Fig. 1.

Simplified algorithm for the work-up for primary aldosteronism. Please note the pivotal role of adrenal vein sampling (AVS) for patient’s assignment to surgery or medical treatment. In case of uncertain AVS results or unsuccessful AVS, the indication to unilateral adrenalectomy can be justified by in case of drug-resistant hypertension and/or unbearable side effects with the antihypertensive treatment. *Confirmatory tests are not explained in this simplified algorithm because their accuracy and diagnostic gain over a well-performed baseline ARR has not been proven in studies that fulfilled the Standards for Reporting of Diagnostic Accuracy (STARD) requirements [25]. Moreover, in the largest and only study that followed these requirements, the captopril test was not shown to provide any diagnostic gain over the baseline ARR [26]. PA primary aldosteronism, ARR aldosterone: renin ratio, PRA plasma renin activity, K⁺ potassium, Na⁺ sodium, CT computed tomography, MRI magnetic resonance imaging, AVS adrenal vein sampling, BP blood pressure