Primary Aldosteronism Guideline Resources

Full Guideline: The Management of Primary Aldosteronism: Case detection, diagnosis, and treatment
JCEM | May 2016

John W. Funder (chair), Robert M. Carey, Franco Mantero, M. Hassan Murad, Martin Reincke, Hirotaka Shibata, Michael Stowasser, and William F. Young, Jr

The 2016 guideline on Primary Aldosteronism is an update of the previous version from 2008. This guideline addresses:

  • Deciding when to screen a patient with hypertension for primary aldosteronism
  • Using diagnostic tests for screening and diagnosing patients
  • Determining when it is appropriate to surgically remove an overactive adrenal gland
  • Deciding when to treat with mineralocorticoid antagonists


Essential Points

The Endocrine Society recommends primary aldosterone screening for people who meet one of the following criteria:

  • Those who have sustained blood pressure above 150/100 in three separate measurements taken on different days;
  • People who have hypertension resistant to three conventional antihypertensive drugs;
  • People whose hypertension is controlled with four or more medications;
  • People with hypertension and low levels of potassium in the blood;
  • Those who have hypertension and a mass on the adrenal gland called an adrenal incidentaloma;
  • People with both hypertension and sleep apnea;
  • People with hypertension and a family history of early-onset hypertension or stroke before age 40; and
  • All hypertensive first-degree relatives of patients with primary aldosteronism.

Other recommendations include:

  • The plasma aldosterone-to-renin ratio (ARR) test should be used to screen for primary aldosteronism.
  • All patients diagnosed with primary aldosteronism should undergo a CT scan of the adrenal glands to screen for a rare cancer called adrenocortical carcinoma.
  • When patients choose to treat the condition by having one adrenal gland surgically removed, an experienced radiologist should take blood samples from each adrenal vein and have them analyzed. This procedure, called adrenal vein sampling, is the gold standard for determining whether one or both adrenal glands is producing excess aldosterone.
  • For people with primary aldosteronism caused by overactivity in one adrenal gland, the recommended course of treatment is minimally invasive surgery to remove that adrenal gland.
  • For patients who are unable or unwilling to have surgery, medical treatment including a mineralocorticoid receptor (MR) agonist is the preferred treatment option.

Summary of Recommendations

+ 1.0 Case Detection

+ 2.0 Case Confirmation

+ 3.0 Subtype Classification

+ 4.0 Treatment