Primary aldosteronism (PA) is one of main causes of secondary hypertension. Accurate subtype diagnosis is crucial for treatment decisions. Traditionally, adrenal venous sampling (AVS) is considered the “gold standard” for subtyping PA. It is used to distinguish unilateral and bilateral aldosterone excess. However, due to the invasiveness, operational complexity and high technical requirements of AVS, there are certain difficulties in its clinical promotion. In recent years, non-invasive methods for subtyping PA have garnered increasing attention. These new approaches include the expanded application of 11 C-MTO PET / CT and 68 Ga-pentixafor PET / CT, the development of subtype prediction models, the new application of functional tests, the adrenocorticotropic hormone (ACTH) stimulation test, steroid hormone profiling, and genetic diagnosis. These prevised help for accurate classification of PA.