Rossi E, Sani C, Perazzoli F, Casoli MC, Negro A, Dotti C.
Alterations of calcium metabolism and of parathyroid function in primary aldosteronism and their reversal by spironolactone or by surgical removal of aldosterone-producing adenomas

Am J Hypert (Sep) 8:884-893 1995

This paper confirms and extends previous studies linking alterations in sodium and in calcium metabolism in hypertension secondary to aldosterone excess. The control and the hypertensive groups (primary hyperaldosteronism, low renin hypertension, normal renin hypertension) are well matched (age, sex, duration of hypertension, arterial pressure and CrCl) and the data are carefully analysed. Serum intact PTH (1-84) was measured by a radiometric assay.

The main results (raised PTH in primary hyperaldosteronism, reversal of raised PTH after surgery in patients with adenoma) are in line with a previous paper by Resnick (Am J Med 1985;385-390) but the increase in serum PTH was comparatively much less than in the cases described by Resnick. To my knowledge this paper includes the largest series of hypertensives with hyperaldosteronism in which alterations in Ca metabolism have been characterized, and it is the first that documents reversal of the Ca abnormalities after spironolactone.

Plasma ionized Ca levels in hypertensives with hyperaldosteronism was less than those in control subjects and comparable to levels in patients with low and normal renin hypertension. Interestingly, ionized Ca levels in the latter two groups were slightly reduced and accompanied by a normal to slightly reduced serum PTH. The authors discuss at length this finding which contrasts with data by Resnick (Ann Int Med 1986; 105:649-654) and attribute the difference to the fact that their sample size is relatively small. A more plausible explanation is that they studied only white hypertensives while Resnick most likely included black hypertensives (the race was not indicated in Resnick's paper). It is worth noting that in another European study in white hypertensives, serum intact PTH was (inappropriately) normal in a group of essential hypertensives with frank hypercalciuria and mild hypocalcemia (Zoccali C. Contrib. Nephrol. 1991;90:49-53).

All in all, this study nicely revisits the alterations in calcium metabolism in hypertension and indicates that a frank derangement of parathyroid function occurs only in patients with primary hyperaldosteronism. (Zoccali)

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H: Special problems : Endocrine hypertension

I am not a doctor. I have been diagnosed to have conn and surgery is indicated. I have been taking spirolactone for the last 10 years and my HP is under control. Recently, a friend of mine who has a similar condition went to australia for surgery - key hole and she has returned home after a successful operation. She is still under monitoring to see if the surgery will cure her condition. I am tempted to do the same thing, if I can afford it. Meantime I would like to know more about this type of surgery on adrenal glands and like to consult centres in the US which undertakes this sort of treatment. I am sorry if I trouble you. I really have not much choice. There is no endoricnologist in my state. I was first diagnosed to have Conn by a singapore doctor. For the past many years, I have been doing research on my own by reading up materials such as yours. Your assistance would be greatly appreciated.
albert TANG
kuching, sarawak malaysia-Sunday, December 07, 1997 at 08:09:33 (PST)