Objective: To investigate the correlation of baseline serum adiponectin and leptin levels with target organ damage and postoperative clinical outcomes of patients with primary aldosteronism (PA). Methods: 68 PA patients who underwent unilateral adrenalectomy and had follow-up information for at least 6 months after surgery were included. Serum adiponectin and leptin concentrations were detected at baseline. Postoperative clinical outcomes were evaluated according to primary aldosteronism surgical outcome (PASO) criteria. The correlation of serum adiponectin and leptin levels with target organ damage and postsurgical clinical outcome was analyzed. Results: 28 patients (41.2%) with PA were clinically cured after surgery, and 40 patients (58.8%) were not clinically cured. The levels of baseline adiponectin and estimated glomerular filtration rate (eGFR) in the clinically cured group were higher than those in the clinically uncured group (all P<0.05), while body mass index (BMI), the daily defined dose value of hypertension medications, the proportion of hyperlipidemia and diabetes were lower (all P<0.05). No difference in leptin levels was detected between the two groups. Leptin levels were negatively correlated with the E/A ratio and ankle-brachial pressure index (all P<0.05). Adiponectin levels were not correlated with target organ damage indicators. Multivariate stepwise logistic regression analysis showed that lower BMI (OR=0.422，95% CI 0.272-0.653，P<0.001) and higher adiponectin levels (OR=1.359，95% CI 1.004-1.840，P=0.047) were independently associated with postoperative clinical cure. We further stratified patients based on BMI, and identified that higher eGFR (OR=1.074，95% CI 1.023-1.127，P=0.004) and adiponectin levels (OR=1.816，95% CI 1.261-2.616，P=0.001) were associated with postoperative clinical cure in non-obese patients with PA. Conclusion: Baseline serum adiponectin and leptin detection is helpful to evaluate PA target organ damage, predict postoperative clinical outcomes, and assist in guiding the accurate management of PA.