Impact of primary aldosteronism on calcium phosphate homeostasis. Results from the SPAIN-ALDO.
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Iriarte-Durán María Bernarda, Paja Fano Miguel, Rizo Gellida Alicia, González-Boillos Marga, Parra Ramírez Paola, Martín Rojas-Marcos Patricia, Caja Laura, García Cano Ana M, Ruiz-Sanchez Jorge Gabriel, Vicente Almudena, Gómez-Hoyos Emilia, Recasens Mònica, Barahona San Millan Rebeca, Picón César María José, Díaz Guardiola Patricia, Perdomo Carolina M, Manjón-Miguélez Laura, Rebollo Román Ángel, Robles Lázaro Cristina, Recio José María, Calatayud María, Jiménez López Noemi, Sampedro Nuñez Miguel, Mena Ribas Elena, Sanmartín Sánchez Alicia, Gonzalvo Diaz Cesar, Lamas Cristina, Serrano Joaquín, Michalopoulou Theodora, Tenes Rodrigo Susana, Jaén Aguila Fernando, Moya Mateo Eva María, Gutiérrez-Medina Sonsoles, Hanzu Felicia Alexandra, Araujo-Castro Marta
Аннотация
METHODS: A retrospective multicenter study of primary aldosteronism (PA) patients followed in 37 Spanish tertiary hospitals and with available information on serum calcium, phosphorus, iPTH, and vitamin D at the time of PA diagnosis. The diagnosis of normocalcemic HPT (n-HPT) associated with PA was based on a iPTH > 65pg/mL with normal corrected serum calcium after excluding the most common causes of secondary HPT, and HPT was classified as secondary (S-HPT) in the presence of chronic kidney disease or vitamin D deficiency, and as primary (PHPT) when iPTH levels >65 pg/mL were associated with high serum calcium levels.
RESULTS: A total of 246 patients with PA were included, of whom 56% (n = 139) had PTH > 65 pg/mL. In the group of participants with HPT (n = 139) the proportion of PHPT was 7.2%, of n-HPT 11.5% and of S-HPT 81.3%. Patients with n-HPT had a higher prevalence of atrial fibrillation (7.9% vs. 1.9%, P = 0.04) and hypokalemia (71.6% vs. 46.2%, P < 0.001) and greater aldosterone (33.2 vs. 26.8 ng/dL, p = 0.003) and 24 h urinary calcium excretion ( 243.5 vs. 160.5 mg/24 h, p = 0.01) than patients without hyperparathyroidism. No differences in surgical outcomes (biochemical and clinical response) were detected between patients with and without hyperparathyroidism.
CONCLUSIONS: HPT is a frequent condition in patients with PA and S-HPT is the most common etiology. Patients with HPT have a higher prevalence of atrial fibrillation and hypokalemia and a more severe PA than those without HPT. However, no differences in surgical outcomes were reported between patients with and without HPT.