Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.
J Clin Endocrinol Metab. 2012 Jan;97(1):E75-9. doi: 10.1210/jc.2011-2183. Epub 2011 Oct 19.
Experimental studies suggest that aldosterone induces hypercalciuria and might contribute to hyperparathyroidism.
We aimed to test for differences in PTH levels and parameters of calcium and vitamin D metabolism in patients with primary aldosteronism (PA) compared with patients with essential hypertension (EH) and to evaluate the impact of PA treatment on these laboratory values.
DESIGN, SETTING, AND PARTICIPANTS: The Graz Endocrine Causes of Hypertension study includes hypertensive patients referred for screening for endocrine hypertension at a tertiary care center in Graz, Austria.
Differences in PTH levels between patients with PA and EH.
Among 192 patients, we identified 10 patients with PA and 182 with EH. PTH levels (mean ± sd in picograms per milliliter) were significantly higher in PA patients compared with EH (67.8 ± 26.9 vs. 46.5 ± 20.9; P = 0.002). After treatment of PA with either adrenal surgery (n = 5) or mineralocorticoid receptor antagonists (n = 5), PTH concentrations decreased to 43.9 ± 14.9 (P = 0.023). Serum 25-hydroxyvitamin D concentrations were similar in both groups. Compared with EH, serum calcium concentrations were significantly lower (2.35 ± 0.10 vs. 2.26 ± 0.10 mmol/liter; P = 0.013), and there was a nonsignificant trend toward an increased spot urine calcium to creatinine ratio in PA [median (interquartile range) 0.19 (0.11-0.31) vs. 0.33 (0.12-0.53); P = 0.094].
Our results suggest that PA contributes to secondary hyperparathyroidism. Further studies are warranted to evaluate whether PTH has implications for PA diagnostics and whether mineralocorticoid receptor antagonists have a general impact on PTH and calcium metabolism.
实验研究表明，醛固酮可引起高钙尿症，并可能导致甲状旁腺功能亢进。
我们旨在检测原发性醛固酮增多症（PA）患者与原发性高血压（EH）患者之间甲状旁腺激素（PTH）水平和钙及维生素 D 代谢参数的差异，并评估 PA 治疗对这些实验室值的影响。
设计、地点和参与者：格拉茨内分泌性高血压研究纳入了因疑似内分泌性高血压而在奥地利格拉茨的三级医疗中心接受筛查的高血压患者。
PA 患者与 EH 患者之间 PTH 水平的差异。
在 192 例患者中，我们确定了 10 例 PA 患者和 182 例 EH 患者。与 EH 患者相比，PA 患者的 PTH 水平（以每毫升皮克表示的平均值±标准差）明显更高（67.8±26.9 比 46.5±20.9；P=0.002）。PA 患者接受肾上腺手术（n=5）或盐皮质激素受体拮抗剂治疗（n=5）后，PTH 浓度降低至 43.9±14.9（P=0.023）。两组患者的血清 25-羟维生素 D 浓度相似。与 EH 患者相比，PA 患者的血清钙浓度明显更低（2.35±0.10 比 2.26±0.10mmol/L；P=0.013），且尿钙/肌酐比值的升高趋势更明显（中位数（四分位数间距）0.19（0.11-0.31）比 0.33（0.12-0.53）；P=0.094）。
我们的结果表明，PA 可导致继发性甲状旁腺功能亢进。需要进一步研究以评估 PTH 是否对 PA 的诊断有影响，以及盐皮质激素受体拮抗剂是否对 PTH 和钙代谢有普遍影响。
