Serum aldosterone is correlated positively to parathyroid hormone (PTH) levels in patients with primary hyperparathyroidism

Brunaud, Laurent; Germain, A; Zarnegar, Rasa; Rancier, Marc; Alrasheedi, Saud; Caillard, C.; Ayav, Ahmet; Weryha, G.; Mirallié, Éric; Bresler, L.

doi:10.1016/j.surg.2009.09.041

Cited by 71 publications

(53 citation statements)

References 22 publications

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“…16 Furthermore, infusion of aldosterone in rats caused an increase of PTH, thus suggesting a cause-effect relationship between hyperaldosteronism and hyperparathyroidism. 17 The observations that in patients with primary hyperparathyroidism: (1) plasma aldosterone and PTH concentrations were positively correlated; (2) at multivariate analysis, preoperative PTH was an independent predictor of plasma aldosterone concentration; (3) PTH levels Ͼ100 ng/L were an independent predictor of abnormally elevated plasma aldosterone concentration, 18 are also consistent with the concept that PTH plays a role in triggering or maintaining aldosterone secretion in vivo. Hence, accumulating evidence altogether suggest that PTH could play a role in human PA by triggering and/or maintaining aldosterone secretion, by stimulating adrenocortical cell proliferation, and also by contributing to the excess cardiovascular damage documented in PA patients.…”

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confidence: 69%

Hyperparathyroidism Can Be Useful in the Identification of Primary Aldosteronism Due To Aldosterone-Producing Adenoma

et al. 2012

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Abstract-Hyperparathyroidism represents as a novel feature of primary aldosteronism (PA). Its occurrence in patients with the surgically correctable aldosterone-producing adenoma (APA) and not in those with bilateral adrenal hyperplasia suggested that the measurement of parathyroid hormone could help in differentiating between these subtypes of PA. To test this hypothesis we measured the plasma levels of intact parathyroid hormone, Ca 2ϩ , and several markers of calcium/phosphorus metabolism in 132 hypertensive patients, including 74 with primary (essential) hypertension and 58 consecutive PA patients. Of the latter, 46 were conclusively diagnosed as APA (by finding of lateralized aldosterone excess, pathology, correction of the hyperaldosteronism, and evidence of a fall of blood pressure after adrenalectomy) and 12 as bilateral adrenal hyperplasia. Based on these diagnoses we used the area under the receiver operator characteristic curve analysis to assess the accuracy of serum parathyroid hormone for identifying the PA cases in the whole group and for distinguishing between APA and bilateral adrenal hyperplasia. In this selected population of hypertensive patients for identifying PA cases, the accuracy of serum parathyroid hormone tended to be lower than that of the aldosterone:renin ratio. However, for discriminating between APA and bilateral adrenal hyperplasia patients it was better than that under the identity line and also that for the aldosterone:renin ratio for pinpointing APA cases among patients with PA. Hence, these findings indicate that raised serum parathyroid hormone levels are a feature of APA that can be useful for selecting the PA patients to be submitted to adrenal vein sampling. (Hypertension. 2012;60:431-436.) Key Words: aldosterone Ⅲ mineralocorticoids Ⅲ PTH Ⅲ endocrine hypertension Ⅲ secondary hypertension Ⅲ aldosterone-producing adenoma Ⅲ diagnosis Ⅲ calcium I n patients with primary aldosteronism (PA), the discrimination between the surgically curable aldosterone-producing adenoma (APA) and the medically treatable bilateral adrenal hyperplasia (BAH) is a challenging task that usually requires adrenal vein sampling, 1 a minimally invasive, risky, expensive, and not widely available procedure. Accordingly, there is an unmet need of a better strategy for selecting patients more likely to have an APA to be submitted to adrenal vein sampling (AVS). After the pilot reports of secondary hyperparathyroidism in patients with PA 2,3 and also with secondary aldosteronism attributed to congestive heart failure, 4-6 we and others recently documented an elevation of serum parathyroid hormone (PTH) levels in large cohorts of patients with confirmed PA. 7,8 These observations are of great interest given the adverse cardiovascular consequences of excess PTH, which is now appreciated as a cardiovascular risk factor, 9,10 and also because of the evidence that PTH can exert a secretagogue effect on aldosterone. In vitro studies consistently showed that PTH concentration-dependently increases aldosterone in...

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confidence: 69%

Hyperparathyroidism Can Be Useful in the Identification of Primary Aldosteronism Due To Aldosterone-Producing Adenoma

et al. 2012

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“…In addition, it has been shown that in patients with PHPT, aldosterone levels were elevated and positively correlated with PTH values, possibly causing atherosclerosis because of proinflammatory, prothrombotic, and profibrotic effects (27,28). However, in our sample, there were no differences in the prevalence of hypertension in patients with or without AAC.…”

Section: Discussioncontrasting

confidence: 57%

High prevalence of abdominal aortic calcification in patients with primary hyperparathyroidism as evaluated by Kauppila score

Pepe

Diacinti

Fratini

et al. 2016

European Journal of Endocrinology

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Objective: The prevalence of abdominal aortic calcification (AAC) in primary hyperparathyroidism (PHPT) is unknown. We assessed both prevalence and severity of AAC in PHPT postmenopausal women. Methods: In this study 70 PHPT postmenopausal women and 70 age-and sex-matched controls were enrolled. Each participant underwent biochemical evaluation, lateral spine radiograph, bone mineral density (BMD) measurement (lumbar, femoral, radial sites), and kidney ultrasound. Lateral lumbar films were analyzed in the region of L1-L4 vertebrae and the Kauppila score (a semi-quantitative grading system) was used to assess the severity of AAC. Results: There were no differences regarding demographic and cardiovascular risk factors in the two groups. PHPT patients had higher prevalence of kidney stones (30% vs 7%, P = 0.0008) and lower radial BMD values (0.558 ± 0.071 vs 0.588 ± 0.082 g/cm 2 , P < 0.05) compared with controls. PHPT patients showed higher prevalence of AAC (31 vs 18, P = 0.03), with more severe calcifications (Kauppila score 7.35 ± 6.1 vs 5.05 ± 3.5, P = 0.007). PHPT patients with AAC were older and had been suffering from the disease for a longer period compared with those without ACC. Moreover, PHPT patients with severe AAC had mean higher serum parathyroid hormone levels compared with patients with moderate or mild calcifications. In PHPT patients with AAC, multiple regression analysis, adjusted for age and years since diagnosis, showed that only parathyroid hormone significantly correlated with Kauppila score. Conclusion: We found a higher prevalence and severity of AAC in PHPT related to parathyroid hormone effect.

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“…20 Interestingly, in a model of secondary aldosteronism developing SHPT, 30 PTH-mediated intracellular Ca 2ϩ overload and oxidative stress have been reported to promote an inflammatory phenotype in immune cells infiltrating coronary vessels, suggesting that PTHmediated Ca 2ϩ overload and oxidative stress have a permissive role in the cardiovascular remodeling mediated by aldosterone. In addition, in patients with PHPT, aldosterone levels are elevated and correlate positively with PTH values, 31 likely explaining the development of arterial hypertension and cardiovascular damage in patients with PHPT.…”

Section: Discussionmentioning

confidence: 99%

Coronary Microvascular Dysfunction Induced by Primary Hyperparathyroidism is Restored After Parathyroidectomy

et al. 2012

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Background-Symptomatic primary hyperparathyroidism (PHPT) is associated with increased cardiovascular mortality.However, data on the association between asymptomatic PHPT and cardiovascular risk are lacking. We assessed coronary flow reserve (CFR) as a marker of coronary microvascular function in asymptomatic PHPT of recent onset. Methods and Results-We studied 100 PHPT patients (80 women; age, 58Ϯ12 years) without cardiovascular disease and 50 control subjects matched for age and sex. CFR in the left anterior descending coronary artery was detected by transthoracic Doppler echocardiography, at rest, and during adenosine infusion. CFR was the ratio of hyperemic to resting diastolic flow velocity. CFR was lower in PHPT patients than in control subjects (3.0Ϯ0. 2).In multivariable linear regression analysis, PTH, age, and heart rate were the only factors associated with CFR (Pϭ0.04, Pϭ0.01, and Pϭ0.006, respectively). In multiple logistic regression analysis, only PTH increased the probability of CFR Յ2.5 (Pϭ0.03). In all PHPT patients with CFR Յ2.5, parathyroidectomy normalized CFR (3.3Ϯ0.7 versus 2.1Ϯ0.5; PϽ0.0001). Conclusions-PHPT patients have coronary microvascular dysfunction that is completely restored after parathyroidectomy. PTH independently correlates with the coronary microvascular impairment, suggesting a crucial role of the hormone in explaining the increased cardiovascular risk in PHPT.

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Serum aldosterone is correlated positively to parathyroid hormone (PTH) levels in patients with primary hyperparathyroidism

Cited by 71 publications

References 22 publications

Hyperparathyroidism Can Be Useful in the Identification of Primary Aldosteronism Due To Aldosterone-Producing Adenoma

Hyperparathyroidism Can Be Useful in the Identification of Primary Aldosteronism Due To Aldosterone-Producing Adenoma

High prevalence of abdominal aortic calcification in patients with primary hyperparathyroidism as evaluated by Kauppila score

Coronary Microvascular Dysfunction Induced by Primary Hyperparathyroidism is Restored After Parathyroidectomy

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