Although GRA is said to be one of the least common of the mineralocorticoid-excess states, it is probably underdiagnosed. Moreover, recent advances in our understanding of its pathogenesis has greatly broadened the understanding of this disorder. The development of direct genetic testing for GRA has simplified the diagnostic approach to GRA and will likely increase the detection of many previously undiagnosed cases. Since appropriate treatment can often result in normalization of this refractory form of hypertension, a high index of suspicion should be maintained for this diagnosis when a patient is diagnosed with mineralocorticoid-induced hypertension. It is only through early detection and institution of directed treatment that the morbidity and mortality associated with GRA can be reduced.