Primary and Secondary Hyperparathyroidism in Patients with Primary Aldosteronism - Findings From the German Conn's Registry.

Abstract

CONTEXT:

Recent studies support a bidirectional interaction between aldosterone and parathyroid hormone (PTH), possibly increasing the individual cardiovascular risk. Primary aldosteronism (PA) and primary hyperparathyroidism can occur simultaneously.

OBJECTIVE:

Our aim was to investigate the prevalence of hyperparathyroidism in PA.

PATIENTS:

We performed a case finding of primary hyperparathyroidism in a retrospective series of 503 patients with PA (cohort 1). We analysed primary and secondary hyperparathyroidism in 141 prospective PA patients who underwent PTH, serum calcium and phosphate measurements at time of diagnosis of PA (cohort 2).

RESULTS:

The prevalence for primary hyperparathyroidism was 1.2% in cohort 1, and 2.1% in cohort 2. Secondary hyperparathyroidism was found in 54.6% of the patients. Patients with secondary hyperparathyroidism had significantly higher aldosterone and lower potassium levels and took more antihypertensive medications compared to those with normal PTH levels. In multivariate analysis, aldosterone and 25-hydroxyvitamin D levels were significantly correlated with serum PTH levels. There was a nonsignificant trend to a higher cardiovascular morbidity in patients with secondary hyperparathyroidism. Patients with aldosterone producing adenoma had significantly higher PTH levels compared to patients with bilateral adrenal hyperplasia. After treatment, there was a significant decrease of PTH levels in both groups.

CONCLUSION:

Patients with PA frequently have primary or secondary hyperparathyroidism, which is alleviated by correction of PA by surgical or medical means. Patients affected by secondary hyperparathyroidism seem to have a more severe phenotype of PA and have a trend towards more cardiovascular co-morbidities.

• Authors: Evelyn Asbach, Margareta Bekeran, Anna König, Katharina Lang, Gregor Hanslik, Marcus Treitl, Roland Ladurner, Martin Bidlingmaier, Felix Beuschlein, Marcus Quinkler, Martin Reincke
• Journal: Experimental and clinical endocrinology & diabetes : official journal, German Society of Endocrinology [and] German Diabetes Association (Exp Clin Endocrinol Diabetes) Vol. 128 Issue 4 Pg. 246-254 (Apr 2020) ISSN: 1439-3646 [Electronic] Germany
• PMID: 31698477 (Publication Type: Journal Article)
• Copyright: © Georg Thieme Verlag KG Stuttgart · New York.

Chemical References

• Hydroxycholecalciferols
• Parathyroid Hormone

Topics

• Adult
• Cardiovascular Diseases (blood, epidemiology)
• Comorbidity
• Female
• Germany (epidemiology)
• Humans
• Hydroxycholecalciferols (blood)
• Hyperaldosteronism (blood, epidemiology)
• Hyperparathyroidism, Secondary (blood, epidemiology)
• Male
• Middle Aged
• Parathyroid Hormone (blood)
• Phenotype
• Registries
• Retrospective Studies
• Severity of Illness Index