Purpose <p>In primary aldosteronism (PA), aldosterone-producing adenoma (APA) has the best surgical outcome. In this study, we aimed to clinically evaluate the diagnostic efficacy of ⁶⁸Ga-pentixafor PET/CT for APA and its predictive value for surgical outcomes.</p> Materials and methods <p>We retrospectively analyzed consecutive 47 aldosterone-producing adenomas (APA) and 26 non-functional adrenal adenoma (NFA) patients who underwent ⁶⁸Ga-pentixafor PET/CT. Semi-quantitative analysis of PET/CT was performed using maximum standardized uptake value (SUVmax), lesion-to-liver ratio (LLR), and lesion-to-contralateral ratio (LCR).</p> Results <p>SUVmax, LLR, LCR were 20.62 and 5.21 (<i>p</i> &lt; 0.0001), 14.07 and 3.61 (<i>p</i> &lt; 0.0001), and 5.89 and 1.47 (<i>p</i> &lt; 0.0001) for aldosterone-producing adenomas and NFA, respectively. PET/CT for APA diagnostic cut-points were SUVmax &gt; 8.98 (specificity 100% / sensitivity 95.74%), LLR &gt; 6.70 (specificity 100% / sensitivity 91.49%), or LCR &gt; 3.62 (specificity 100%/ sensitivity 91.49%). All patients with APA were complete biochemical success during more than six months of follow-up, indicating ⁶⁸Ga-pentixafor PET/CT was able to accurately predict the ideal surgical outcomes.</p> Conclusions <p>⁶⁸Ga-Pentixafor PET/CT can be used to noninvasively detect APA and provide guidance for surgery for primary aldosteronism.</p>