More Than Half of Primary Aldosteronism Patients Have HPT

TOPLINE:

More than 50% of patients with primary aldosteronism had hyperparathyroidism (HPT), primarily secondary HPT. These patients also exhibited higher rates of atrial fibrillation and hypokalaemia, in addition to experiencing more severe aldosteronism.

METHODOLOGY:

• Researchers in Spain conducted a retrospective multicentric study to examine the prevalence of HPT in patients with primary aldosteronism and analyse the differences in cardiometabolic comorbidities, along with surgical and medical outcomes, between those with HPT and those without HPT.
• They analysed 246 patients with primary aldosteronism who had available data on phospho-calcium metabolism, collected between January 2018 and July 2024.
• HPT was classified as normocalcaemic when intact parathyroid hormone (iPTH) levels exceeded 65 pg/mL with normal corrected serum calcium levels, secondary when iPTH levels exceeded 65 pg/mL with normal or low corrected serum calcium levels and either chronic kidney disease or vitamin D deficiency, and primary when iPTH levels exceeded 65 pg/mL with high serum calcium levels.
• Adrenal vein sampling was performed to diagnose the primary aldosteronism subtype, with adrenalectomy carried out for patients with unilateral primary aldosteronism and pharmacologic treatment provided to those with bilateral disease or those deemed unsuitable for surgery.

TAKEAWAY:

• Overall, 56% of the patients with primary aldosteronism had HPT, with secondary HPT being the most prevalent at 81.3%, followed by normocalcaemic HPT at 11.5% and primary HPT at 7.2%.
• Compared with patients without HPT, those with HPT had a higher prevalence of atrial fibrillation (1.9% vs 7.9%; P = .04) and hypokalaemia (46.2% vs 71.6%; P < .0001), along with higher aldosterone levels (26.8 vs 33.2 ng/dL; P = .003) and greater 24-hour urinary calcium excretion (160.5 vs 243.5 mg/24 h; P = .01).
• The type of treatment for primary aldosteronism, whether surgical or medical, did not have a significant impact on PTH levels in patients with HPT.
• Among patients who underwent surgery, no significant differences in clinical or biochemical outcomes were observed between those with HPT and those without HPT; however, among patients who received medical therapy, plasma renin concentrations were lower in those with HPT than in those without HPT.

IN PRACTICE:

“This study confirms that PA [primary aldosteronism] has an impact in calcium phosphate metabolism and provides a basis for further studies to evaluate the effect of PA on bone mineral density and bone microarchitecture, as well as the effect on fracture risk,” the authors wrote.

SOURCE:

The study was led by María Bernarda Iriarte-Durán, Hospital Universitario Fundacion Valle del Lili, Cali, Colombia. It was published online on April 19, 2025, in the Journal of Endocrinological Investigation.

LIMITATIONS:

The retrospective nature of the study did not allow comprehensive data collection; specifically, information on variables such as urinary calcium excretion, dual-energy x-ray absorptiometry T-scores, and incident fractures was missing. The 24-hour urinary calcium excretion data were not available for all patients. Moreover, the diagnosis of normocalcaemic HPT was primarily determined by ruling out chronic kidney disease, vitamin D deficiency, and hypocalcaemia.

DISCLOSURES:

The study was funded by Sociedad Española de Endocrinologia y Nutricion. The authors reported no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.