Relationship Between Parathyroid Hormone And Cardiac Damage And Adrenal Mass In Patients With Primary Aldosteronism

Objective:1.To investigate the changes and influencing factors of parathyroid hormone(PTH)in primary aldosteronism.2.To explore the relationship between PTH and primary aldosteronism heart damage.3.To explore the relationship between PTH and adrenal mass size in primary aldosteronism.Methods:Clinical data of patients with primary aldosterone disorder(PA)diagnosed in the first affiliated hospital of guangxi medical university from July 2012 to October 2018 and patients with primary hypertension(EH)diagnosed in the same period of hospitalization were retrospectively analyzed.The hematuric electrolytes,PTH levels and cardiac structural and functional indicators of PA patients and EH patients were compared and analyzed,as well as the PTH status between different adrenal occupying groups of PA patients.Results:1.Biochemical indexes of 71 PA patients and 46 EH patients:(1)compared with EH group,PTH,24 h urinary potassium,urinary sodium,urinary calcium levels in PA group were higher,and serum potassium levels were decreased(P<0.05).Spearman correlation analysis showed that PTH in PA group was negatively correlated with serum potassium(r=-0.334,P=0.004),serum calcium(r=-0.239,P=0.044),and positively correlated with serum sodium(r=0.269,P=0.023),urinary potassium(r=0.345,P=0.003),and aldosterone(r=0.292,P=0.013).(3)multiple linear stepwise regression analysis showed that serum potassium(?=-0.310,P=0.007)and decustrine PAC(?=0.249,P=0.028)were independent influencing factors of PTH change in PA group.2.Results of cardiac ultrasound in 48 PA patients and 34 EH patients:(1)Compared with EH group,the levels of aortic root diameter,left atrial diameter,left ventricular end diastolic diameter and left ventricular end systolic diameter in PA group were higher(P<0.05).(2)PA patients were divided into groups according to their median PTH level(46.85pg/mL).The left ventricular mass index(LVMI)of the high PTH group was higher than that of the low PTH group(P<0.05).(3)Spearman correlation analysis showed that PTH level in PA group was positively correlated with left ventricular end diastolic inner diameter,left ventricular end systolic inner diameter,left ventricular mass(LVM),LVMI(r=0.338,0.294,0.287,0.395,all P<0.05).3.Adrenal mass :(1)Among the 71 PA patients,42 cases of adrenal mass were suggested by CT,including 36 cases(85.70%)of adenoma,5 cases(11.90%)of nodular hyperplasia,and 1 case(2.40%)of adenoma with nodular hyperplasia.There were 21 cases(50%)on the left,17 cases(40.48%)on the right,and 4 cases(9.52%)on both sides.There were 11 male cases(26.19%)and 31 female cases(73.81%).The diameter ranges from 0.4cm to 3.9cm.Divided into three groups according to the diameter: <1cm group,1-2cm group,?2cm group.(2)Clinical characteristics of 42 PA patients with different space occupying sizes:(1)Comparison of diameter,diastolic blood pressure,body mass index,specific gravity of urine,bicarboxylate,blood potassium,24 h urinary potassium,recumbent PAC and PTH in the three groups showed statistically significant differences(P <0.05),while no difference was found between the other groups(P>0.05).(2)The Bonferroni correction method two comparison results show that: with the diameter of < 1 cm group,the diameter of the diameter of 1-2 cm group,diastolic blood pressure,and bicarbonate PTH level higher(P < 0.05);In the group with diameter ?2cm,the diameter,bicarboxylate,24 h urinary potassium and PTH levels were higher,while the body mass index,urine specific gravity and blood potassium levels were lower(P<0.05).Compared with the group with a diameter of 1-2cm,the diameter and PAC level of the group with a diameter ?2cm were higher,while serum potassium was significantly reduced(P<0.05).(3)5 cases of hyperplasia were removed and analyzed again:(1)Comparison of diameter,body mass index,serum potassium,serum sodium,24 h urinary potassium and PTH in the three groups showed statistically significant differences(P<0.05),while there was no difference between the remaining indicators groups(P>0.05).(2)The Bonferroni correction method two comparison results show that: with the diameter of < 1 cm group,the diameter of the diameter of 1-2 cm group,PTH level higher(P< 0.05);In the group with diameter?2cm,the diameter,serum sodium,24 h urinary potassium and PTH levels were higher,while the bmi and serum potassium were lower(P<0.05).(2)Compared with the group with a diameter of 1-2cm,the serum potassium in thegroup with a diameter of ?2cm was significantly reduced(P<0.05).(4)Spearman correlation analysis results showed that:Before the removal of hyperplasia patients,diameter was positively correlated with diastolic blood pressure,bicarboxylate,serum sodium,24 h urinary potassium,PTH(r = 0.316,0.530,0.345,0.518,0.524,all P<0.05),and negatively correlated with body mass index,serum uric acid,and serum potassium(r =-0.424,-0.355,-0.506,all P<0.05).After removing 5 patients with hyperplasia,diameter was positively correlated with bicarboxylate,serum sodium,24 h urinary potassium,PTH,PAC(r = 0.449,0.387,0.504,0.422,0.349,all P<0.05),and negatively correlated with body mass index,serum uric acid,and serum potassium(r =-0.349,-0.325,-0.415,all P<0.05).Conclusion:1.Compared with EH patients,PA patients have higher PTH level,more obvious electrolyte disorder and more serious heart damage.2.PTH may be related to the occurrence of heart damage in PA patients.3.Adrenal mass diameter was positively correlated with PTH and negatively correlated with serum potassium in PA patients;The relationship with aldosterone needs to be further clarified.4.The larger the adrenal mass,the higher the diastolic blood pressure,and the lower the body mass index and blood uric acid level in PA patients.