Primary aldosteronism (PA), a prevalent form of secondary hypertension, compared with essential hypertension, PA patients exhibit significantly higher risks of cardiovascular/cerebrovascular events and renal impairment. The goal of subtype diagnosis is to clarify the etiology and determine subsequent treatment strategies. Due to inadequate understanding of PA among most clinicians and insufficient emphasis on its diagnosis and treatment, there is a lack of validated clinical research data. Current clinical studies on PA subtyping diagnosis are predominantly limited in scope. PA subtyping diagnosis has remained a clinical challenge. Future large-scale, multicenter clinical studies are required to further investigate PA subtyping diagnostic methods, thereby enhancing diagnostic and therapeutic approaches for PA patients. Regarding the subtyping methods for PA current commonly used methods include Adrenal CT, Adrenal Venous Sampling (AVS), Positron Emission Tomography-Computed Tomography (PET/CT), clinical prediction models, clinical trials, biochemical markers, and genetic testing. If AVS cannot be performed due to other factors, subtyping diagnosis may be conducted using the aforementioned alternative methods, with comprehensive analysis integrated with the patient’s actual clinical data. For PA patients who meet the criteria for adrenal venous sampling (AVS), AVS remains the preferentially recommended method for subtype diagnosis. In conclusion, although multiple PA subtyping diagnostic methods have been proposed—including Adrenal CT, PET/CT, clinical prediction models, clinical trials, biochemical markers, and genetic testing—which can assist in PA subtyping diagnosis to some extent, all exhibit inherent limitations. None can match the sensitivity and specificity of Adrenal Venous Sampling (AVS). Therefore, AVS remains the gold standard for PA subtyping diagnosis. This article provides a comprehensive review of current PA subtyping diagnosis approaches. In order to provide clinicians with more choices for the classification diagnosis and treatment of patients with Primary aldosteronism.
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