The mineralocorticoid-excess state caused by primary aldosteronism usually causes hypokalemia and moderate to sever hypotension. A directed approach to the patient with suspected primary aldosteronism is essential. Appropriate use of biochemical and diagnostic imaging studies can identify the etiology of the primary aldosteronism in an efficient and noninvasive way in most cases. Precision in defining the etiology of the mineralocorticoid-excess state logically leads to therapeutic strategies that usually cure or improve the hypertensive state.