Depending on the etiology, surgery or pharmacological treatment should be chosen. Surgical treatment: 1. Recommended surgical indications: (1) aldosterone tumor (APA); (2) unilateral adrenal hyperplasia (UNAH); (3) aldosterone-secreting adrenocortical carcinoma or ectopic tumor; (4) IHA patients who cannot tolerate long-term drug therapy due to drug side effects. 2. Surgical methods: (1) APA recommends laparoscopic adrenal tumor resection as the first choice, preserving adrenal tissue as much as possible. The efficacy of laparoscopy is the same as that of open surgery. If multiple APA is suspected, total adrenalectomy on the affected side is recommended. (2) UNAH recommends total laparoscopic adrenalectomy on the dominant aldosterone-producing side. (3) IHA, GRA: medication-based treatment, bilateral total adrenalectomy is still difficult to control hypertension and hypokalemia, and surgery is not recommended. However, surgery can be considered when the patient is unable to adhere to medical treatment due to the side effects of medication, and the adrenal gland on the side with more aldosterone secretion or larger size can be removed. The cure rate of hypertension after unilateral or bilateral adrenalectomy is only 19%. 3. Perioperative management: (1) Preoperative preparation: Pay attention to the evaluation of the heart, kidney, brain and vascular system. Correct hypertension and hypokalemia. For normal renal function, preoperative preparation with spironolactone is recommended at a dose of 100-400 mg, 2-4 times daily. If hypokalemia is severe, oral or intravenous potassium supplementation should be administered. The preparation is usually done for 1 to 2 weeks, during which time the patient’s blood pressure and potassium are monitored. In renal insufficiency, spironolactone is reduced at discretion to prevent hyperkalemia. For those with unsatisfactory blood pressure control, add other antihypertensive drugs. (2) Postoperative treatment: Stop potassium, spironolactone and antihypertensive drugs on the first day after surgery, and adjust the drugs according to the facts if blood pressure fluctuates. Intravenous rehydration fluids should be appropriate saline without potassium chloride (unless blood potassium <3 mmol/L). A sodium-rich diet is recommended for the first few weeks after surgery to avoid hyperkalemia due to prolonged contralateral adrenal suppression and inadequate aldosterone production. Rare cases may require glucocorticoid supplementation. Drug therapy: mainly salt corticosteroid receptor antagonists, calcium channel blockers, angiotensin converting enzyme inhibitors (ACEI), etc. also have some efficacy. Aldosterone synthesis inhibitors are in the research stage, but may be the future direction. 1.Treatment indications: (1) IHA; (2) GRA; (3) APA patients who cannot tolerate surgery or do not want surgery. 2, drug selection (specific medication please combine with clinical, by the doctor's interview guidance shall prevail): (1) spironolactone (Anserine): recommended first choice. Binding salt corticosteroid receptors, antagonizing aldosterone. Initial dose 20-40 mg/day, gradually increasing to a maximum of <400 mg/day, 2-4 times/day, to maintain blood potassium within the upper limit of normal values. It can make blood pressure <140/90mmHg in 48% of patients, 50% of which can be controlled by single drug. If blood pressure is not well controlled, other antihypertensive drugs such as thiazides are used in combination. The main side effects are mostly related to its binding to progesterone receptors and androgen receptors, painful male breast development, impotence, loss of libido, female menstrual irregularities, etc. The incidence is dose-dependent, <50 mg, 6.9%; >150 mg, 52%. (2) Eplerenone: recommended for those who cannot tolerate spironolactone. Highly selective aldosterone receptor antagonist. Affinity for androgen receptors and luteinizing hormone receptors is 0.1% and 1% of that of spironolactone, respectively, with a significantly lower incidence of sex-related side effects [70]. However, the antagonistic activity is only about 60% of that of spironolactone. 50-200 mg/d in 2 doses with an initial dose of 25 mg/d. (3) Sodium channel antagonists: amiloride. Potassium-preserving and sodium-excluding diuretic, initial dose of 10-40 mg/d, divided into oral doses, can better control blood pressure and blood potassium. No side effects of spironolactone. (4) Calcium channel blockers: inhibit aldosterone secretion and vascular smooth muscle contraction. Such as nifedipine, amlodipine, nicardipine, etc. (5) ACEI and angiotensin receptor blockers: reduce the production of IHA aldosterone. Captopril, enalapril, etc. are commonly used. (6) Glucocorticoids: recommended for GRA. initial dose, dexamethasone 0.125-0.25mg/d, or prednisone 2.5-5mg/d, taken at bedtime, the minimum dose to maintain normal blood pressure, blood potassium and ACTH levels is preferred, usually less than the physiological replacement dose. Add eplerenone if blood pressure control is unsatisfactory, especially in children. 3. Precautions: Blood pressure, potassium, and renal function should be monitored for drug therapy. Spironolactone and eplerenone should be used with caution in patients with impaired renal function (GFR <60mL/min・1.73m²) and contraindicated in patients with renal insufficiency to avoid hyperkalemia.