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Just published July 14th, 2025 -The Endocrine Society’s newest guideline on Primary Aldosteronism. (PA)

The objective of this guideline is to provide a practical, clinical approach to

identifying and managing PA to improve diagnosis rates and encourage targeted treatment.

There are 10 recommendations, so let’s get started

  • In all individuals with hypertension, the guideline suggests screening for PA
  • In individuals with hypertension and PA, the guideline suggest PA-specific therapy (medical or surgical).
  • In individuals with hypertension, the guideline suggest PA screening with serum/plasma aldosterone concentration and plasma renin (concentration or activity)
  • In individuals who screen positive for PA, the guideline suggest aldosterone-suppression testing in situations when screening results suggest an intermediate probability for lateralizing PA and individualized decision making confirms a desire to pursue eligibility for surgical therapy.
  • In individuals with PA, the guideline suggest medical therapy or surgical therapy with the choice of therapy based on lateralization of aldosterone hypersecretion and candidacy for surgery.
  • In individuals with PA considering surgery, the guideline suggest adrenal lateralization with CT scanning and AVS prior to deciding the treatment approach (medical or surgical).
  • In individuals with PA receiving PA-specific medical therapy whose hypertension is not controlled and renin is suppressed, the guideline suggest increasing PA-specific medical therapy to raise renin.
  • In individuals with PA and adrenal adenoma, the guideline suggest a dexamethasone-suppression test.
  • In individuals with PA receiving PA-specific medical therapy, the guideline suggest spironolactone457
  • over other MRAs due to its low cost and widespread availability.
  • For individuals with PA receiving PA-specific medical therapy, the guideline suggest using MRAs rather than ENaC inhibitors (amiloride, triamterene)

Make sure to check out the full guideline from The Endocrine Society and other related clinical decision support tools at guideline.central.com.

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