Rare germline variants in canonical and candidate genes in apparently sporadic bilateral primary aldosteronism.

Variants in canonical primary aldosteronism genes were identified in 5 patients (9.6%), including CACNA1H ( n = 4) and CACNA1D ( n = 1).

In 4 patients (7.5%), rare variants were identified in plausible candidate genes ( ANO1, KCNK3, CASZ1, and STRN ).

Compared with noncarriers, carriers showed a lower frequency of hypokalemia ( P < .0001), higher prevalence of family history of hypertension ( P < .0001), higher frequency of resistant hypertension ( P < .0001), required more antihypertensives ( P = .0264), and had more frequent adrenal computed tomography abnormalities, particularly bilateral involvement ( P < .0001).