What does this research mean for the field?

The Primary Aldosteronism Severity Classification identified 13.9% mild, 63.0% moderate, and 23.1% severe cases, correlating with subtype prevalence rates. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

The study aims to establish a severity classification for primary aldosteronism to enhance clinical management.

February 8, 2026Open Access

Expert Consensus on the Primary Aldosteronism Severity Classification and its strategic application in indicating adrenal venous sampling

Key Result

The Primary Aldosteronism Severity Classification strongly correlates with lateralized PA subtype prevalence (72.6% in severe cases) aiding AVS indication.

Key Points

The study aims to establish a severity classification for primary aldosteronism to enhance clinical management.
Used the Delphi method among 45 international experts from 40 centers.
Developed a severity classification based on expert consensus.
Retrospectively applied the classification to 2593 PA patients from 26 centers.
Established Primary Aldosteronism Severity Classification categorizing PA into mild, moderate, and severe.
Among the cohort, 13.9% were mild, 63.0% moderate, and 23.1% severe.
The classification correlated with prevalence rates of lateralized PA subtypes.

Structured PICO

Does the Primary Aldosteronism Severity Classification (PASC) correlate with lateralized disease subtype in patients with primary aldosteronism?

Population

2593 patients with primary aldosteronism from 26 centers

Intervention

Primary Aldosteronism Severity Classification (PASC) integrating serum potassium, blood pressure, and basal plasma aldosterone concentration

Outcome

Association with the disease subtype (lateralized subtype prevalence)

The Primary Aldosteronism Severity Classification (PASC) is a novel, semi-quantitative tool that correlates with lateralized PA subtypes and may help guide the use of adrenal venous sampling.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Objective: Severity classifications are essential for many diseases to prioritize patient management tasks such as diagnosis, treatment, and follow-up. Primary aldosteronism (PA), a common cause of secondary hypertension, lacks a standardized severity scale despite generally requiring invasive diagnostics like adrenal venous sampling (AVS). This study aimed to develop a global expert consensus-based classification for PA severity to improve clinical decision-making. Methods: A panel of 45 international experts from 40 centers across four continents used the Delphi method to create a consensus severity classification for PA. This classification was then applied retrospectively to 2593 PA patients from 26 centers to assess its association with the disease subtype. Results: After four rounds, the Primary Aldosteronism Severity Classification (PASC), which integrates biochemical and clinical parameters including serum potassium, blood pressure, and basal plasma aldosterone concentration, was established. Primary Aldosteronism Severity Classification classifies PA into mild (3 and 4 points), moderate (5-7 points), and severe (8 and 9 points). Among the cohort from 26 centers, 13.9%, 63.0%, and 23.1% were classified as mild, moderate, and severe, respectively, aligning with lateralized subtype prevalence rates of 14.7%, 44.6%, and 72.6%. Conclusion: Primary Aldosteronism Severity Classification is a newly developed simplified, semi-quantitative classification of PA severity. The correlation between PASC and lateralized PA subtype supports its potential to provide graded recommendations of AVS prior to surgical indication in each patient.