title: Bone involvement in aldosteronism.
abstract: In rats with aldosteronism, a reduction of bone mineral density (BMD) and cortical bone strength has been reported. Our study was aimed to evaluate bone involvement in patients with primary aldosteronism (PA). A total of 188 consecutive subjects with adrenal incidentaloma, observed between November 2009 and October 2011, were screened for PA with aldosterone-to-renin ratio. After confirmatory tests, in those who screened positive, 11 patients were diagnosed as PA and 15 patients were not (nPA). A serum/urinary biochemical profile, parathyroid hormone (PTH), BMD measured at lumbar spine (LS) and total and femoral neck (TN and FN) by dual X-ray absorptiometry, and conventional spinal radiographs (T(4) -L(4) ) were obtained in all subjects. PA patients had a significantly higher 24-hour urinary calcium (6.28 ± 1.85 versus 4.28 ± 1.18 mmol/d; p < 0.01), and PTH (9.8 [5.8-14.6], median [range] versus 5.3 [2.5-10.8] pmol/L; p < 0.01) than nPA patients. BMD expressed as Z-value at LS (-1.18 ± 0.99 versus 0.22 ± 1.12), FN (-0.85 ± 0.73 versus 0.01 ± 0.82), and TN (-0.49 ± 0.61 versus 0.39 ± 0.93) was lower in PA than in nPA (p = 0.003, p = 0.011, and p = 0.012, respectively). The prevalence of osteoporosis was higher in PA than in nPA (8/11, 72.7% versus 3/15, 20.0%; Fisher's exact test: p = 0.015). Vertebral fractures tended to be more prevalent in PA than in nPA (5/11, 45.5% versus 2/15, 13.3%; Fisher's exact test: p = 0.095). Logistic regression analysis showed that osteoporosis and morphometric vertebral fractures were associated with PA (odds ratio [OR], 15.4; 95% confidence interval [CI] = 1.83-130, p = 0.012; and OR, 30.4; 95%CI, 1.07-862, p = 0.045, respectively) regardless of age, body mass index (BMI), and LS-BMD. In 9 of 11 PA patients, 6 months after beginning of treatment (surgery or spironolactone) there was a significant reduction of urinary calcium excretion (p < 0.01) and PTH (p < 0.01), whereas in 5 of 11 PA patients, 1 year after beginning of treatment, BMD was significantly increased at LS, p < 0.01). In conclusion, PA is associated with osteoporosis, vertebral fractures, and increased urinary calcium excretion.
authors.affiliation: Endocrinology Unit, Casa Sollievo della Sofferenza, IRCCS, San Giovanni Rotondo (FG), Italy.
authors.forename: Antonio Stefano
authors.initials: AS
authors.lastname: Salcuni
authors.forename: Serena
authors.initials: S
authors.lastname: Palmieri
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Carnevale
authors.forename: Valentina
authors.initials: V
authors.lastname: Morelli
authors.forename: Claudia
authors.initials: C
authors.lastname: Battista
authors.forename: Vito
authors.initials: V
authors.lastname: Guarnieri
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Guglielmi
authors.forename: Gaetano
authors.initials: G
authors.lastname: Desina
authors.forename: Cristina
authors.initials: C
authors.lastname: Eller-Vainicher
authors.forename: Paolo
authors.initials: P
authors.lastname: Beck-Peccoz
authors.forename: Alfredo
authors.initials: A
authors.lastname: Scillitani
authors.forename: Iacopo
authors.initials: I
authors.lastname: Chiodini
mesh_terms: D000818:Animals; D015519:Bone Density / Q000502:physiology; D001842:Bone and Bones / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002118:Calcium / Q000097:blood / Q000652:urine; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000652:urine; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D011859:Radiography; D051381:Rats
chemical_list: D010281:Parathyroid Hormone; D002118:Calcium