A little-known and misunderstood disease affecting as many as 12 million Americans, putting them at risk of potentially deadly complications, is often missed or misdiagnosed.
Primary aldosteronism (PA) is a serious condition that affects as many as 5 to 10 percent of adults with high blood pressure (BP). High BP is widely prevalent in the U.S., nearly half of all adults (almost 120 million individuals) have it. Yet, for many years, PA was considered uncommon. However, recent research shows PA is both prevalent and under-detected. Untreated, it significantly raises risk of heart attack, stroke, and kidney disease.
Despite these risks, as few as 1 to 3 percent of patients with high BP are screened for PA. In fact, more than 35 percent of affected patients report waiting more than five years between an initial diagnosis of hypertension (high blood pressure) and PA.
The hidden dangers of primary aldosteronism
Primary aldosteronism occurs when the adrenal glands produce too much aldosterone, a hormone that helps regulate sodium and potassium in the blood. High BP is a defining feature of PA, though affected individuals may have other common symptoms like headaches or muscle cramps. However, many patients with PA have only high BP, and no other symptoms, making securing a diagnosis challenging.
If left untreated, several complications can persist. Unfortunately, diagnostic delay of PA is all too common.
One teacher’s struggle to receive a diagnosis
Tammie Robie, a teacher living in New Hampshire, developed hypertension in 2007, but no doctor could tell her the cause or provide treatments to alleviate her symptoms. After 16 years of debilitating symptoms, including chronic headaches and heart palpitations, and visits to multiple doctors, she was finally diagnosed with PA in 2023. Why did so many physicians struggle to help her for so long?
PA is severely underscreened primarily due to low clinical awareness. “I saw so many different doctors over the years,” Tammie said. “No one ever suggested primary aldosteronism might be the cause of my symptoms until I was diagnosed nearly two decades later. The physician who finally tested me for PA said most doctors aren’t aware of the condition or how common it is.”
In some ways, Tammie was lucky. Her symptoms prompted her to seek evaluation leading, eventually, to a diagnosis and later, curative surgery. But many patients are asymptomatic in early stages, leading to challenges in diagnosis. For them, a diagnosis may not occur until after a devastating event.
There is also a misconception among physicians that PA is a rare condition. Those who know about PA may opt not to screen for it because they believe it is uncommon.
Adding to that is confusion around testing procedures for the disease. Some physicians believe patients need to stop taking their blood pressure medications before testing, but modern guidelines suggest that many can remain. Other physicians find the traditional screening test, a plasma aldosterone-to-renin ratio (ARR), complex to interpret. By finding ways to make testing simpler and smarter, experts in PA hope to help more patients get diagnosed sooner, so no one waits for treatment as long as Tammie did.
Looking ahead to the future of primary aldosteronism
For the first time ever, guideline recommendations issued in 2025 from the Endocrine Society are suggesting all patients with hypertension be evaluated for PA. Evaluation includes a simple blood test, first, to screen for markers of PA, and then, to confirm the condition with follow-up testing (though this can be performed with a single blood draw).
Identifying PA as early as possible is critical to favorable outcomes. By increasing physician awareness of the disease, and just how common it is among individuals with high BP, more patients can be screened and brought to treatment sooner.
Tammie’s health struggles shaped most of her life, and only after a relentless pursuit of aid did she have the insights she needed to own her health. But with more time spent on preventative care, providers can start with health, not sickness, to keep patients well, and not diagnose and treat them after they have been struggling for years.
Sanjay B. Dixit is an endocrinologist and physician executive.
