[Spontaneous remission of primary aldosteronism: a case series of three patients and literature review].

This article reports three cases of primary aldosteronism (PA) with spontaneous remission following withdrawal of long-term mineralocorticoid receptor antagonist (MRA) therapy at Department of Endocrinology, the First Medical Center of Chinese PLA General Hospital between May 2018 and December 2024. The cohort included 1 male and 2 females, aged 42 to 60 years, with a hypertension duration of 6-27 years. All patients met the diagnostic criteria for PA outlined in the Expert Consensus on the Diagnosis and Treatment of Primary Aldosteronism (2024 edition) from the Chinese Society of Endocrinology. After 3-5 years of MRA treatment followed by gradual dose reduction until complete discontinuation, all three patients maintained normokalemia (4.1-4.6 mmol/L) during 12 months of follow-up. Two patients discontinued all antihypertensive medications, while one remained on monotherapy, with blood pressure maintained at 100-127/56-80 mmHg (1 mmHg=0.133 kPa). The aldosterone-to-renin ratio (ARR) normalized (<3.7) in all cases. A literature review suggested that ARR normalization occurs in 5%~80% of patients with PA following MRA withdrawal, indicating that spontaneous remission of PA is not uncommon. Regular re-evaluation every 1-2 years is recommended for PA patients receiving medical therapy. In eligible cases, dose reduction or discontinuation may be considered under close monitoring to avoid lifelong medication.