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. 报道2018年5月至2024年12月在解放军总医院第一医学中心内分泌科就诊的3例经长期盐皮质激素受体拮抗剂（MRA）治疗后成功停药并获得自发缓解的原发性醛固酮增多症（PA）病例（男1例，女2例，年龄42~60岁，高血压病程6~27年）。3例患者均符合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）》PA诊断标准。经MRA治疗3~5年后逐步减量并停药，随访12个月，3例患者血钾均恢复正常（4.1~4.6 mmol/L），2例完全停用降压药、1例仅单一降压药物维持，血压控制在100~127/56~80 mmHg（1 mmHg=0.133 kPa），醛固酮/肾素比值（ARR）均<3.7。文献复习显示PA患者停药后ARR正常化比例为5%~80%，提示PA自发缓解并非罕见。临床应对药物治疗的PA患者每1~2年进行再评估，对符合条件者可尝试在严密监测下减量或停药，避免终身不必要的药物治疗。.
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