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Multicenter Study
. 2025 Jul;48(7):1611-1622.
doi: 10.1007/s40618-025-02563-y. Epub 2025 Apr 19.

Impact of primary aldosteronism on calcium phosphate homeostasis. Results from the SPAIN-ALDO

María Bernarda Iriarte-Durán  1 , Miguel Paja Fano  2 , Alicia Rizo Gellida  3 , Marga González-Boillos  3 , Paola Parra Ramírez  4 , Patricia Martín Rojas-Marcos  4 , Laura Caja  5 , Ana M García Cano  5 , Jorge Gabriel Ruiz-Sanchez  6 , Almudena Vicente  7 , Emilia Gómez-Hoyos  8 , Mònica Recasens  9 , Rebeca Barahona San Millan  9 , María José Picón César  10 , Patricia Díaz Guardiola  11 , Carolina M Perdomo  12 , Laura Manjón-Miguélez  13 , Ángel Rebollo Román  14 , Cristina Robles Lázaro  15 , José María Recio  15 , María Calatayud  16 , Noemi Jiménez López  16 , Miguel Sampedro Nuñez  17 , Elena Mena Ribas  18 , Alicia Sanmartín Sánchez  18 , Cesar Gonzalvo Diaz  19 , Cristina Lamas  19 , Joaquín Serrano  20 , Theodora Michalopoulou  21 , Susana Tenes Rodrigo  22 , Fernando Jaén Aguila  23 , Eva María Moya Mateo  24 , Sonsoles Gutiérrez-Medina  25 , Felicia Alexandra Hanzu  26 , Marta Araujo-Castro  27
Affiliations
Multicenter Study

Impact of primary aldosteronism on calcium phosphate homeostasis. Results from the SPAIN-ALDO

María Bernarda Iriarte-Durán et al. J Endocrinol Invest. 2025 Jul.

Abstract

Purpose: To determine the prevalence of hyperparathyroidism (HPT), including primary, secondary and normocalcemic in a cohort of patients with PA of the SPAIN-ALDO registry.

Methods: A retrospective multicenter study of primary aldosteronism (PA) patients followed in 37 Spanish tertiary hospitals and with available information on serum calcium, phosphorus, iPTH, and vitamin D at the time of PA diagnosis. The diagnosis of normocalcemic HPT (n-HPT) associated with PA was based on a iPTH > 65pg/mL with normal corrected serum calcium after excluding the most common causes of secondary HPT, and HPT was classified as secondary (S-HPT) in the presence of chronic kidney disease or vitamin D deficiency, and as primary (PHPT) when iPTH levels >65 pg/mL were associated with high serum calcium levels.

Results: A total of 246 patients with PA were included, of whom 56% (n = 139) had PTH > 65 pg/mL. In the group of participants with HPT (n = 139) the proportion of PHPT was 7.2%, of n-HPT 11.5% and of S-HPT 81.3%. Patients with n-HPT had a higher prevalence of atrial fibrillation (7.9% vs. 1.9%, P = 0.04) and hypokalemia (71.6% vs. 46.2%, P < 0.001) and greater aldosterone (33.2 vs. 26.8 ng/dL, p = 0.003) and 24 h urinary calcium excretion ( 243.5 vs. 160.5 mg/24 h, p = 0.01) than patients without hyperparathyroidism. No differences in surgical outcomes (biochemical and clinical response) were detected between patients with and without hyperparathyroidism.

Conclusions: HPT is a frequent condition in patients with PA and S-HPT is the most common etiology. Patients with HPT have a higher prevalence of atrial fibrillation and hypokalemia and a more severe PA than those without HPT. However, no differences in surgical outcomes were reported between patients with and without HPT.

Keywords: Aldosterone; Calcium; Hyperparathyroidism; Parathyroid hormone; Primary aldosteronism.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare no conflict of interest. Informed Consent: Patient consent was waived due to the retrospective nature of the study. Institutional Review Board: The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Ethics Committee of the Hospital Universitario Ramón y Cajal. Madrid. Spain (approval date: 10th November 2020, code: ACTA 401).

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