原發性高醛固酮症(primary aldosteronism)是目前最常見的次發性高血壓(secondaryhypertension)。近年來對原發性高醛固酮症已有更進一步的了解，我們可以用篩選檢驗(screening test)：血清醛固酮濃度(plasma aldosterone concentration)與血清張力素活性(plasma renin activity)之比值(ARR)(aldosterone to renin ratio)大於30 ng/dl per ng/ml/hour及確認檢驗(confirmatory tests)：1.口服鈉鹽負載試驗(oral sodium loading test), 2.靜脈生理食鹽水輸注試驗(intravenous saline infusion test), 3.Fludrocortisone抑制試驗(Fludrocortisone suppressiontest), 4.Captopril test；診斷之。並可進一步對原發性高醛固酮症之兩種主要的亞型(subtypes)：醛固酮分泌腺瘤(aldosterone-producing adenoma)(APA)及雙側腎上腺增生(bilateral adrenal hyperplasia)(BAH)以高解析度電腦斷層攝影(high resolution computed tomography)(HRCT)甚或腎上腺靜脈取樣篩檢(adrenal vein sampling)加以鑑別診斷。醛固酮分泌腺瘤是一種可以腎上腺切除術(adrenalectomy)治癒之疾病，而雙側腎上腺增生則以內科治療。希望藉由本文對原發性高醛固酮症之診斷與治療的認識，使臨床醫師在高血壓的診療上可以注意並發掘可能潛在的原發性高醛固酮症，並進一步以外科手術或內科方式積極的加以治療。

Primary aldosteronism is the most common form of secondary hypertension. We got more information about this disease in recent years. We could use aldosterone to renin ratio (ARR) above 30 ng/dL per ng/ml/hour asscreening test and confirmatory tests (oral sodium loading test, intravenous saline infusion test, fludrocortisone suppression test or captopril test) in diagnosis, and we could also differentially diagnose the two major subtypes of primary aldosteronism, aldosterone-producing adenoma (APA) and bilateral adrenal hyperplasia (BAH) by high resolution computed tomography (HRCT) and even adrenal vein sampling. APA could be cured by adrenalectomy, but BAH was treated medically. In hypertensive management, by reviewing of the diagnosis and treatment of primary aldosteronism in this literature, clinicians should pay much more attention to and find possible occult primary aldosteronism and thus aggressive surgical intervention or medical treatment is indicated.