Aldosterone Variations in Patients With Primary Hyperparathyroidism After Surgery

Primary hyperparathyroidism is a disorder of calcium and phosphorus metabolism linked to dysfunction of one or more parathyroid glands, without any underlying chronic kidney disease. The disease manifests itself in its classic forms as elevated blood calcium, parathyroid hormone and calcium levels. It has an impact on bone mineralisation, the presence of kidney stones, glucose metabolism (1)(2) and cardiovascular function (3)(4)(5).

A Scottish study published in 2023, based on a robust medical information system enabling prospective follow-up, showed an overall prevalence of primary hyperparathyroidism between 2007 and 2018 of 0.84%, which was much higher in women (1.18%) than in men (0.48%) (6) The latest recommendations from the American Association of Endocrine Surgeons (7) consider the presence of hypertension as an argument for proposing the removal of a parathyroid adenoma in the context of primary hyperparathyroidism: 'Parathyroidectomy may be offered to surgical candidates with cardiovascular disease who might benefit from mitigation of potential cardiovascular sequelae other than hypertension.' There appears to be an association between hypertension and primary hyperparathyroidism (4)(5). Its mechanism is currently poorly understood and little described. Using the keywords 'hyperaldosteronism' AND 'hyperparathyroidism', we found only one case report (in Spanish) and one article, but these focused more on patients already suffering from primary hyperaldosteronism (8)(9).

The renin-angiotensin-aldosterone system is involved in regulating blood pressure.

This is why we systematically measure aldosterone and renin preoperatively and at three postoperative points following surgery for primary hyperparathyroidism.

This is a retrospective study including among 400 patients with primary hyperparathyroidism. Allt his patients underwent parathyroidectomy.

Inclusion critera : patients with primary hyperparathyroidism, age\>18 years Exclusion criteria : patients with hyperparathyroidism and renal insuffisency Pregant women, patients \< 18 years. All patients underwent blood tests including PTH, calcium, aldosterone and renin levels before surgery and 3 months, 6 months and 12 months after surgery.

The number and type of antihypertensive treatments were systematically recorded before and 3 months after surgery.

In a second step, the aldosterone levels of patients with primary hyperparathyroidism will be compared with a cohort of patients from the general population: the STNISLAS cohort, and with a cohort of patients with cardiovascular disease. This will enable to identify whether aldosterone levels in the population of patients with primary hyperparathyroidism differ from those in the general population.

The Main objective is to assess the role of phosphorus-calcium metabolism on the renin-angiotensin system in patients with primary hyperparathyroidism (PHPT)

The Secondary objectives are :

1. To describe the evolution of the renin-angiotensin system (plasma aldosterone and renin levels) before and after parathyroidectomy (at 3, 6 and 12 months) in patients with PHPT. 2. To evaluate the links between changes in phosphorus-calcium metabolism and variations in plasma aldosterone and renin levels after surgery for PHPT. 3. To evaluate changes in the number and dosage (WHO-DDD classification) of antihypertensive medications before and after surgery for PHPT. 4. To evaluate changes in blood pressure values before and after surgery for PHPT (five measurements). 5. To evaluate the links between blood pressure values before and after surgery for PHPT and changes in plasma aldosterone and renin levels. 6. To compare the renin-angiotensin system (plasma aldosterone and renin levels) in patients with PHPT versus healthy patients from the general population (STANISLAS cohort)

8\) To compare the renin-angiotensin system (plasma aldosterone and renin levels) in patients with PHPT versus patients with cardiovascular disease (REMI cohort)

• Plasma Parathormon levels [Time frame: 3 months before surgery to 12 months after surgery The measure is done at 3,6 and 12 months after surgery]
• Plasma Calcium and Phosphorus levels [Time frame: 3 months before surgery to 12 months after surgery The measure is done at 3,6 and 12 months after surgery]
• Plasma renin levels [Time frame: 3 months before surgery to 12 months after surgery The measure is done at 3,6 and 12 months after surgery]
• type and number of antihypertensive medications [Time frame: from 3 months before surgery to 3 months after]
• WHO_DDD classification [Time frame: from 3 months before surgery to 3 months after]
• Systolic and diastolic blood pressure (SBP and DBP) [Time frame: from 3 months before surgery to 3 months after]
• Preoperative glomerular filtration rate (GFR) [Time frame: 3 months before surgery.]
• Preoperative 25 OH vitD [Time frame: 3 months before surgery]
• Preoperative 24h calciuria [Time frame: 3 months before surgery]
• Kidney stones [Time frame: 3 months before surgery]
• femoral T score [Time frame: 3 months before surgery]