Endocrine Society Releases New Guidelines Advocating for Broader Screening of Primary Aldosteronism in Hypertension Patients

The Endocrine Society has issued newly updated clinical guidelines emphasizing the importance of expanded screening for primary aldosteronism, a common hormonal disorder that often goes undiagnosed in individuals with high blood pressure. Research indicates that between 5% and 14% of patients with hypertension, especially those seen in primary care, and up to 30% in referral centers, may have primary aldosteronism. This condition is caused by overproduction of aldosterone from the adrenal glands, leading to sodium retention and high blood pressure.

Many patients with hypertension do not undergo blood testing for aldosterone levels, which can result in missed diagnoses. If left untreated, primary aldosteronism significantly increases the risk of cardiovascular complications, including stroke, coronary artery disease, atrial fibrillation, heart failure, and kidney disease.

The guideline suggests that testing for aldosterone, renin, and potassium levels should be routinely performed for all individuals diagnosed with hypertension. Although the recommendation leans toward universal screening, it recognizes that blood tests may produce false positives, necessitating confirmatory tests.

For those diagnosed with primary aldosteronism, treatment options include medication and surgical intervention, both aimed at normalizing hormone levels and reducing blood pressure. Proper diagnosis and targeted treatment are crucial, as patients with this condition face higher cardiovascular risks than those with primary hypertension.

The updated guidelines were published online in the Journal of Clinical Endocrinology & Metabolism and were presented during the Society's annual ENDO 2025 meeting. They represent an advancement from the Society's 2016 recommendations, incorporating evidence-based research to improve patient outcomes.

The Society underscores that widespread, low-cost screening can help identify more cases of primary aldosteronism, allowing for appropriate treatment strategies that could mitigate long-term health risks.