<p>Primary hyperaldosteronism (PHA) is one of the more frequent causes of secondary hypertension. The diagnostics currently contain three steps: screening, confirmatory tests and localization tests. The screening for PHA with the aldosterone-renin ratio (ARR) has considerably increased the number of diagnosed cases in recent years; however, the accuracy of the ARR is not yet satisfactory. The number of false positive or borderline findings is relatively high. The confirmatory tests after positive screening (e. g., intravenous or oral salt loading, the fludrocortisone or the captopril test) are also not yet sufficiently accurate. This is also true for the localization procedures after confirmation of the diagnosis of PHA that are necessary to discriminate between unilateral and bilateral disease. Bilateral disease requires drug treatment but in cases of unilateral disease first the potential success of an operative intervention is assessed. Adrenal vein blood sampling, which has so far been regarded as the gold standard, is invasive and prone to errors. More recent studies on the use of positron emission tomography (PET)-computed tomography (CT) with pentixafor suggest that the localization procedures, which are necessary to plan the appropriate treatment, will be more practicable in the future. It is to be expected that the pharmacotherapy of PHA will be markedly improved by the use of the newly developed aldosterone synthase inhibitors.</p>