BACKGROUND: Primary aldosteronism is the most common specifically treatable and potentially curable cause of hypertension. OBJECTIVE: The aim of this study was to analyse the referral pattern and disease characteristics of patients with hypertension and suspected primary aldosteronism. METHODS: We prospectively collected clinical data from patients who attended the Endocrine Hypertension Service (EHS) at Monash Health from May 2016 to May 2017. RESULTS: Of 87 patients, 69.2% had indications for primary aldosteronism screening in the primary care setting, although only 3.7% were actually screened. At the time of referral to the EHS, 61% had hypertension for over 10 years and 42% of the patients with primary aldosteronism had associated end-organ damage. Targeted treatment of primary aldosteronism led to biochemical and clinical improvement in all patients. DISCUSSION: The diagnosis of primary aldosteronism is currently delayed and associated with significant end-organ damage. Increased awareness of primary aldosteronism and its screening indications in primary and tertiary care is needed for earlier diagnosis and improved outcomes.