Primary aldosteronism

Last reviewed: 5 Jan 2023
Last updated: 08 Oct 2021



History and exam

Key diagnostic factors

  • hypertension
  • presence of risk factors
More key diagnostic factors

Other diagnostic factors

  • age 20 to 70 years
  • nocturia, polyuria
  • lethargy
  • mood disturbance (irritability, anxiety, depression)
  • difficulty concentrating
  • paraesthesias, muscle cramps
  • muscle weakness
  • palpitations
Other diagnostic factors

Risk factors

  • family history of PA
  • family history of early onset of hypertension and/or stroke
More risk factors

Diagnostic investigations

1st investigations to order

  • plasma potassium
  • aldosterone/renin ratio
More 1st investigations to order

Investigations to consider

  • fludrocortisone suppression test
  • saline infusion testing
  • oral salt loading
  • genetic testing
  • adrenal CT
  • adrenal venous sampling
  • adrenal MRI
  • adrenal selenocholesterol scanning
  • posture stimulation testing
  • angiotensin II infusion testing
  • 24-hour urinary hybrid steroids (18-hydroxy- and 18-oxo-cortisol)
  • dexamethasone suppression testing
More investigations to consider

Emerging tests

  • ¹¹ C-Metomidate PET/CT

Treatment algorithm


unilateral PA

bilateral PA (excluding familial hyperaldosteronism type I)

familial hyperaldosteronism type I



Michael Stowasser, MBBS, FRACP, PhD
Michael Stowasser


Endocrine Hypertension Research Centre

University of Queensland School of Medicine

Greenslopes and Princess Alexandra Hospitals





MS is an author of references cited in this monograph.


Professor Michael Stowasser would like to gratefully acknowledge Professor Richard D. Gordon, a previous contributor to this monograph.

Peer reviewers

Paolo Mulatero, MD

Department of Medicine and Experimental Oncology

Division of Medicine and Hypertension

San Giovanni Battista Hospital




PM declares that he has no competing interests.

Wail Malaty, MD

Clinical Professor

Department of Family Medicine

University of North Carolina

Chapel Hill

Assistant Program Director

MAHEC Rural Family Medicine Residency




WM declares that he has no competing interests.

  • Primary aldosteronism images
  • Differentials

    • Essential hypertension (HTN)
    • Thiazide-induced hypokalaemia in patient with essential HTN
    • Renal artery stenosis
    More Differentials
  • Guidelines

    • The 2020 Italian Society of Arterial Hypertension (SIIA) practical guidelines for the management of primary aldosteronism
    • The management of primary aldosteronism: case detection, diagnosis, and treatment
    More Guidelines
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