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Context Recent studies support a bidirectional interaction betweenaldosterone and parathyroid hormone (PTH), possibly increasing theindividual cardiovascular risk. Primary aldosteronism (PA) and primaryhyperparathyroidism can occur simultaneously.  Objective Our aim was to investigate the prevalence ofhyperparathyroidism in PA.  Patients We performed a case finding of primary hyperparathyroidismin a retrospective series of 503 patients with PA (cohort 1). We analysedprimary and secondary hyperparathyroidism in 141 prospective PA patients whounderwent PTH, serum calcium and phosphate measurements at time of diagnosisof PA (cohort 2).  Results The prevalence for primary hyperparathyroidism was1.2% in cohort 1, and 2.1% in cohort 2. Secondaryhyperparathyroidism was found in 54.6% of the patients. Patientswith secondary hyperparathyroidism had significantly higher aldosterone andlower potassium levels and took more antihypertensive medications comparedto those with normal PTH levels. In multivariate analysis, aldosterone and25-hydroxyvitamin D levels were significantly correlated with serum PTHlevels. There was a nonsignificant trend to a higher cardiovascularmorbidity in patients with secondary hyperparathyroidism. Patients withaldosterone producing adenoma had significantly higher PTH levels comparedto patients with bilateral adrenal hyperplasia. After treatment, there was asignificant decrease of PTH levels in both groups.  Conclusion Patients with PA frequently have primary or secondaryhyperparathyroidism, which is alleviated by correction of PA by surgical ormedical means. Patients affected by secondary hyperparathyroidism seem tohave a more severe phenotype of PA and have a trend towards morecardiovascular co-morbidities.

Primary and Secondary Hyperparathyroidism in Patients with Primary Aldosteronism – Findings From the German Conn’s Registry