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Exp Clin Endocrinol Diabetes 2020; 128(04): 246-254
DOI: 10.1055/a-1027-6472
Article
© Georg Thieme Verlag KG Stuttgart · New York

Primary and Secondary Hyperparathyroidism in Patients with Primary Aldosteronism – Findings From the German Conn’s Registry

Evelyn Asbach
1   Endocrinology, Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, München, Germany
,
Margareta Bekeran
1   Endocrinology, Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, München, Germany
,
Anna König
2   Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover
,
Katharina Lang
3   Medizinische Klinik I, Julius-Maximilians-Universität Würzburg, Germany
,
Gregor Hanslik
4   Klinische Endokrinologie, Charité Campus Mitte, Universitätsmedizin Berlin, Germany
,
Marcus Treitl
5   Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität, München, Germany
,
Roland Ladurner
6   Klinik für Viszeral-und Endokrine Chirurgie, Klinikum der Ludwig-Maximilians-Universität, München, Germany
,
Martin Bidlingmaier
1   Endocrinology, Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, München, Germany
,
Felix Beuschlein
1   Endocrinology, Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, München, Germany
7   Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, Universitätsspital Zürich, Germany
,
Marcus Quinkler
8   Endokrinologie in Charlottenburg, Berlin, Germany
,
Martin Reincke
1   Endocrinology, Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, München, Germany
› Author Affiliations Funding This work was supported by the Else Kröner-Fresenius Stiftung in support of the German Conns Registry-Else-Kröner Hyperaldosteronism Registry (2013_A182 and 2015_A171 to MR), the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (grant agreement No [6949 13] to MR), by the Deutsche Forschungsgemeinschaft (DFG) (within the CRC/Transregio 205/1 “The Adrenal: Central Relay in Health and Disease” to FB and MR).
Further Information

Publication History

received 14 May 2019
revised   27 September 2019

accepted 14 October 2019

Publication Date:
07 November 2019 (online)

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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.

Key words

primary aldosteronism - aldosterone - vitamin D - primary hyperparathyroidism - secondary hyperparathyroidism
 

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