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Abdominal aortic calcification is more severe in unilateral primary aldosteronism patients and is associated with elevated aldosterone and parathyroid hormone levels

Hypertension Research volume 43, pages 1413–1420 (2020)Cite this article

Abstract

Primary aldosteronism (PA) is associated with a higher prevalence of abdominal aortic calcification (AAC). Unilateral and bilateral PA are the most common subtypes of PA. However, no studies have addressed the difference in the prevalence of AAC between the two subtypes. In addition to aldosterone, parathyroid hormone (PTH), an important regulator of calcium metabolism, was also reported to be elevated in individuals with unilateral PA. Therefore, we hypothesized that the prevalence of AAC may be higher in individuals with unilateral PA, which may be related to the plasma aldosterone concentration (PAC) and PTH levels. We included 156 PA patients who underwent adrenal venous sampling and 156 with essential hypertension (EH) matched by age and sex. Of the former, 76 were diagnosed with unilateral PA, and 80 were diagnosed with bilateral PA. The aortic calcification index (ACI) presented the severity of AAC and was measured by adrenal computed tomography scan. Our results showed that compared with the EH group, the prevalence and severity of AAC were higher in PA patients (32.7 vs. 19.6%; 4.32 ± 3.61% vs. 2.53 ± 2.42%, respectively). In the PA subgroup analysis, unilateral PA was associated with a higher and more severe AAC than bilateral PA (40.7 vs. 25.0%; 5.12 ± 4.07% vs. 3.08 ± 2.34%, respectively). Moreover, PAC and PTH levels were higher in individuals with unilateral PA than in those with bilateral PA (P < 0.05). After risk adjustment, multivariate regression analysis revealed that PAC and PTH were positively-associated with AAC in patients with PA (P < 0.05). In conclusion, unilateral PA patients exhibited a higher prevalence of AAC and more severe AAC due to elevated PAC and PTH levels.

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References

  1. Funder JW, Carey RM, Fardella C, Gomez-Sanchez CE, Mantero F, Stowasser M, et al. Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline[J]. J Clin Endocrinol Metab. 2008;93:3266–81.

    Article  CAS  Google Scholar 

  2. Nishikawa T, Omura M, Satoh F, Shibata H, Takahashi K, Tamura N, et al. The Task Force Committee on Primary Aldosteronism, the Japan Endocrine Society. Guidelines for the diagnosis and treatment of primary aldosteronism-the Japan Endocrine Society 2009[J]. Endocr J. 2011;58:711–21.

    Article  CAS  Google Scholar 

  3. Monticone S, D’Ascenzo F, Moretti C, Williams TA, Veglio F, Gaita F, et al. Cardiovascular events and target organ damage in primary aldosteronism compared with essential hypertension: a systematic review and meta-analysis[J]. Lancet Diabetes Endocrinol. 2018;6:41–50.

    Article  CAS  Google Scholar 

  4. Savard S, Amar L, Plouin PF, Steichen O. Cardiovascular complications associated with primary aldosteronism: a controlled cross-sectional study[J]. Hypertension. 2013;62:331–6.

    Article  CAS  Google Scholar 

  5. Mulatero P, Monticone S, Bertello C, Viola A, Tizzani D, Iannaccone A. et al. Long-term cardio-and cerebrovascular events in patients with primary aldosteronism[J]. J Clin Endocrinol Metab. 2013;98:4826–33.

    Article  CAS  Google Scholar 

  6. Rennenberg RJ, Kessels AG, Schurgers LJ, van Engelshoven JM, de Leeuw PW, Kroon AA. Vascular calcifications as a marker of increased cardiovascular risk: a meta-analysis[J]. Vasc Health Risk Manag. 2009;5:185–97.

    Article  CAS  Google Scholar 

  7. Liu P, Zhang S, Gao J, Lin Y, Shi G, He W, et al. Downregulated serum 14, 15-epoxyeicosatrienoic acid is associated with abdominal aortic calcification in patients with primary aldosteronism[J]. Hypertension. 2018;71:592–8.

    Article  CAS  Google Scholar 

  8. Gao J, Zhang K, Chen J, Wang MH, Wang J, Liu P, et al. Roles of aldosterone in vascular calcification: an update[J]. Eur J Pharm. 2016;786:186–93.

    Article  CAS  Google Scholar 

  9. Fabrizio B, Silvia M, Tracy W, Denis R, Jacopo B, Martina T, et al. Subtype diagnosis of primary aldosteronism: is adrenal vein sampling always necessary?[J]. Int J Mol Sci. 2017;18:848.

    Article  Google Scholar 

  10. El Ghorayeb N, Bourdeau I, Lacroix A. Role of ACTH and other hormones in the regulation of aldosterone production in primary aldosteronism[J]. Front Endocrinol. 2016;7:72.

    Article  Google Scholar 

  11. Zhang Y, Niu W, Zheng F, Zhang H, Zhu L. Identifying unilateral disease in Chinese patients with primary aldosteronism by using a modified prediction score[J]. J Hypertens. 2017;35:2486.

    Article  CAS  Google Scholar 

  12. Rossi GP, Ragazzo F, Seccia TM, Maniero C, Barisa M, Calo LA, et al. Hyperparathyroidism can be useful in the identification of primary aldosteronism due to aldosterone-producing adenoma[J]. Hypertension. 2012;60:431–6.

    Article  CAS  Google Scholar 

  13. Zhang LX, Gu WJ, Li YJ, Wang Y, Mu YM. PTH is a promising auxiliary index for the clinical diagnosis of aldosterone-producing adenoma[J]. Am J Hypertens. 2015;29:575–81.

    Article  Google Scholar 

  14. Fortina F, Bellosta S. Hyperparathyroidism secondary to hyperaldosteronism[J]. High Blood Press Cardiovasc Prev. 2010;17:27–30.

    Article  Google Scholar 

  15. Brunaud L, Germain A, Zarnegar R, Rancier M, Alrasheedi S, Caillard C, et al. Serum aldosterone is correlated positively to parathyroid hormone (PTH) levels in patients with primary hyperparathyroidism[J]. Surgery. 2009;146:1035–41.

    Article  Google Scholar 

  16. Chau K, Holmes D, Melck A, Clifford Chan-Yan. Secondary hypertension due to concomitant aldosterone-producing adenoma and parathyroid adenoma[J]. Am J Hypertens. 2014;28:280–2.

    Article  Google Scholar 

  17. Tomaschitz A, Ritz E, Pieske B, Rus-Machan J, Kienreich K, Verheyen N, et al. Aldosterone and parathyroid hormone interactions as mediators of metabolic and cardiovascular disease[J]. Metabolism. 2014;63:20–31.

    Article  CAS  Google Scholar 

  18. Malluche HH, Blomquist G, Monier-Faugere MC, Cantor TL, Davenport DL. High parathyroid hormone level and osteoporosis predict progression of coronary artery calcification in patients on dialysis[J]. J Am Soc Nephrol. 2015;26:2534–44.

    Article  CAS  Google Scholar 

  19. Di LL, Gorini A, Bellasi A, Morrone LF, Rivera R, Russo L, et al. Fibroblast growth factor 23 and parathyroid hormone predict extent of aortic valve calcifications in patients with mild to moderate chronic kidney disease[J]. Clin Kidney J. 2015;8:732–6.

    Article  Google Scholar 

  20. Luo Q, Li NF, Yao XG, Zhang DL, Abulikemu SFY, Chang GJ, et al. Potential effects of age on screening for primary aldosteronism[J]. J Hum Hypertens. 2016;30:53.

    Article  Google Scholar 

  21. Whitworth JA. World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension[J]. J Hypertens. 2003;21:1983–92.

    Article  Google Scholar 

  22. Fujita N, Hatakeyama S, Yamamoto H, Tobisawa Y, Yoneyama T, Yoneyama T, et al. Implication of aortic calcification on persistent hypertension after laparoscopic adrenalectomy in patients with primary aldosteronism[J]. Int J Urol. 2016;23:412–7.

    Article  Google Scholar 

  23. Brown NJ. Contribution of aldosterone to cardiovascular and renal inflammation and fibrosis[J]. Nat Rev Nephrol. 2013;9:459.

    Article  CAS  Google Scholar 

  24. Mayyas F, Alzoubi KH, Van Wagoner DR. Impact of aldosterone antagonists on the substrate for atrial fibrillation: aldosterone promotes oxidative stress and atrial structural/electrical remodeling[J]. Int J Cardiol. 2013;168:5135–42.

    Article  Google Scholar 

  25. Mathew JT, Patni H, Chaudhary AN, Liang W, Gupta A, Chander PN, et al. Aldosterone induces mesangial cell apoptosis both in vivo and in vitro[J]. Am j physiol Ren physiol. 2008;295:73–81.

    Article  Google Scholar 

  26. Mazzocchi G, Aragona F, Malendowicz LK, Nussdorfer GG. PTH and PTH-related peptide enhance steroid secretion from human adrenocortical cells[J]. Am J Physiol Endocrino Metab. 2001;280:E209–E213.

    Article  CAS  Google Scholar 

  27. Kawashima M, Takahashi T, Yanai H, Ogawa H, Yasuoka T. Direct action of parathyroid hormone-related peptide to enhance corticosterone production stimulated by adrenocorticotropic hormone in adrenocortical cells of hens[J]. Poult Sci. 2005;84:1463–9.

    Article  CAS  Google Scholar 

  28. Rizk-Rabin M, Assie G, Rene-Corail F, Perlemoine K, Hamzaoui H, Tissier F, et al. Differential expression of parathyroid hormone–related protein in adrenocortical tumors: autocrine/paracrine effects on the growth and signaling pathways in H295R Cells[J]. Cancer Epidemiol Biomark Prev. 2008;17:2275–85.

    Article  CAS  Google Scholar 

  29. Maniero C, Fassina A, Seccia TM, Toniato A, Rossi GP. Mild hyperparathyroidism: a novel surgically correctable feature of primary aldosteronism[J]. J Hypertens. 2012;30:390–5.

    Article  CAS  Google Scholar 

  30. Pilz S, Kienreich K, Drechsler C, Ritz E, Fahrleitner-Pammer A, Gaksch M, et al. Hyperparathyroidism in patients with primary aldosteronism: cross-sectional and interventional data from the GECOH study[J]. J Clin Endocrinol Metab. 2012;97:E75–E79.

    Article  CAS  Google Scholar 

  31. Rossi E, Perazzoli F, Negro A, Sani C, Davoli S, Dotti C, et al. Acute effects of intravenous sodium chloride load on calcium metabolism and on parathyroid function in patients with primary aldosteronism compared with subjects with essential hypertension[J]. Am J Hypertens. 1998;11(1 Pt 1):8.

    Article  CAS  Google Scholar 

  32. Kota S, Jammula S, Kota S, Meher L, Modi K. Correlation of vitamin D, bone mineral density and parathyroid hormone levels in adults with low bone density[J]. Indian J Orthop. 2013;47:402–7.

    Article  Google Scholar 

  33. Neves KR, Graciolli FG, Dos Reis LM, Graciolli RG, Neves CL, Magalhães AO, et al. Vascular calcification: contribution of parathyroid hormone in renal failure[J]. Kidney Int. 2007;71:1262–70.

    Article  CAS  Google Scholar 

  34. Mary A, Hartemann A, Brazier M, Aubert CE, Kemel S, Salem JE, et al. Higher parathyroid hormone levels are associated with increased below-the-knee arterial calcification in type 2 diabetes[J]. Diabetes Metab. 2018;44:305–8.

    Article  CAS  Google Scholar 

  35. Cheng Z, Ye T, Ling Q, Wu T, Wu G, Zong G. Parathyroid hormone promotes osteoblastic differentiation of endothelial cells via the extracellular signal-regulated protein kinase 1/2 and nuclear factor-κB signaling pathways[J]. Exp Ther Med. 2018;15:1754–60

    CAS  PubMed  Google Scholar 

  36. Williams Rachael. Parathyroidectomy might reduce cardiovascular calcification in dialysis patients[J]. Nat Clin Pract Nephrol. 2005;1:64–5.

    Article  Google Scholar 

  37. Krysiak R, Kobielusz-Gembala I, Okopień B. Primary aldosteronism in a patient after surgical treatment of primary hyperparathyroidism[J]. Przegl Lek. 2011;68:388–90.

    PubMed  Google Scholar 

  38. Concistré A, Petramala L, Zinnamosca L, Settevendemmie A, Corpaci F, Marinelli C, et al. Primary aldosteronism with concurrent primary hyperparathyroidism: clinical case load in a single centre.[J]. Eur Rev Med Pharm Sci. 2015;19:971–6.

    Google Scholar 

  39. Asbach E, Bekeran M, König A, Katharina L, Gregor H, Marcus T, et al. Primary and secondary hyperparathyroidism in patients with primary aldosteronism–findings from the german conn’s registry[J]. Exp Clin Endocrinol Diab. 2020;128:246–54.

    Article  CAS  Google Scholar 

  40. Gao X, Yamazaki Y, Onodera Y, Ogata H, Omata K, Morimoto R. et al. The crosstalk between aldosterone and calcium metabolism in primary aldosteronism~A possible calcium metabolism-associated aberrant “neoplastic” steroidogenesis in adrenals~[J]. J Steroid Biochem Mol Biol. 2019;21:1–37.

    Google Scholar 

  41. Deska M, Romuk E, Segiet OA, Truchanowski W, Stolecka D, Birkner E, et al. Oxidative stress and angiogenesis in primary hyperparathyroidism[J]. Eur Surg. 2017;49:118–26.

    Article  Google Scholar 

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Funding

This study was supported by the Nonprofit Central Research Institute Fund of the Chinese Academy of Medical Sciences [2019PT330003].

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  1. These authors contributed equally: Tilakezi Tuersun, Qin Luo

Authors and Affiliations

  1. Hypertension Center of People’s Hospital of Xinjiang Uygur Autonomous Region; Xinjiang Hypertension Institute, National Health Committee Key Laboratory of Hypertension Clinical Research, Urumqi, 830001, Xinjiang, China

    Tilakezi Tuersun, Qin Luo, Zhihua Zhang, Guoliang Wang, Delian Zhang, Menghui Wang, Ting Wu, Keming Zhou, Na Yue & Nanfang Li

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  1. Tilakezi Tuersun
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Correspondence to Nanfang Li.

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The study was conducted in accordance with the principles of the Declaration of Helsinki and its amendments and was approved by the Ethics Committee of People’s Hospital of Xinjiang Uygur Autonomous Region.

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Tuersun, T., Luo, Q., Zhang, Z. et al. Abdominal aortic calcification is more severe in unilateral primary aldosteronism patients and is associated with elevated aldosterone and parathyroid hormone levels. Hypertens Res 43, 1413–1420 (2020). https://doi.org/10.1038/s41440-020-0529-7

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