Adrenal vein sampling (AVS) is recommended for diagnosing unilateral aldosterone-producing adenomas or bilateral adrenal hyperplasia, which can then inform treatment decisions; however, AVS is expensive and difficult to perform. Investigators in a randomized controlled trial have now compared the comparatively inexpensive adrenal CT scanning of primary aldosteronism with AVS. No difference was seen in the intensity of treatment required for blood pressure control or any clinical benefit at 1 year follow up between participants in the two arms of the trial. The investigators highlight that hospitals with only adrenal CT facilities can obtain results that are similar to those centres with AVS for directing treatment in patients with primary aldosteronism, which might be a more efficient use of health-care resources.