Etiology Adrenal adenoma, unilateral or bilateral adrenal hyperplasia, and, less commonly, adenocarcinoma and glucocorticoid-regulated aldosteronism (GRA) are causes. In recent years, it has been reported that proaldosteronism may account for 5% to 15% of hypertension and nearly 2O% of refractory hypertension, with only some patients having hypokalemia. Diagnosis Screen for proaldosteronism in patients with early-onset hypertension, refractory hypertension with persistent or diuretic-induced hypokalemia (blood potassium <3.5 mmoI/L ), unexpected adrenal tumors, or a family history of proaldosteronism. Plasma aldosterone to renin activity was measured and the ratio calculated for initial screening. Confirmatory tests include oral salt loading test, saline infusion test, and captopril test. Drugs that have an effect on the assay should be discontinued before the test, and high sodium loading test is contraindicated in patients with hypokalemia, cardiac insufficiency, and severe hypertension. CT thin-layer (2-3 mm) scan of the adrenal glands for classification and localization of proaldosteronism subtypes, identification of adenoma and hyperplasia, except adrenocortical carcinoma. In case of surgical treatment, aldosterone levels can be measured by selective adrenal venous blood sampling. In patients with proaldosteronism, such as <2O years old, with a family history of proaldosteronism or stroke at a young age, genetic testing is recommended to confirm the diagnosis or exclude GRA. Treatment In patients with confirmed unilateral aldosterone-secreting tumors or unilateral adrenal hyperplasia, salt corticosteroid receptor antagonists are administered and laparoscopic unilateral adrenalectomy is performed after blood pressure and potassium are normalized. If surgery is not possible, long-term treatment with salt corticosteroid receptor antagonists is recommended. In the case of bilateral adrenal hyperplasia, treatment with salt corticosteroid receptor antagonists is recommended, with spironolactone (Amphotericin) as the first-line drug and eplerenone as the drug of choice. Small doses of adrenal glucocorticoids are used to treat patients with GRA. CCB, ACEI and ARB can lower blood pressure, but there is no significant antagonism of aldosterone.