1.Can primary aldehyde be treated surgically? What preparations should be made before surgery? A: (1) For adrenal aldosterone tumor, unilateral adrenal hyperplasia, aldosterone-secreting adrenocortical carcinoma or ectopic tumor and idiopathic aldosteronism that cannot tolerate long-term medication due to drug side effects should be treated surgically. (1) Laparoscopic adrenal tumor resection is recommended as the first choice for adrenal aldosterone tumors, preserving as much adrenal tissue as possible. The efficacy of laparoscopic and open surgery is consistent. If multiple adrenal aldosteronomas are suspected, total adrenalectomy is recommended for the affected side. (2) Unilateral adrenal hyperplasia is recommended for total laparoscopic adrenalectomy on the dominant aldosterone-producing side. (3) Although idiopathic aldosteronism and glucocorticoid-suppressible aldosteronism are mainly treated with medication, surgery can be considered when patients cannot adhere to medical treatment due to medication side effects, 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%. (2) Perioperative management 1) Preoperative preparation: Pay attention to the evaluation of the heart, kidney, brain and vascular system. Correct hypertension and hypokalemia. For those with 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 changes 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 salts, spironolactone and antihypertensive drugs on the first day after surgery, and adjust the drugs according to the facts if the blood pressure fluctuates. Intravenous rehydration should be done with appropriate amount of saline without potassium chloride (unless the blood potassium is <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. Rarely, glucocorticoid supplementation may be required. Postoperative blood potassium tends to recover within 1 week. Blood pressure can be normalized in most patients. 2. What should I do if my blood pressure does not drop even after surgical removal of the adrenal mass causing the original aldehyde? A: Most patients' blood pressure can return to normal; if blood pressure is still mildly elevated, it can be controlled by adding Antiseptic and other antihypertensive drugs; if blood pressure does not improve satisfactorily, it may be related to long-term hypertension causing renal damage and arteriosclerosis. One week before and after surgery, hydrocortisone 100-200mg/day can be added and gradually stopped after one week. 3.How should I follow up after primary aldehyde surgery? A: The purpose of follow-up after primary aldehyde surgery is to understand the effect of treatment, determine whether the treatment plan is reasonable; to detect possible multiple aldosteronism and to understand the side effects of drug treatment. The follow-up visit includes clinical symptoms, blood pressure, routine blood biochemical examination, endocrinological examination (blood and urine aldosterone, plasma renin activity level), abdominal CT examination, etc. The first follow-up visit is 4-6 weeks after surgery, mainly to assess blood pressure, blood electrolytes and the presence of surgical complications; after the normal function of the contralateral adrenal gland is restored in 3 months after surgery, biochemical methods such as fludrocortisone inhibition test can be performed to understand whether primary adrenocortical hyperplasia is cured according to the situation; after that, follow-up visits should be made every 6 months for more than 2 years, and long-term follow-up visits should be made for drug treatment.