Recent studies suggested patients with primary aldosteronism (PA) presented higher parathyroid hormone (PTH) levels than that of essential hypertension (EH) patients. To study the difference of PTH level in Chinese patients with PA or EH, and the presentation of PTH in different subtype of PA.Design and method:
This prospective study recruited 203 patients with PA and 368 patients with EH hospitalized in the Department of hypertension in Ruijin Hospital between 2013 and 2015. They were matched by sex, age and blood pressure level. Laparoscopic adrenalectomy was carried out under the guide of adrenal venous sampling. KCNJ5, ATP1A1, ATP2B3 and CACNA1D genes were tested on the DNA extracted from the removed adrenal tissues.Results:
Table 1 showed the patients with PA had higher PTH level than that of patients with EH (73.9 (53.0–100.9) vs 51.5 (40.8–66.8), P < 0.001). This difference existed after further matching of plasma and urinary aldosterone (71.1 (51.9–87.3) vs. 48.9 (37.5–68.8), P = 0.002). There were no difference of urinary excretion of Ca2+and P. PTH level decreased after adrenalectomy (81.5 ± 35.1 vs 57.8 ± 20.0 pg/ml, P < 0.001). There were no difference of PTH levels between unilateral (n = 52) and bilateral (n = 20) disease in 72 patients who underwent AVS, neither between the adenoma (n = 22) and the hyperplasia (n = 45) confirmed by the pathological examination. 33 patients had hypertension cured and 34 had improved after adrenalectomy. No differences of PTH levels were found in these two groups. DNA sequencing was able to carry out on 39 patient's adrenal tissues, and KCNJ5 (n = 29), ATP1A1 (n = 2) mutation were detected. The PTH level in mutation group was lower than that of nonmutant without significance.Conclusions:
PA patients present higher PTH levels than EH patients with matched plasma and urinary aldosterone. There was no difference of PTH level in different subtype of PA. Hyperaldosteronism may not be the unique factor to cause increasing PTH level in patients with PA.