Rossi E, Sani C, Perazzoli F, Casoli M C, Negro A, Dotti C
Fourth Department of Internal Medicine, S. Maria Nuova Hospital, Reggio Emilia, Italy.
Am J Hypertens. 1995 Sep;8(9):884-93. doi: 10.1016/0895-7061(95)00182-O.
In order to investigate the possible existence of abnormal calcium metabolism and parathyroid function in primary aldosteronism (PA), we have compared the calcium/parathyroid hormone (PTH) profile of patients with PA with the profile of healthy normotensive subjects and of patients with essential hypertension (EH). Furthermore, we have evaluated the effects of spironolactone and the surgical removal of aldosterone-producing adenomas on the calcium/PTH profile in the PA patients. Four groups of 10 subjects each participated in the study: 1) hypertensive patients with PA, 2) patients with low-renin EH (LREH), 3) patients with normal-renin EH (NREH), 4) normotensive healthy subjects (NS). The four groups were well-matched for age, sex, body mass index, and renal function. The three hypertensive groups were also matched closely for blood pressure values and for duration of hypertension. In all subjects, after 1 week of a controlled intake of Na and K, the following parameters were measured: urine excretion of Na, K, Ca, Mg, and P, plasma levels of K, Mg, inorganic P, total calcium and ionized calcium, and plasma renin activity, aldosterone concentration, and intact PTH. Blood pressure and laboratory parameters were determined again in all the PA patients after 1 month of 100 mg daily spironolactone administration, and in four out of the 10 PA patients 2 months after surgical removal of aldosterone-producing adenomas. All of these subjects had undergone the same controlled intake of Na and K indicated above. Serum intact PTH was higher in PA patients than in the other three groups (P < .01), and serum ionized calcium was significantly higher in normotensive subjects than in the three hypertensive groups (v PA P < .01, v LREH and v NREH P < .05). An increase in serum ionized calcium and a decrease in PTH level were associated with both spironolactone administration (P < .001) and surgical treatment (P < .05). These results suggest the presence of calcium metabolism alterations in both PA and EH patients, but that these alterations are more exaggerated in PA, so that higher PTH levels are needed for maintaining low-normal levels of serum ionized calcium.
为了研究原发性醛固酮增多症（PA）患者是否存在钙代谢和甲状旁腺功能异常，我们比较了PA患者与健康血压正常者以及原发性高血压（EH）患者的钙/甲状旁腺激素（PTH）情况。此外，我们还评估了螺内酯以及手术切除醛固酮瘤对PA患者钙/PTH情况的影响。四组，每组10名受试者参与了该研究：1）PA高血压患者，2）低肾素EH（LREH）患者，3）正常肾素EH（NREH）患者，4）血压正常的健康受试者（NS）。四组在年龄、性别、体重指数和肾功能方面匹配良好。三个高血压组在血压值和高血压病程方面也紧密匹配。在所有受试者中，在控制钠和钾摄入1周后，测量以下参数：尿钠、钾、钙、镁和磷排泄量，血钾、镁、无机磷、总钙和离子钙血浆水平，以及血浆肾素活性、醛固酮浓度和完整PTH。在所有PA患者每日服用100 mg螺内酯1个月后，以及在10名PA患者中的4名手术切除醛固酮瘤2个月后，再次测定血压和实验室参数。所有这些受试者都进行了上述相同的钠和钾控制摄入。PA患者的血清完整PTH高于其他三组（P <.01），血压正常受试者的血清离子钙明显高于三个高血压组（与PA相比P <.01，与LREH和NREH相比P <.05）。血清离子钙升高和PTH水平降低与螺内酯给药（P <.001）和手术治疗（P <.05）均相关。这些结果表明PA和EH患者均存在钙代谢改变，但PA患者的这些改变更为明显，因此需要更高的PTH水平来维持血清离子钙的低正常水平。
