, treatment, and cardiovascular outcomes for high-risk individuals.

Keywords:

adrenalectomy aldosterone-renin ratio hypertension hypokalemia obstructive sleep apnea primary aldosteronism screening

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Area of Science:

Endocrinology
Cardiovascular Medicine
Health Services Research

Background:

Primary aldosteronism (PA) is an underdiagnosed cause of hypertension.
Current clinical practice for PA screening is inconsistent with established guidelines for high-risk populations.
Systematic evaluation of PA screening and treatment is needed within large healthcare systems.

Purpose of the Study:

To evaluate the rates and patterns of PA screening among hypertensive patients meeting guideline-based criteria.
To assess the diagnostic yield of PA screening.
To examine subsequent treatment strategies and their impact on patient outcomes.

Main Methods:

Retrospective cohort study of hypertensive patients (2017-2019) with 5-year follow-up.
Inclusion criteria: meeting at least one Endocrine Society PA screening criterion (resistant hypertension, hypokalemia, adrenal mass, OSA).
Screening defined by aldosterone-renin ratio (ARR); positivity by ARR ≥20 and aldosterone ≥10 ng/dl.

Main Results:

Of 40,865 hypertensive patients, 43.4% met screening criteria, but only 4.1% were screened.
Screening rates varied significantly by indication (e.g., 4.7% for resistant hypertension, 26% for adrenal mass).
28.9% of screened patients tested positive; 12% underwent adrenalectomy, 38% received medical treatment, 50% remained untreated. Treated patients showed improved BP, hypokalemia resolution, and fewer antihypertensive medications at 5 years.

Conclusions:

PA is significantly underdiagnosed and undertreated in high-risk hypertensive patients.
Adherence to guideline-based screening protocols is crucial for improving PA detection and management.
Improved screening and timely treatment may positively impact cardiovascular outcomes in PA patients.