Effects of Glucocorticoid Therapy on Renal Function in Patients With PA Complicated by CKD After Adrenalectomy: A Multicenter RCT

Inclusion criteria

• Signed and dated informed consent form.
• Age 18-75 years, any gender.
• Confirmed diagnosis of primary aldosteronism (PA): positive PA screening test plus positive saline infusion test or captopril challenge test.
• Imaging findings indicating unilateral adrenal lesion, with adrenal vein sampling (AVS) confirming unilateral dominant secretion consistent with the lesion side, and planned unilateral adrenalectomy.
• Baseline eGFR 30-60 mL/min/1.73 m² OR positive proteinuria.

Exclusion criteria

• Use of hydrocortisone within 3 months prior to AVS.
• eGFR < 30 mL/min/1.73 m², or documented acute kidney injury (AKI) within the past 3 months.
• Overt cortisol-secreting tumor (clinical Cushing's syndrome) or requirement for long-term hormone replacement therapy.
• Severe proteinuria (24-hour urinary protein ≥ 3.5 g or ACR ≥ 300 mg/g).
• NYHA class III-IV heart failure, or acute coronary syndrome or stroke within the past 3 months.
• Severe allergy to hydrocortisone or history of serious adverse reactions to hydrocortisone.
• Pregnancy, lactation, or planned pregnancy in the near future.
• Active malignancy or life expectancy < 1 year.
• Inability to tolerate surgery.
• Inability to comply with follow-up as judged by the investigator, or any other condition deemed unsuitable for study participation.