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I hope this testing becomes more available! It would probably help fix my hypertension, I know it's aldosterone based.

Isn’t there a 24 hour urine test to check for markers for that?

That’s for hypercortsolism causing Cushings disease.

You test for hyperaldosteronism with a aldosterone to renin ratio- done by blood draw

But that won't tell you if it's only one adrenal gland causing trouble... or which one it is...

No but it’s the first step. And it’s important because you need to make sure there’s actually increased aldosterone causing the hypertension because increased renin will do that as well (e.g. from renal artery stenosis). There’s several causes of secondary hypertension- it doesn’t always localize to the adrenal gland.

To build on what’s already been said, there is a test for unilateral vs bilateral hyperaldosteronism - adrenal venous sampling. But it is critical to get a specialist with a lot of experience because it’s a technically challenging procedure.

https://www.mayoclinic.org/medical-professionals/endocrinology/news/primary-aldosteronism-the-role-of-adrenal-venous-sampling/mac-20430855

Exactly. Adrenal venous sampling is problematic and imperfect, to put it nicely. This seems like a much better method for the patients with hyperaldosteronism without an obvious nodule as the source. This is still a pretty small percentage of people with hypertension.