Recent studies have found that about 10% of young and middle-aged patients with hypertension are caused by primary aldosteronism, and some of the hypertension caused by primary aldosteronism can be cured by surgical removal of the adrenal glands. Therefore, screening for primary aldosteronism in common hypertension, especially in hypertension that is not well controlled by medication, is clinically significant, and lifelong medication can be avoided in some patients with hypertension. Today we will look at this different secondary hypertension – primary aldosteronism. 1, what is primary aldosteronism refers to excessive secretion of aldosterone by the adrenal cortex, resulting in sodium retention, potassium excretion, increased blood volume, and suppressed activity of the renin-angiotensin system. The main clinical manifestation is hypertension with hypokalemia. There are five main types of proaldosteronism, namely aldosteronism, idiopathic aldosteronism (idiopathic aldosteronism), primary adrenocortical hyperplasia, familial aldosteronism, aldosterone-secreting adrenocortical carcinoma, and ectopic aldosterone-secreting tumor or carcinoma. Studies have found that excess aldosterone is an important risk factor for cardiac hypertrophy, heart failure, and impaired renal function. Compared with patients with primary hypertension, patients with proaldosteronism have more severe damage to the heart, kidneys and other target organs of hypertension. Therefore, early diagnosis and early treatment become crucial. 2, what are the common clinical symptoms and manifestations of primary aldehyde disease (1) hypertension: for the earliest appearance of symptoms. Most patients have substantially increased blood pressure, but malignant hypertension is rare. (2) The manifestation of reduced blood potassium: some patients with significant low potassium may have muscle weakness and periodic paralysis is very common. Numbness of the extremities and twitching of the hands and feet are common. In severe hypokalemia, hand and foot twitching may be mild or not appear due to reduced neuromuscular stress, while hand and foot twitching often becomes obvious after potassium supplementation. (3) Renal manifestations: Due to the large amount of potassium loss, the renal tubular epithelial cells are vacuolated and deformed, and the concentration function is reduced, accompanied by polyuria, especially nocturnal urination, followed by thirst and excessive drinking, and often complicated by urinary tract infection. Increased urine protein, a few can occur hyperalgesia. (1) Plasma aldosterone to renin activity ratio: It is the preferred screening index for proaldosteronism. This test can be performed in the endocrinology clinic. It should be performed 2 hours after waking up in the morning, preferably between 8:00 and 10:00. Before the test, attention should be paid to potassium supplementation to bring the blood potassium to the normal range, because low blood potassium inhibits the secretion of aldosterone. Suspension of influential drugs before the trial: the following drugs are suspended for 4 weeks: spironolactone, eplerenone, amiloride, aminopterin, hydrochlorothiazide, furosemide; the following drugs are suspended for 2 weeks: priligy antihypertensive drugs, satanic antihypertensive drugs. The original antihypertensive drugs can be replaced with drugs that have little effect on test measurements such as prazosin, terazosin, and verapamil extended-release tablets. (2) Imaging examination Adrenal ultrasound: It can help to distinguish adrenal adenoma from hyperplasia and determine the location and imaging characteristics of adenoma: it can show adenoma >1.3cm in diameter. Adrenal CT and magnetic resonance imaging (MRI): High-resolution CT and MRI can show adenomas >0.5 cm in diameter, (3) Bilateral adrenal vein blood sampling: In recent years, bilateral adrenal vein blood sampling has been widely used at home and abroad to determine the source of high aldosterone in the body. The sensitivity of this test is 95% and the specificity is 100%. Adrenal vein blood sampling is an invasive test and should be performed by an experienced physician. 4.How to treat Treatment principles:The treatment plan depends on the etiology of proaldosteronism and the patient’s response to drugs. There are two methods of treatment for proaldosteronism, surgery and drugs. (1) Surgical treatment: laparoscopic unilateral adrenalectomy is recommended for patients with confirmed aldosteronism or unilateral adrenal hyperplasia. Since aldosterone-secreting adrenocortical carcinoma develops rapidly and metastasizes early, the primary tumor should be removed as soon as possible. If there is local metastasis, the primary lesion and metastasis should be removed as much as possible, and postoperative treatment with mitotane should be added. (2) Drug therapy: The first choice of drug therapy is recommended for Tetralogy of Fallot. Spironolactone is recommended as the first-line drug, and eplerenone as the second-line drug. For patients on drug therapy, regular review of renal function and electrolytes, and blood pressure testing are required, and drug doses are adjusted according to blood potassium and blood pressure indicators. If you are younger than 50 years old and find elevated blood pressure with paroxysmal weakness, tingling in the hands and feet, or high blood pressure taking 3 drugs still cannot effectively control blood pressure, or have a first-line relative with primary aldosteronism, then you must be further examined to rule out the possibility of primary aldosteronism.