Randomised Trial Comparing Thermal Ablation With Adrenalectomy in the Treatment of Unilateral Asymmetric PA

Inclusion criteria (all of): * Age \> 18 years * Primary aldosteronism diagnosed according to international guidelines * Unilateral disease by AVS or PET-CT criteria * Ipsilateral radiological abnormality with benign imaging characteristics and technically amenable to both thermal ablation and surgery * Able and willing to give informed consent * Randomisation approved by MDT Exclusion criteria (any of): * Absolute contraindication to α- or β-adrenoceptor antagonist therapy or CT contrast * Contraindication or unwillingness for either surgery or thermal ablation * Inability to withdraw β-adrenoceptor antagonist therapy for 2 weeks * Unwilling to undergo either LA or thermal ablation * Unwilling to comply with study visit schedule * Pregnancy or unwillingness to undertake secure contraception for the study duration (female participants only) * Life-limiting comorbidity (at the discretion of the PI) * Clinical and/or biochemical evidence of autonomous cortisol secretion sufficient, in the opinion of the patient's physician, to mandate a unilateral adrenalectomy independent of autonomous aldosterone secretion