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Long-term follow-up studies on primary aldosteronism (PA) are lacking. We aim to review results of diagnostic procedures and histopathology for patients diagnosed during 2012–2016 in Iceland, compare unilateral (UD) and bilateral disease (BD) and assess treatment response. Thirty-two patients aged 28–88 were diagnosed and treated according to guidelines. The majority had BD. Everyone needed potassium supplementation at case detection. We saw a reduction in systolic blood pressure (p <.001, both groups), antihypertensive agents (p =.002 UD and p =.04 BD) and potassium supplementation (p <.001, both groups). Similar treatment response was seen in both subgroups. Ratio of hypokalemia and number of cases indicates severe PA underdiagnosis in Iceland. [ABSTRACT FROM AUTHOR]