Primary hyperaldosteronism
The commonest curable cause of hypertension. Screen with aldosterone and renin (now in everyone with hypertension under the 2025 Endocrine Society guideline), confirm when needed, lateralise with adrenal vein sampling, then adrenalectomy for unilateral disease or a renin-guided MRA for bilateral disease.
Tier 2Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Autonomous aldosterone secretion, not driven by renin. The result is sodium retention, low renin, potassium wasting and hypertension.
- The commonest secondary cause of hypertension, and one of the few curable ones. Most cases are never diagnosed because few people with hypertension are ever screened.
- Aldosterone damages heart, kidney and vessels independently of BP. Compared with matched essential hypertension, PA carries roughly 3 to 4 times the risk of AF, and more stroke, heart failure and CKD.
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Sources
- Adler GK, Stowasser M, Correa RR et al. Primary aldosteronism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2025;110(9):2453-95Endocrine Society, 2025 (correction published October 2025; checked November 2026 as current)
- Guideline for the diagnosis and management of hypertension in adultsAU/NZNational Heart Foundation of Australia, 2016 (summary in Med J Aust 2016;205(2):85-9). Heart Foundation page says new guidelines are coming soon; not yet released when checked November 2026
- Libianto R et al. Detecting primary aldosteronism in Australian primary care: a prospective study. Med J Aust 2022;216(8)AU/NZMedical Journal of Australia, 2022
- Nelson MR. If you look for primary aldosteronism, you find it (commentary on Libianto et al.). Med J Aust 2022;216(8):405-6AU/NZMedical Journal of Australia, 2022
- Williams TA, Lenders JWM, Mulatero P et al. Outcomes after adrenalectomy for unilateral primary aldosteronism (PASO study). Lancet Diabetes Endocrinol 2017;5:689-99The Lancet Diabetes & Endocrinology, 2017
- Hundemer GL, Curhan GC, Yozamp N et al. Cardiometabolic outcomes and mortality in medically treated primary aldosteronism. Lancet Diabetes Endocrinol 2018;6:51-9The Lancet Diabetes & Endocrinology, 2018
- Endocrinology (Therapeutic Guidelines)AU/NZTherapeutic Guidelines Ltd
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy