原发性醛固酮增多症基本与精准相结合诊疗50问

Fifty questions on the combination of basic and precision diagnosis and treatment of primary aldosteronism

摘要

原发性醛固酮增多症的基本诊疗可确保患者及时接受筛查与规范化治疗，使临床及生化指标恢复正常，并有效保护心、脑、肾等重要靶器官。精准诊疗则能实现准确的病灶定位与病因分型，并提供科学可靠的特异性治疗，从而降低复发率。本文提出了基本与精准相结合的诊疗策略与措施，对各级医疗机构在高血压患者中连续、系统地开展原发性醛固酮增多症诊疗具有指导意义。

Abstract

Basic diagnosis and treatment of primary aldosteronism ensures timely screening and standardized intervention for every patient, normalizes clinical and biochemical indicators, and protects vital target organs such as the heart, brain, and kidneys. Precision diagnosis and treatment enables accurate lesion localization and etiological classification, delivers evidence-based targeted therapy, and reduces the recurrence rate. This study proposes strategies and measures integrating basic and precision diagnosis and treatment, providing an important reference for medical institutions at all levels to carry out continuous and systematic management of primary aldosteronism in hypertensive populations.

关键词

原发性醛固酮增多症 / 继发性高血压 / 高血压 / 筛查 / 基本诊疗 / 精准诊疗 / 特异性治疗

Key words

primary aldosteronism / secondary hypertension / hypertension / screening / basic diagnosis and treatment / precise diagnosis and treatment / targeted therapy

参考文献

[1] Loh KC, Koay ES, Khaw MC, et al. Prevalence of primary aldosteronism among Asian hypertensive patients in Singapore[J]. J Clin Endocrinol Metab, 2000, 85(8): 2854-2859.

[2] Mosso L, Carvajal C, Gonzalez A, et al. Primary aldosteronism and hypertensive disease[J]. Hypertension, 2003, 42(2): 161-165.

[3] Xu Z, Yang J, Hu J, et al. Primary aldosteronism in patients in China with recently detected hypertension[J]. J Am Coll Cardiol, 2020, 75(16): 1913-1922.

[4] Calhoun DA . Is there an unrecognized epidemic of primary aldosteronism? Pro[J]. Hypertension, 2007, 50(3): 447-453.

[5] Sang X, Jiang Y, Wang W, et al. Prevalence of and risk factors for primary aldosteronism among patients with resistant hypertension in China[J]. J Hypertens, 2013, 31(7): 1465-1471, 1471-1472; discussion 1471-1472.

[6] Monticone S, D'Ascenzo F, Moretti C, et al. Cardiovascular events and target organ damage in primary aldosteronism compared with essential hypertension: a systematic review and meta-analysis[J]. Lancet Diabetes Endocrinol, 2018, 6(1): 41-50.

[7] Wu X, Yu J, Tian H . Cardiovascular risk in primary aldosteronism: a systematic review and meta-analysis[J]. Medicine (Baltimore), 2019, 98(26): e15985.

[8] Ohno Y, Sone M, Inagaki N, et al. Prevalence of cardiovascular disease and its risk factors in primary aldosteronism: a multicenter study in Japan[J]. Hypertension, 2018, 71(3): 530-537.

[9] Prejbisz A, Warchol-Celinska E, Lenders JM, et al. Cardiovascular risk in primary hyperaldosteronism[J]. Horm Metab Res, 2015, 47(13): 973-980.

[10] Ha J, Park JH, Kim KJ, et al. 2023 Korean Endocrine Society Consensus Guidelines for the diagnosis and management of primary aldosteronism[J]. Endocrinol Metab (Seoul), 2023, 38(6): 597-618.

[11] Patil S, Rojulpote C, Amanullah A . Primary aldosteronism and ischemic heart disease[J]. Front Cardiovasc Med, 2022, 9: 882330.

[12] Hajji M, Rais L, Kheder R, et al. Primary aldosteronism diagnosed in a patient with severe renal disease[J]. Tunis Med, 2018, 96(7): 454-457.

[13] Araujo-Castro M, Parra-Ramirez P . Diagnosis of primary hyperaldosteronism[J]. Med Clin (Barc), 2022, 158(9): 424-430.

[14] Mulatero P, Monticone S, Bertello C, et al. Long-term cardio- and cerebrovascular events in patients with primary aldosteronism[J]. J Clin Endocrinol Metab, 2013, 98(12): 4826-4833.

[15] Hanslik G, Wallaschofski H, Dietz A, et al. Increased prevalence of diabetes mellitus and the metabolic syndrome in patients with primary aldosteronism of the German Conn's Registry[J]. Eur J Endocrinol, 2015, 173(5): 665-675.

[16] Murase K, Nagaishi R, Takenoshita H, et al. Prevalence and clinical characteristics of primary aldosteronism in Japanese patients with type 2 diabetes mellitus and hypertension[J]. Endocr J, 2013, 60(8): 967-976.

[17] Manosroi W, Atthakomol P, Wattanawitawas P, et al. Differences in glycemic abnormalities between primary aldosteronism and essential hypertension: a systematic review and meta-analysis[J]. Front Endocrinol (Lausanne), 2022, 13: 870047.

[18] Adler GK, Stowasser M, Correa RR, et al. Primary aldosteronism: an endocrine society clinical practice guideline[J]. J Clin Endocrinol Metab, 2025, 110(9): 2453-2495.

[19] 余振球, 缪思斯 . 读美国2025《原发性醛固酮增多症: 内分泌学会临床实践指南》, 谈我国原发性醛固酮增多症的筛查和诊疗[J/OL]. 中华高血压杂志. 2026-02-25, https://kns.cnki.net/kcms2/article/abstract?v=tVGN6Um245pyq-jjKszFI2ZL_ydc3P2gugohzn8HcCgkcOOc-ex2x1Ky1wf06YToBkf6A_pcUuCM7u4q9XSnv_YsY6Yda_bcfIh7lJhxs9U_xi_6Ix-uNSnTMcWVHXtnQRxj7OCSXnY3H6Kq0PAV4EoNRzskmKbvvca7tv7VGco1IHgetusSEw==&uniplatform=NZKPT&language=CHS

[20] Benoit J, Gaudissard J, Doublet J, et al. Adrenal Bordeaux registry: Bordeaux single-center study of hypertensive patients with primary hyperaldosteronism[J]. J Hypertens, 2022, 40(5): 908-915.

[21] Lin Y, Wang S, Wu V, et al. The association of serum potassium level with left ventricular mass in patients with primary aldosteronism[J]. Eur J Clin Invest, 2011, 41(7): 743-750.

[22] 中华医学会内分泌学分会 . 原发性醛固酮增多症诊断治疗的专家共识(2024版)[J]. 中华内分泌代谢杂志, 2025, 41(1): 12-24.

[23] Song Y, Yang S, He W, et al. Confirmatory tests for the diagnosis of primary aldosteronism: a prospective diagnostic accuracy study[J]. Hypertension, 2018, 71(1): 118-124.

[24] 陈适, 曾正陪, 宋爱羚, 等 . 卡托普利试验在原发性醛固酮增多症诊断中的应用[J]. 中华内科杂志, 2017, 56(6): 402-408.

[25] Li B, Liu Z, Qin N, et al. An automated magnetic-bead-assisted liquid chromatography-tandem mass spectrometry method for analyzing angiotensins, ALD, and 18-OH derivatives: application of primary aldosteronism early screening and subtyping[J]. Talanta, 2025, 295: 128268.

[26] Umakoshi H, Ogasawara T, Takeda Y, et al. Accuracy of adrenal computed tomography in predicting the unilateral subtype in young patients with hypokalaemia and elevation of aldosterone in primary aldosteronism[J]. Clin Endocrinol (Oxf), 2018, 88(5): 645-651.

[27] Chen F, Cheng Z, Wang Z, et al. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) based assay for the simultaneous quantification of 18-hydroxycorticosterone, 18-hydroxycortisol and 18-oxocortisol in human plasma[J]. J Chromatogr B Analyt Technol Biomed Life Sci, 2022, 1188: 123030.

[28] 赵志敏, 黄涛 . 肾上腺性高血压影像学研究进展[J]. 实用放射学杂志, 2022, 38(1): 156-159.

[29] 余振球, 李治菁 . 原发性醛固酮增多症诊断规范[J]. 中国乡村医药, 2024, 31(17): 1-6.

[30] Wang H, Wang F, Zhang Y, et al. Surgical outcomes of aldosterone-producing adenoma on the basis of the histopathological findings[J]. Front Endocrinol (Lausanne), 2021, 12: 663096.

[31] Song Y, Yang J, Shen H, et al. Development and validation of model for sparing adrenal venous sampling in diagnosing unilateral primary aldosteronism[J]. J Hypertens, 2022, 40(9): 1692-1701.

[32] Benameur S, Bertolino J, Bonnaud L, et al. Primary aldosteronism and long-term cardiovascular complications: comparison of medical versus surgical treatment[J]. J Clin Hypertens (Greenwich), 2025, 27(8): e70128.

[33] 中国医疗保健国际交流促进会泌尿健康促进分会, 中国研究型医院学会泌尿外科学专业委员会 . 腹腔镜肾上腺切除术安全共识[J]. 现代泌尿外科杂志, 2022, 27(2): 97-103.

[34] Hu J, Zhou Q, Sun Y, et al. Efficacy and safety of finerenone in patients with primary aldosteronism: a pilot randomized controlled trial[J]. Circulation, 2025, 151(2): 196-198.

[35] Kolkhof P, Barfacker L . 30 years of the mineralocorticoid receptor: mineralocorticoid receptor antagonists: 60 years of research and development[J]. J Endocrinol, 2017, 234(1): T125-T140.

[36] Ryan MJ, Tuttle KR . Elevations in serum creatinine with RAAS blockade: why isn't it a sign of kidney injury?[J]. Curr Opin Nephrol Hypertens, 2008, 17(5): 443-449.

[37] 李兰, 姜笑, 卢飞, 等 . 特发性醛固酮增多症的治疗现状及展望[J]. 中华高血压杂志(中英文), 2025, 33(1): 22-27.

[38] Salvador M, Chamontin B, Rostaing L, et al. Influence of angiotensin on the secretion of aldosterone in idiopathic hyperaldosteronism[J]. Arch Mal Coeur Vaiss, 1987, 80(6): 992-994.

[39] Motomura N, Yamazaki Y, Gao X, et al. Visualization of calcium channel blockers in human adrenal tissues and their possible effects on steroidogenesis in the patients with primary aldosteronism (PA)[J]. J Steroid Biochem Mol Biol, 2022, 218: 106062.

[40] Felizola SJA, Maekawa T, Nakamura Y, et al. Voltage-gated calcium channels in the human adrenal and primary aldosteronism[J]. J Steroid Biochem Mol Biol, 2014, 144 Pt B: 410-416.

[41] Williams TA, Lenders JWM, Mulatero P, et al. Outcomes after adrenalectomy for unilateral primary aldosteronism: an international consensus on outcome measures and analysis of remission rates in an international cohort[J]. Lancet Diabetes Endocrinol, 2017, 5(9): 689-699.

[42] Karagiannis A, Tziomalos K, Kakafika AI, et al. Medical treatment as an alternative to adrenalectomy in patients with aldosterone-producing adenomas[J]. Endocr Relat Cancer, 2008, 15(3): 693-700.

[43] 朱理敏, 龚艳春, 林伯贤, 等 . 原发性醛固酮增多症患者药物治疗随访分析[J]. 中华高血压杂志, 2013, 21(6): 531-535.

[44] Hundemer GL, Curhan GC, Yozamp N, et al. Cardiometabolic outcomes and mortality in medically treated primary aldosteronism: a retrospective cohort study[J]. Lancet Diabetes Endocrinol, 2018, 6(1): 51-59.

[45] Catena C, Colussi G, Lapenna R, et al. Long-term cardiac effects of adrenalectomy or mineralocorticoid antagonists in patients with primary aldosteronism[J]. Hypertension, 2007, 50(5): 911-918.

[46] Lin Y, Lin L, Chen A, et al. Adrenalectomy improves increased carotid intima-media thickness and arterial stiffness in patients with aldosterone producing adenoma[J]. Atherosclerosis, 2012, 221(1): 154-159.

[47] Hung C, Sung S, Liao C, et al. Aldosterone induces vascular damage[J]. Hypertension, 2019, 74(3): 623-629.

[48] Liao C, Lin L, Hung C, et al. Time course and factors predicting arterial stiffness reversal in patients with aldosterone-producing adenoma after adrenalectomy: prospective study of 102 patients[J]. Sci Rep, 2016, 6: 20862.

[49] Yang J, Burrello J, Goi J, et al. Outcomes after medical treatment for primary aldosteronism: an international consensus and analysis of treatment response in an international cohort[J]. Lancet Diabetes Endocrinol, 2025, 13(2): 119-133.

[50] 胡金波 . 《原发性醛固酮增多症药物治疗结局: 一项国际共识及国际队列治疗结果分析》(2025版)要点解读[J]. 临床内科杂志, 2025, 42(6): 445-447.

[51] 蒋怡然, 张翠, 姜蕾, 等 . 螺内酯单药治疗及低剂量螺内酯联合治疗特发性醛固酮增多症的有效性及安全性[J]. 中华内分泌代谢杂志, 2018, 34(6): 479-484.

[52] Ren R, Han H, Ma J, et al. Glucocorticoid replacement therapy after retroperitoneal laparoscopic unilateral adrenal adenoma resection in patients with non-cortisol secreting tumors: a retrospective cohort study[J]. Gland Surg, 2024, 13(11): 2189-2197.

[53] DeLozier OM, Dream SY, Findling JW, et al. Selective glucocorticoid replacement following unilateral adrenalectomy for hypercortisolism and primary aldosteronism[J]. J Clin Endocrinol Metab, 2022, 107(2): e538-e547.

[54] Scholl UI, Stolting G, Schewe J, et al. CLCN2 chloride channel mutations in familial hyperaldosteronism type II[J]. Nat Genet, 2018, 50(3): 349-354.

[55] Monticone S, Hattangady NG, Penton D, et al. a Novel Y152C KCNJ5 mutation responsible for familial hyperaldosteronism type III[J]. J Clin Endocrinol Metab, 2013, 98(11): E1861-E1865.

[56] Pons Fernandez N, Moreno F, Morata J, et al. Familial hyperaldosteronism type III a novel case and review of literature[J]. Rev Endocr Metab Disord, 2019, 20(1): 27-36.

[57] Nanba K, Blinder AR, Rege J, et al. Somatic CACNA1H mutation as a cause of aldosterone-producing adenoma[J]. Hypertension, 2020, 75(3): 645-649.

[58] Daniil G, Fernandes-Rosa FL, Chemin J, et al. CACNA1H mutations are associated with different forms of primary aldosteronism[J]. EBioMedicine, 2016, 13: 225-236.

[59] Funder JW, Carey RM, Mantero F, et al. The management of primary aldosteronism: case detection, diagnosis, and treatment: ane endocrine society clinical practice guideline[J]. J Clin Endocrinol Metab, 2016, 101(5): 1889-1916.

[60] 中华医学会内分泌学分会 . 原发性醛固酮增多症诊断治疗的专家共识(2020版)[J]. 中华内分泌代谢杂志, 2020, 36(9): 727-736.

[61] Jing Y, Liao K, Li R, et al. Cardiovascular events and all-cause mortality in surgically or medically treated primary aldosteronism: a meta-analysis[J]. J Renin Angiotensin Aldosterone Syst, 2021, 22(1): 1148438405.

[62] Mulatero P, Sechi LA, Williams TA, et al. Subtype diagnosis, treatment, complications and outcomes of primary aldosteronism and future direction of research: a position statement and consensus of the working group on endocrine hypertension of the European Society of Hypertension[J]. J Hypertens, 2020, 38(10): 1929-1936.

[63] Naruse M, Katabami T, Shibata H, et al. Japan Endocrine Society clinical practice guideline for the diagnosis and management of primary aldosteronism 2021[J]. Endocr J, 2022, 69(4): 327-359.

[64] Yang S, Du Z, Zhang X, et al. Corticotropin stimulation in adrenal venous sampling for patients with primary aldosteronism: the ADOPA randomized clinical trial[J]. JAMA Netw Open, 2023, 6(10): e2338209.

[65] Rossi GP, Rossitto G, Amar L, et al. Clinical outcomes of 1625 patients with primary aldosteronism subtyped with adrenal vein sampling[J]. Hypertension, 2019, 74(4): 800-808.

[66] Hu J, Xu T, Shen H, et al. Accuracy of gallium-68 pentixafor positron emission tomography-computed tomography for subtyping diagnosis of primary aldosteronism[J]. JAMA Netw Open, 2023, 6(2): e2255609.

[67] Zhang X, Song Y, Jing Y, et al. Comparison of different diagnostic criteria of⁶⁸Ga-Pentixafor PET/CT for the classification of primary aldosteronism [J]. J Clin Endocrinol Metab, 2025, 110(8): e2583-e2590.

[68] Long T, Liu G, Zhou M, et al. First-in-human evaluation of [¹⁸F]AldoView: a highly selective PET tracer for aldosterone synthase imaging in primary aldosteronism [J]. Clin Nucl Med, 2025, 50(9): 847-855.

[69] Goodchild E, Wu X, Senanayake R, et al. Molecular imaging versus adrenal vein sampling for the detection of surgically curable primary aldosteronism: a prospective within-patient trial[J]. Ann Intern Med, 2025, 178(3): 336-347.

[70] Preda C, Teodoriu LC, Placinta S, et al. Persistent severe hyperkalemia following surgical treatment of aldosterone-producing adenoma[J]. J Res Med Sci, 2020, 25: 17.

[71] Tetti M, Brüdgam D, Burrello J, et al. Unilateral primary aldosteronism: long-term disease recurrence after adrenalectomy[J]. Hypertension, 2024, 81(4): 936-945.

[72] Grundy MC, Leung AA, Pasieka JL, et al. Outcomes after unilateral adrenalectomy in asymmetrical bilateral primary aldosteronism[J]. Hypertension, 2025, 82(10): 1612-1622.

[73] 刘学洋, 张尧 . 应用PASO标准评估两种手术方式治疗单侧醛固酮瘤疗效的对比研究[J]. 重庆医学, 2021, 50(21): 3706-3712.

[74] 杨庆, 李汉忠 . 后腹腔镜下保留肾上腺手术治疗腺瘤型原发性醛固酮增多症[J]. 中华泌尿外科杂志, 2008(11): 736-739.

[75] Chen SF, Chueh SC, Wang SM, et al. Clinical outcomes in patients undergoing laparoscopic adrenalectomy for unilateral aldosterone producing adenoma: partial versus total adrenalectomy[J]. J Endourol, 2014, 28(9): 1103-1106.

[76] Artiles Medina A, Gómez Dos Santos V, Mínguez Ojeda C, et al. The role of adrenal-sparing surgery in the management of aldosterone-producing adenoma: a systematic review and meta-analysis[J]. Eur J Endocrinol, 2025, 193(3): S36-S52.

[77] Nanba K, Kaneko H, Mishina M, et al. Bilateral cortical-sparing cdrenalectomy for the treatment of bilateral aldosterone-producing adenomas[J]. JCEM Case Rep, 2023, 1(6): luad144.

[78] Zheng W, Chen S, Qiu Q, et al. Total or partial adrenalectomy for aldosterone-producing adenoma: can (68)Ga-Pentixafor PET/CT predict surgical outcomes?[J]. Eur J Nucl Med Mol Imaging, 2025, 52(10): 3632-3642.

[79] Liu Y, Jiang Y, Wang Y, et al. Ectopic adrenocortical adenoma in the renal hilum: a case report and literature review[J]. Diagn Pathol, 2016, 11: 40.

[80] 谢鼎新 . 腹腔镜下肾上腺部分切除术与全切术治疗单侧醛固酮腺瘤的对比研究[D]. 新疆医科大学, 2023.

[81] Fu B, Zhang X, Wang G, et al. Long-term results of a prospective, randomized trial comparing retroperitoneoscopic partial versus total adrenalectomy for aldosterone producing adenoma[J]. J Urol, 2011, 185(5): 1578-1582.

[82] 管智慧, 安海泉 . 后腹腔镜肾上腺部分切除术与肾上腺全切术在治疗原发性醛固酮综合征中的临床研究[J]. 临床医药文献电子杂志, 2019, 6(10): 36-37.

[83] Liu JH, Wei XD, Fu CC, et al. Long-term results of laparoscopic partial versus total adrenalectomy for aldosterone producing adenoma[J]. Urol J, 2020, 17(4): 4981.

[84] Ishidoya S, Ito A, Sakai K, et al. Laparoscopic partial versus total adrenalectomy for aldosterone producing adenoma[J]. J Urol, 2005, 174(1): 40-43.

[85] Kitamoto T, Kitamoto KK, Omura M, et al. Precise mapping of intra-adrenal aldosterone activities provides a novel surgical strategy for primary aldosteronism[J]. Hypertension, 2020, 76(3): 976-984.

[86] Billmann F, Billeter A, Thomusch O, et al. Minimally invasive partial versus total adrenalectomy for unilateral primary hyperaldosteronism-a retrospective, multicenter matched-pair analysis using the new international consensus on outcome measures[J]. Surgery, 2021, 169(6): 1361-1370.

[87] Nagai S, Yoshida Y, Miyamoto S, et al. Complete unilateral adrenalectomy is recommended to prevent residual disease in unilateral primary aldosteronism[J]. JCEM Case Rep, 2025, 3(12): luaf264.

[88] 孙曼 . 单侧肾上腺原发性醛固酮增多症手术方式选择探讨[D]. 大理大学, 2024.

[89] 张微, 杨溢, 李俊龙, 等 . 单侧原发性醛固酮增多症肾上腺病灶特点分析: 一项前瞻性研究[J]. 中华泌尿外科杂志, 2025, 46(7): 537-543.

[90] Fassnacht M, Terzolo M, Allolio B, et al. Combination chemotherapy in advanced adrenocortical carcinoma[J]. N Engl J Med, 2012, 366(23): 2189-2197.

[91] 王慧萍, 崔云英, 马晓森, 等 . 特发性醛固酮增多症的病理分型和手术预后[J]. 基础医学与临床, 2021, 41(10): 1481-1485.

[92] Szabo Yamashita T, Shariq OA, Foster TR, et al. Unilateral adrenalectomy for primary aldosteronism due to bilateral adrenal disease can result in eesolution of hypokalemia and amelioration of hypertension[J]. World J Surg, 2023, 47(2): 314-318.

[93] Williams TA, Gong S, Tsurutani Y, et al. Adrenal surgery for bilateral primary aldosteronism: an international retrospective cohort study[J]. Lancet Diabetes Endocrinol, 2022, 10(11): 769-771.

[94] Adachi M, Muroya K, Asakura Y, et al. Discordant genotype-phenotype correlation in familial hyperaldosteronism type III with KCNJ5 gene mutation: a patient report and review of the literature[J]. Horm Res Paediatr, 2014, 82(2): 138-142.

[95] Monticone S, Tetti M, Burrello J, et al. Familial hyperaldosteronism type III[J]. J Hum Hypertens, 2017, 31(12): 776-781.

[96] Ng L, Libertino JM . Adrenocortical carcinoma: diagnosis, evaluation and treatment[J]. J Urol, 2003, 169(1): 5-11.

[97] Choukair D, Beuschlein F, Zwermann O, et al. Virilization of a young girl caused by concomitant ectopic and intra-adrenal adenomas of the adrenal cortex[J]. Horm Res Paediatr, 2013, 79(5): 318-322.

[98] Nakamura H, Vo P, Kanakis I, et al. Aggrecanase-selective tissue inhibitor of metalloproteinase-3 (TIMP3) protects articular cartilage in a surgical mouse model of osteoarthritis[J]. Sci Rep, 2020, 10(1): 9288.

[99] 杨定燕, 余振球 . 妊娠期原发性醛固酮增多症病例分析[J]. 中华高血压杂志, 2022, 30(7): 680-684.

[100] Riester A, Reincke M . Progress in primary aldosteronism: mineralocorticoid receptor antagonists and management of primary aldosteronism in pregnancy[J]. Eur J Endocrinol, 2015, 172(1): R23-R30.

[101] Kamoun M, Mnif MF, Charfi N, et al. Adrenal diseases during pregnancy: pathophysiology, diagnosis and management strategies[J]. Am J Med Sci, 2014, 347(1): 64-73.

[102] Kosaka K, Onoda N, Ishikawa T, et al. Laparoscopic adrenalectomy on a patient with primary aldosteronism during pregnancy[J]. Endocr J, 2006, 53(4): 461-466.

[103] Nursal TZ, Caliskan K, Ertorer E, et al. Laparoscopic treatment of primary hyperaldosteronism in a pregnant patient[J]. Can J Surg, 2009, 52(5): E188-E190.

[104] Cabassi A, Rocco R, Berretta R, et al. Eplerenone use in primary aldosteronism during pregnancy[J]. Hypertension, 2012, 59(2): e18-e19.

[105] 鲍颖芳, 李库林, 吴小庆, 等 . 原发性醛固酮增多症24 h动态血压特点[J]. 实用临床医药杂志, 2013, 17(24): 131-133.

[106] 车金娜, 李雪丽, 曹彩霞, 等 . 老年高血压病人原发性醛固酮增多症的临床特点[J]. 青岛大学学报(医学版), 2020, 56(3): 305-308.

[107] Parra Ramirez P, Rojas-Marcos PM, Paja Fano M, et al. Differences in the presentation and evolution of primary aldosteronism in elderly (≥65 years) and young patients (＜65 years)[J]. Endocr Connect, 2022, 11(6): e220169.

[108] Mulatero P, Burrello J, Williams TA, et al. Primary aldosteronism in the elderly[J]. J Clin Endocrinol Metab, 2020, 105(7): dgaa206.

[109] Sun K, Gong M, Yu Y, et al. Comparison of saline infusion test and captopril challenge test in the diagnosis of Chinese with primary aldosteronism in different age groups[J]. Front Endocrinol (Lausanne), 2024, 15: 1343704.

[110] Parisien-La Salle S, Brown JM, Tsai CH, et al. Subclinical primary aldosteronism[J]. Arch Endocrinol Metab, 2025, 70(Spec 1): e250400.

[111] Goupil R, Desbiens LC, Merabtine A, et al. Subclinical primary aldosteronism and major adverse cardiovascular events: a longitudinal population-based cohort study[J]. Circulation, 2025, 152(13): 913-923.

[112] Omata K, Tomlins SA, Rainey WE . Aldosterone-producing cell clusters in normal and pathological states[J]. Horm Metab Res, 2017, 49(12): 951-956.

[113] Kmiec P, Zalewska E, Kunicka K, et al. Autonomous aldosterone secretion in patients with adrenal incidentaloma[J]. Biomedicines, 2022, 10(12): 3075.

[114] Flack JM, Azizi M, Brown JM, et al. Efficacy and safety of baxdrostat in uncontrolled and resistant hypertension[J]. N Engl J Med, 2025, 393(14): 1363-1374.