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French Endocrinology Society (SFE), French Hypertension Society (SFHTA) and Francophone Endocrine Surgery Association (AFCE) highlight the need for PA screening in patients with hypertension and disproportionate target organ damage ( Alongside the lack of uniform indications for PA screening, recommended aldosterone-to-renin ratio (ARR) as a screening test is subject to several limitations ( Since the advantage of ARR in the screening for PA was shown by Hiramatsu et al., ARR screening has been used widely ( Bloods for aldosterone and renin measurement should be drawn in the morning, after 2hr in upright position, then permitted to settle (sit for 5 to 15 minutes) before the blood collection ( Once a positive ARR is confirmed, lack of aldosterone suppression should be demonstrated in one of four tests (saline infusion test, oral sodium loading test, fludrocortisone suppression test or captopril challenge test) ( After the diagnosis of PA, optimal treatment (unilateral adrenalectomy or pharmacotherapy with mineralocorticoid receptor antagonist) should be initiated, depending on the source (unilateral/bilateral) of autonomous aldosterone secretion, surgical candidacy, and patient preference ( Thus, all the listed limitations of routine diagnostics of PA ( Figure 1 ) indicate the necessity to establish novel, improved diagnostic strategies

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Stephan et al., 2012