Clinical Trial: The Effect of Disease-specific Treatment on Bone Turnover Markers in Patients With Primary Aldosteronism

Study Status: Completed
Recruit Status: Completed
Study Type: Observational

Official Title: The Effect of Disease-specific Treatment on Bone Turnover Markers in Patients With Primary Aldosteronism

Brief Summary:

Primary aldosteronism (PA) is a disorder of the adrenal gland causing an autonomous overproduction of mineralocorticoids, leading to arterial hypertension. Although rare, it is the most frequent cause of secondary hypertension. Early detection is important to avoid end organ damage, specifically cardiovascular and metabolic morbidity. Recent studies showed a positive correlation between patients with PA with lower bone density especially at the spine, with significant improvement post treatment, either medically or surgically. There was also a positive correlation between high aldosterone renin ratio with higher levels of intact parathyroid hormone (iPTH) which is responsible for cortical bone loss especially at the distal forearm.

We hypothesize that our patients with PA have a higher level of iPTH, with lower bone density especially at the distal forearm, with improvement post treatment.

Detailed Summary:

In 2004, through an animal model study, rats given aldosterone/salt treatment were found to have reduction in bone mineral density (BMD) and cortical bone strength. This was believed to be due to hypermagnesuria and hypercalciuria leading to bone loss.

This led to subsequent studies which found the association between PA with low serum ionized calcium, increased urine calcium and magnesium, raised intact parathyroid hormone (PTH) levels with subsequent low bone mineral density.

In one small study of 11 patients with confirmed PA taken from a cohort of 188 patients with adrenal incidentaloma, BMD of vertebral, total and neck of femur was found to be lower than non-PA patients, with a higher prevalence of vertebral osteoporotic fractures (72.7% among PA patients vs 20% among non-PA patients). Serum PTH was significantly higher in PA group compared to non-PA group. Six months of treatment either medically or surgically led to significant decrease of urinary calcium excretion and PTH in PA group. Lumbar spine BMD showed significant improvement one year after treatment in 5 patients.

The cross-sectional and interventional data from the GECOH study, which was conducted in a tertiary center in Austria on patients confirmed to have PA, looked at differences in PTH levels between patients with PA (n=10) and essential hypertension (EH) (n=182) and found PTH levels to be significantly higher in PA patients compared with EH group. Treatment with either adrenalectomy or mineralocorticoid receptor antagonists led to a significant decrease of PTH concentrations. Both of these studies had no significant differences in serum Vitamin D level in both cases and controls, as well as pre and post treatment for PA patients. However in the latter study, PTH reduction was found to be more significa
Sponsor: University Malaysia Sarawak

Current Primary Outcome: Bone mineral density [ Time Frame: 3 months ]

Original Primary Outcome: Same as current

Current Secondary Outcome: Bone turnover markers [ Time Frame: 3 months ]

Original Secondary Outcome: Same as current

Information By: University Malaysia Sarawak

Dates:
Date Received: August 12, 2014
Date Started: August 2014
Date Completion:
Last Updated: November 30, 2015
Last Verified: November 2015