Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy.
Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy.
Endocr Pract. 2022 Jan;28(1):90-95. doi: 10.1016/j.eprac.2021.09.002. Epub 2021 Sep 8.
Patients with primary aldosteronism (PA) can present with high PTH levels and negative calcium balance, with some studies speculating that aldosterone could directly stimulate PTH secretion. Either adrenalectomy or mineralocorticoid receptor blockers could reduce PTH levels in patients with PA. The aim of this study was to assess the relationship between aldosterone levels and parathyroid hormone (PTH)-vitamin D-calcium axis in a cohort of patients with PA, compared with patients with nonsecreting adrenocortical tumors in conditions of vitamin D sufficiency.
We enrolled a series of 243 patients retrospectively, of whom 66 had PA and 177 had nonsecreting adrenal tumors, and selected those with full mineral metabolism evaluation and 25(OH) vitamin D levels >20 ng/mL at the time of initial endocrine screening. The final cohort was composed of 26 patients with PA and 39 patients, used as controls, with nonsecreting adrenal tumors. The relationships between aldosterone, PTH levels, and biochemistries of mineral metabolism were assessed.
Aldosterone was positively associated with PTH levels (r = 0.260, P < .05) in the whole cohort and in the PA cohort alone (r = 0.450; P = .02). In the multivariate analysis, both aldosterone concentrations and urinary calcium excretion were significantly related to PTH levels, with no effect of 25(OH) vitamin D or other parameters of bone metabolism.
PTH level is associated with aldosterone, probably independent of 25(OH) vitamin D levels and urinary calcium. Whether aldosterone interacts directly with the parathyroid glands remains to be established.
原发性醛固酮增多症（PA）患者可表现出甲状旁腺激素（PTH）水平升高和负钙平衡，一些研究推测醛固酮可能直接刺激 PTH 分泌。肾上腺切除术或盐皮质激素受体阻滞剂均可降低 PA 患者的 PTH 水平。本研究旨在评估在维生素 D 充足的条件下，与无分泌性肾上腺皮质肿瘤患者相比，PA 患者的醛固酮水平与甲状旁腺激素（PTH）-维生素 D-钙轴之间的关系。
我们回顾性纳入了 243 例患者，其中 66 例为 PA 患者，177 例为无分泌性肾上腺皮质肿瘤患者，并选择了在初始内分泌筛查时具有完整矿物质代谢评估和 25（OH）维生素 D 水平>20ng/ml 的患者。最终队列由 26 例 PA 患者和 39 例作为对照的无分泌性肾上腺皮质肿瘤患者组成。评估了醛固酮、PTH 水平与矿物质代谢生化指标之间的关系。
在整个队列和 PA 队列中，醛固酮与 PTH 水平呈正相关（r=0.260，P<.05）。在多变量分析中，醛固酮浓度和尿钙排泄均与 PTH 水平显著相关，而 25（OH）维生素 D 或其他骨代谢参数无影响。
PTH 水平与醛固酮相关，可能独立于 25（OH）维生素 D 水平和尿钙。醛固酮是否与甲状旁腺直接相互作用仍有待确定。
