Background Primary aldosteronism (PA) is a common but under‐recognized cause of secondary hypertension. Data directly comparing screening rates across single and overlapping indications are lacking. Methods and Results We conducted a retrospective review of adults with hypertension seen in outpatient clinics at a tertiary referral academic center between January 1, 2017, and June 30, 2020. We included patients with hypertension plus at least one of the following: resistant hypertension; age<35 years; obstructive sleep apnea; hypokalemia; or an adrenal mass. We excluded patients with adrenal insufficiency, severe renal disease, or heart failure, and renovascular hypertension. Of 203 535 patients with hypertension, 86044 (42.3%) met at least 1 PA screening criterion, and of these, 2898 (3.4%) were screened for PA. Screening occurred in 2.7% of patients with resistant hypertension; 4.2% of those with obstructive sleep apnea; 5.1% of those <35 years; 10.0% of those with hypokalemia; and 47.3% of patients with an adrenal mass. Screening rates were higher in patients with multiple risk factors: 16.8% for ≥3, 5.7% for 2, and 2.5% for 1 criterion. Multiple logistic regression showed that the odds of PA screening were higher in patients with hypokalemia: odds ratio (95% CI): 3.0 (2.7–3.3); women: 1.3 (1.2–1.4); Black versus White: 1.5 (1.4–1.7); those with obstructive sleep apnea, chronic renal disease, stroke, and dyslipidemia. Conclusions Consideration for PA is given in a small subset of at‐risk patients, and typically after comorbidities have developed.

Background Pheochromocytomas and paragangliomas (PPGL) are rare causes of secondary hypertension, but when unrecognized, they can lead to serious complications. Data regarding PPGL screening are lacking. Objective To assess the rates and patterns of PPGL screening among eligible patients. Subjects and Study Design We conducted a retrospective review of adults with hypertension seen in outpatient clinics of a large academic center between 01/01/2017 - 06/30/2020. We included patients with treatment-resistant hypertension, hypertension at age &lt;35 years, and/or adrenal mass(es). Results Of 203,535 patients with hypertension identified, 71,088 (35%) met ≥1 inclusion criterion(a), and 2,013 (2.83%) were screened for PPGL. Patients screened were younger (56.2 ± 17.4 vs. 64.0 ± 17.1 years), more often women (54.1% vs. 44.2%), and never-smokers (54.6% vs. 47.5%, p &lt; 0.001 for all). The rate of screening was highest in patients with hypertension and adrenal mass(es) (51.7%, vs. 3.9% in patients with early-onset hypertension, and 2.4% in those with treatment-resistant hypertension). Multivariable logistic regression showed higher odds of PPGL screening in women (OR [95% confidence interval, CI]: 1.48 [1.34 - 1.63]); black vs. white patients (1.35 [1.19-1.53]); patients with adrenal mass(es) (55.1 [44.53-68.15]), stroke (1.34 [1.16-1.54]), dyslipidemia (1.41 [1.26-1.58]), chronic kidney disease (1.40 [1.26-1.56]), and obstructive sleep apnea (1.96 [1.76-2.19]). Conclusions PPGL screening is pursued in roughly half of patients with adrenal nodules and hypertension, but rarely in patients with treatment-resistant or early-onset hypertension. Like for other forms of secondary hypertension, PPGL screening occurs more often after serious complications develop.