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Hyperparathyroidism in patients with overt and mild primary aldosteronism

Abstract

Introduction

Increased prevalence of hyperparathyroidism (HP) has been observed in primary aldosteronism (PA) patients. However, HP prevalence in milder forms of PA has not to date been evaluated.

Objectives

The objectives of this study were to assess the prevalence of primary and secondary HP in overt and milder misdiagnosed cases of PA and to investigate the effect of treatment on parathormone (PTH) secretion.

Patients and methods

Seventy PA patients with normal renal function were included prospectively. Specifically, patients with biochemically overt PA (increased basal aldosterone/renin ratio (ARR) and a positive diagnostic suppression test (DCVT)) and patients with mild PA (normal basal ARR and a positive DCVT) were analyzed. Mean blood pressure and mineral metabolism were evaluated at diagnosis and after treatment.

Results

Primary and secondary HP were found in 4.3% (3/70) and 51.4% (36/70) of patients, respectively, and biochemically overt and mild PA in 47.1% (33/70) and 52.9% (37/70) of patients, respectively. Sixty-three PA patients were followed up after treatment without receiving calcium or vitamin D. There was a decrease of mean blood pressure (p < 0.001), PTH (p < 0.001), and 24-h urinary calcium (p < 0.001), and an increase of serum potassium (p < 0.001) and calcium (p = 0.018) levels in secondary HP patients. There was no significant difference between biochemically overt and mild PA patients as concerned serum PTH, calcium, and 25-hydroxyvitamin-D levels either before or after treatment. Aldosterone levels before treatment were positively correlated with serum PTH levels.

Conclusions

HP prevalence was high in both overt and mild PA patients, whereas the effect of treatment on serum and urinary calcium and PTH levels was similar in both groups.

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Author information

Affiliations

Authors

Contributions

CG: collected data and wrote the article

LP: organized the study and wrote the article

SG, NV, ET: collected data

KT: contributed intellectually

GP: contributed intellectually, assigned duties, and edited the article

AM: assigned duties and edited the article

Corresponding author

Correspondence to Christos Gravvanis.

Ethics declarations

Ethics approval

The study protocol is approved from the institutional ethics committee of the General Hospital of Athens G Gennimatas, Greece, and the reporting of the study conforms to the Guidelines for Good Clinical Practice, the Declaration of Helsinki.

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Informed consent was obtained from all patients participating in the study.

Conflict of interest

The authors declare no competing interests.

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Gravvanis, C., Papanastasiou, L., Glycofridi, S. et al. Hyperparathyroidism in patients with overt and mild primary aldosteronism. Hormones (2021). https://doi.org/10.1007/s42000-021-00319-w

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Keywords

  • Hyperparathyroidism
  • Primary aldosteronism
  • Misdiagnosed forms
  • Aldosterone
  • Calcium