[The updated key points of the 2025 international clinical practice guidelines for primary aldosteronism].

Abstract

On July 15, 2025, the updated 2025 Clinical Practice Guideline for the Management of Primary Aldosteronism (PA) was released on the American Society of Endocrinology Annual Meeting. This guideline was spearheaded by the Endocrine Society and co-endorsed by 6 international academic organizations. Compared with the 2016 version, the new guideline has made significant updates in screening, diagnosis, classification and treatment. The new guideline recommends expanding the screening scope, conducting aldosterone-renin ratio screening for all patients with hypertension, without the need for strict drug elimination; it simplifies the diagnostic process, reducing the four diagnostic tests to three aldosterone suppression tests; it adopts a probability stratification strategy, allowing high-probability patients to skip the aldosterone suppression test and directly proceed to the classification assessment; at the same time, it optimizes the classification method, further clarifying the exemption conditions for adrenal venous sampling. In terms of treatment, unilateral lesions are recommended for surgery, while for bilateral or those with surgical contraindications, lifelong use of mineralocorticoid receptor antagonists is suggested, and the recovery of renin levels is used as a monitoring indicator of the efficacy. The new guideline focuses on "population-wide screening-precise classification-individualized intervention", aiming to reduce the risk of PA-related complications through early identification and targeted intervention. This article provides an interpretation of the core recommendations outlined in the 2025 guideline, presents a point-by-point comparison highlighting differences from the 2016 edition, and aims to deliver rapid and accurate, evidence-based information.