Primary aldosteronism(PA) is a common cause of secondary hypertension. Differentiation of unilateral from bilateral lesions is essential in the treatment options of PA. Although adrenal vein blood sample(AVS) has been recommended as a " gold standard" by the guidelines, there are limitations such as invasive and technical difficulty. Noninvasive functional imaging is an option. Compared with traditional iodine cholesterol imaging, 11C-MTO, 123I-IMTO, and 68Ga-pentixafor have higher specificity and more advantages in shortening the acquisition time, reducing radiation exposure to patients and improving image resolution. However, these new functional imaging agents still have limitations in identifying the sensitivity of adenomas less than 1 cm, which need further study. This article reviews the research progress of radionuclide functional imaging in PA diagnosis.