Endocrine Abstracts (2013) 32 P54 | DOI: 10.1530/endoabs.32.P54

Hyperaldosteronism in patients with hyperparathyroidism: three cases

Teresa Ruiz Gracia, Francisco Fernandez Capel, Nuria Fuertes Zamorano, Emilia Gomez Hoyos, Martin Cuesta Hernandez, Alfonso Calle Pascual & Isabelle Runkle De La Vega

Hospital Clinico San Carlos, Madrid, Spain.

Introduction: Hyperaldosteronism can induce elevated parathyroid hormone (PTH) levels, presumably by increasing calciuria. Furthermore, PTH stimulates aldosterone secretion in vitro, and increases angiotensin–II-stimulated aldosterone release. In a patient with hyperaldosteronism and hyperparathyroidism, PTH receptors were detected in aldosteronoma tissue. We present three patients sent to an endocrinologist for treatment/follow-up of primary hyperparathyroidism, with resistant hypertension, in whom hyperaldosteronism was diagnosed. Aldosterone (ald) and renin (re) (RIA) are expressed in pg/ml. The captopril test (CAP) was performed per protocol: minimum 2 weeks on doxazosin as sole antihypertensive, minimum 133 mEq sodium intake for 3 days, basal ald/re (Bald/re), 1 and 2 h post-25 mg captopril. Test positive if 2 h ald >120 or ald/re >50.

Case 1: A 74-year-old male presented calcemia(Ca): 11.1 mg/dl, PTH (IRMA) 71 pg/ml. Office BP: 160/95 mmHg, on losartan (100 mg), amlodipine (10 mg), hydrochlorothiazide (25 mg), and atenolol (50 mg). Ultrasound: parathyroid adenoma. He rejects parathyroid surgery. Treatment: cinacalcet 30 mg/day. CAP: Bald/re 352/3=117.3 1 h:339/2=169.5, 2 h: 408/3=136. He rejects adrenal catheterization/surgery. Treatment: eplerenone 50 mg b.i.d.

Case 2: A 68-year-old female is referred following parathyroidectomy for parathyroid hyperplasia. Pre-surgical Ca: 11.4 mg/dl, PTH(IRMA): 84 pg/ml, Office BP: 200/100 mmHg on losartan (50 mg), hydrochlorothiazide (12.5 mg), atenolol (50 mg). CAP: Bald/re 174/4=43.5, 1 h:224/4=55.5 2 h: 170/5=34. The patient rejects catheterization/surgery. Treatment: eplerenone 50 mg b.i.d.

Case 3: A 81-year-old female presents Ca: 10.9 mg/dl, PTH (ChL) 129 pg/ml, Office BP: 175/90 mmHg on nebivolol (5 mg), lercardipine (20 mg), and furosemide (40 mg). Parathyroid disease not detected by Ultrasound. CAP: Bald/re 203/2=101.5, 1 h: 129/6=21.5, 2 h:169/9=18.7. Treatment: spironolactone (100 mg/24 h), cinacalcet (30 mg/day).

Conclusions: Three cases of hyperaldosteronism associated with hyperparathyroidism were detected in the clinic of a single endocrinologist over 2 years, suggesting that the association is not infrequent, and underlying the importance of ruling out hyperaldosteronism in patients with hyperparathyroidism and moderate/severe or resistant hypertension.

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