Exp Clin Endocrinol Diabetes 2015; 123 - P09_18
DOI: 10.1055/s-0035-1547711

Primary aldosteronism and the occurrence of hyperparathyroidism in the German Conn's registry

E Fischer 1, A Pallauf 1, M Bekeran 1, A Dietz 1, K Lang 2, G Hanslik 3, M Bidlingmaier 4, F Beuschlein 1, M Quinkler 5, M Reincke 6
  • 1Medizinische Klinik und Poliklinik IV, Klinikum der Universität München
  • 2Dept. of Medicine I; Endocrinology and Diabetology; University Hospital Würzburg
  • 3Klinische Endokrinologie, Charité Campus Mitte, Universitätsmedizin Berlin
  • 4Ludwig Maximillians Universität München; Med. Klinik Innenstadt
  • 5Endokrinologie in Charlottenburg
  • 6Universität München; Medizinische Klinik und Poliklinik IV; Med. Klinik und Poliklinik IV

Introduction:

Primary aldosteronism (PA) is the most frequent curable form of hypertension. The two main causes are aldosterone producing adenoma (APA) and idiopathic bilateral adrenal hyperplasia (IAH). PA is associated with a higher frequency of cardiovascular (CV) complications and thus with a higher mortality. Recent studies support a bi-directional interaction between parathyroid hormone (PTH) and aldosterone with a significant impact on CV morbidity. Our aim was to investigate the effect of PA and hyperparathyroidism on the CV system. Besides, we wanted to identify the prevalence of primary (pHPT) and secondary hyperparathyroidism (sHPT) in a large cohort of patients with PA.

Methods:

125 patients underwent iPTH, serum calcium and phosphate measurements at time of diagnosis of PA and had a PA subtype differentiation (70 APA, 55 IAH). Follow-up investigation was performed 12 months after initiation of therapy. Cardiovascular events were defined as: atrial fibrillation, coronary heart disease, acute coronary syndrome, heart failure and stroke.

Results:

APA patients had significantly higher iPTH levels compared to patients with IAH (72.1 vs. 61.8 pg/ml, p = 0.007). In APA patients there were 3% with pHPT and 24% with sHPT, in IAH patients there were 2% with pHPT and 13% with sHPT. Patients with elevated PTH levels had higher aldosterone levels compared to patients with normal PTH levels. In sHPT patients there was a significant decrease of iPTH levels and an increase of serum calcium levels after initiation of PA directed therapy (adrenalectomy or spironolactone treatment). Patients with CV morbidity (n = 27) compared to patients without CV morbidity (n = 114) had significantly higher iPTH levels.

Conclusion:

Hyperparathyreoidism is a frequent condition in patients with PA and appears to be associated with a higher CV morbidity.