Primary Aldosteronism: An Endocrine Society Clinical Practice Guideline

Screen all individuals with hypertension for PA by measuring aldosterone and renin and determining the ARR; guide subsequent care by the results.

Individuals with PA receive PA-specific therapy, either medical or surgical.

In those screening positive: commence PA-specific medical therapy where surgery is not desired or not a candidate, and where probability of lateralizing PA is low based on screening results.

In those screening positive: aldosterone suppression testing where screening indicates intermediate probability of lateralizing PA and individualized decision making confirms a desire to pursue eligibility for surgery.

In those positive on aldosterone suppression testing, or with high probability of lateralizing PA on screening, adrenal lateralization with CT and AVS before deciding medical vs surgical treatment.

In all individuals with PA and an adrenal adenoma, perform a 1-mg overnight dexamethasone suppression test.

Use mineralocorticoid receptor antagonists (MRAs) over ENaC inhibitors in the medical treatment of PA.

Use spironolactone over other MRAs, given lower cost and greater availability; all MRAs titrated to equivalent potencies are anticipated to have similar efficacy.

In individuals receiving MRA therapy, monitor renin and, where hypertension remains uncontrolled and renin is suppressed, titrate the MRA to increase renin.