Unilateral primary aldosteronism as an independent risk factor for vertebral fracture

Yokomoto‐Umakoshi, Maki; Sakamoto, Ryuichi; Umakoshi, Hironobu; Matsuda, Yayoi; Nagata, Hiromi; Fukumoto, Tazuru; Ogata, Masatoshi; Ogawa, Yoshihiro

doi:10.1111/cen.14145

Cited by 16 publications

(12 citation statements)

References 28 publications

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“…Twelve studies ( 17 ), ( 18 ), ( 25 ), ( 27 , 29 – 31 ), ( 12 , 15 , 16 , 28 , 33 ) compared 501 PA patients before medical or surgical treatment to 491 who were followed-up after treatment in terms of the serum calcium and urinary calcium levels; the serum PTH, 25-OHD, and BAP levels; and the BMD. Eight studies (nine datasets) ( 14 ), ( 25 ), ( 26 ), ( 29 ), ( 15 ), ( 11 , 13 , 19 ) compared 489 unilateral PA patients with 558 bilateral PA patients (three studies diagnosed PA via AVS after ACTH stimulation; four via AVS without ACTH stimulation; and one via AVS both with and without ACTH stimulation); all presented the serum calcium and urinary calcium and PTH and 25-OHD levels; and the BMD.…”

Section: Resultsmentioning

confidence: 99%

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Bone and mineral metabolism in patients with primary aldosteronism: A systematic review and meta-analysis

Wang

Liu³

et al. 2022

Front. Endocrinol.

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PurposePatients with primary aldosteronism (PA) tend to exhibit a high prevalence of osteoporosis (OP) that may vary by whether PA is unilateral or bilateral, and responsive to PA treatment. To explore relationships between bone metabolism, PA subtypes, and treatment outcomes, we performed a systematic review and meta-analysis.MethodsThe PubMed, Embase, and Cochrane databases were searched for clinical studies related to PA and bone metabolism markers. Articles that met the criteria were screened and included in the systematic review; the data were extracted after evaluating their quality. R software (ver. 2022-02-16, Intel Mac OS X 11.6.4) was used for the meta-analysis.ResultsA total of 28 articles were subjected to systematic review, of which 18 were included in the meta-analysis. We found that PA patients evidenced a lower serum calcium level (mean difference [MD] = –0.06 mmol/L, 95% confidence interval [CI]: −0.10 ~ −0.01), a higher urine calcium level (MD = 1.29 mmol/24 h, 95% CI: 0.81 ~ 1.78), and a higher serum parathyroid hormone (PTH) level (MD = 2.16 pmol/L, 95% CI: 1.57 ~ 2.75) than did essential hypertension (EH) subjects. After medical treatment or adrenal surgery, PA patients exhibited a markedly increased serum calcium level (MD = –0.08 mmol/L, 95% CI: –0.11 ~ –0.05), a decreased urine calcium level (MD = 1.72 mmol/24 h, 95% CI: 1.00 ~ 2.44), a decreased serum PTH level (MD = 2.67 pmol/L, 95% CI: 1.73 ~ 3.62), and an increased serum 25-hydroxyvitamin D (25-OHD) level (MD = –6.32 nmol/L, 95% CI: –11.94 ~ –0.70). The meta-analysis showed that the ser um PTH level of unilateral PA patients was significantly higher than that of bilateral PA patients (MD = 0.93 pmol/L, 95% CI: 0.36 ~ 1.49) and the serum 25-OHD lower than that of bilateral PA patients (MD = –4.68 nmol/L, 95% CI: –7.58 ~ 1.77). There were, however, no significant differences between PA and EH patients of 25-OHD, or BMD of femoral neck and lumbar spine. BMDs of the femoral neck or lumbar spine did not change significantly after treatment. The meta-analytical results were confirmed via sensitivity and subgroup analyses.ConclusionExcess aldosterone was associated with decreased serum calcium, elevated urinary calcium, and elevated PTH levels; these effects may be enhanced by low serum 25-OHD levels. The risks of OP and fracture might be elevated in PA patients, especially unilateral PA patients, but could be reduced after medical treatment or adrenal surgery. In view, however, of the lack of BMD changes, such hypothesis needs to be tested in further studies.

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Section: Resultsmentioning

confidence: 99%

“…After excluding the effect of hypertension ( 23 ), PA patients still had a higher fracture risk than general populations ( 28 ), ( 13 ), ( 23 ), ( 22 ). Wu et al.…”

Section: Discussionmentioning

confidence: 98%

Bone and mineral metabolism in patients with primary aldosteronism: A systematic review and meta-analysis

Wang

Liu³

et al. 2022

Front. Endocrinol.

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“…For post-DST cortisol, 1 mg of dexamethasone had been administered at 2300 h the day before the collection. Their reference ranges and assay methods have been described previously ( Yokomoto-Umakoshi et al, 2020c ). The estimated glomerular filtration rate (eGFR), serum calcium level, intact-parathyroid hormone (PTH) level, urinary calcium-to-creatinine ratio, tartrate-resistant acid phosphatase-5b (TRACP-5b) level, and bone-alkaline phosphatase (BAP) level were measured, as described previously ( Yokomoto-Umakoshi et al, 2020c ).…”

Section: Methodsmentioning

confidence: 99%

“…Their reference ranges and assay methods have been described previously ( Yokomoto-Umakoshi et al, 2020c ). The estimated glomerular filtration rate (eGFR), serum calcium level, intact-parathyroid hormone (PTH) level, urinary calcium-to-creatinine ratio, tartrate-resistant acid phosphatase-5b (TRACP-5b) level, and bone-alkaline phosphatase (BAP) level were measured, as described previously ( Yokomoto-Umakoshi et al, 2020c ). Dehydroepiandrosterone sulfate (DHEAS) and 25-hydroxyvitamin D levels were measured using electrochemiluminescence and chemiluminescent enzyme immunoassays, respectively.…”

Section: Methodsmentioning

confidence: 99%

Coexistence of bone and vascular disturbances in patients with endogenous glucocorticoid excess

et al. 2022

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“…Patients with PA have higher cardiovascular morbidity and mortality than age-and sex-matched patients with essential hypertension 3,4 . Furthermore, those with unilateral subtype of PA are at an increased risk of cardiometabolic disease relative to those with bilateral subtype of PA, thus requiring a more specific treatment adrenalectomy, rather than drug therapy [5][6][7] . According to the Endocrine Society clinical practice guideline 8 , the diagnosis of PA is hierarchical: case detection, case confirmation, and subtype classification.…”

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confidence: 99%

Machine learning based models for prediction of subtype diagnosis of primary aldosteronism using blood test

Kaneko

Umakoshi

Ogata

et al. 2021

Sci Rep

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Primary aldosteronism (PA) is associated with an increased risk of cardiometabolic diseases, especially in unilateral subtype. Despite its high prevalence, the case detection rate of PA is limited, partly because of no clinical models available in general practice to identify patients highly suspicious of unilateral subtype of PA, who should be referred to specialized centers. The aim of this retrospective cross-sectional study was to develop a predictive model for subtype diagnosis of PA based on machine learning methods using clinical data available in general practice. Overall, 91 patients with unilateral and 138 patients with bilateral PA were randomly assigned to the training and test cohorts. Four supervised machine learning classifiers; logistic regression, support vector machines, random forests (RF), and gradient boosting decision trees, were used to develop predictive models from 21 clinical variables. The accuracy and the area under the receiver operating characteristic curve (AUC) for predicting of subtype diagnosis of PA in the test cohort were compared among the optimized classifiers. Of the four classifiers, the accuracy and AUC were highest in RF, with 95.7% and 0.990, respectively. Serum potassium, plasma aldosterone, and serum sodium levels were highlighted as important variables in this model. For feature-selected RF with the three variables, the accuracy and AUC were 89.1% and 0.950, respectively. With an independent external PA cohort, we confirmed a similar accuracy for feature-selected RF (accuracy: 85.1%). Machine learning models developed using blood test can help predict subtype diagnosis of PA in general practice.

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Unilateral primary aldosteronism as an independent risk factor for vertebral fracture

Cited by 16 publications

References 28 publications

Bone and mineral metabolism in patients with primary aldosteronism: A systematic review and meta-analysis

Bone and mineral metabolism in patients with primary aldosteronism: A systematic review and meta-analysis

Coexistence of bone and vascular disturbances in patients with endogenous glucocorticoid excess

Machine learning based models for prediction of subtype diagnosis of primary aldosteronism using blood test

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