| Background and objective: Primary aldosteronism(PA)is the most common endocrine hypertensive disorder and mainly includes idiopathic aldosteronism(IHA)and aldosteronoma(APA).Plasma aldosterone/renin ratio(ARR)is the preferred index for PA screening,but age,body position,medications,potassium,renal function and renin assay methods all have an effect on ARR,with the effect of age on the diagnostic cut point of ARR in patients with PA reported inconsistently in the literature.Recent studies found increased serum parathyroid hormone(PTH)levels in patients with PA,suggesting that PTH may be a new feature of PA,but whether PTH can be used as an indicator for screening or subtyping PA is still inconclusive.Therefore,this study summarizes and analyzes clinical data such as ARR and PTH levels in patients with PA and essential hypertension(EH),observes the changes of age-related ARR,and explores the auxiliary diagnostic value of PTH for PA.Methods:1.230 PA patients with a mean age of 49.32 ± 11.09 years and181 patients with a mean age of 47.61 ± 12.62 years diagnosed with EH between January 1st,2017 and December 31 st,2021 in the Department of Endocrinology,Xiangya Hospital,Central South University were included.General data such as age,gender,BMI,biochemical results such as blood electrolytes,urine electrolytes,blood lipids,glycated hemoglobin,upright aldosterone concentration(PAC),upright renin concentration(DRC),PTH and 25 hydroxyvitamin D were collected and comparatively analyzed.2.The study subjects were divided into≤39,40-49,50-59,and ≥60 years old groups,and the age-related ARR cut points were analyzed using receiver operating curve(ROC curves).3.The study subjects were divided into idiopathic aldosteronism group,aldosteronoma group and primary hypertension group,and the differences of PTH between three groups were compared,and the value of PTH as an aid to diagnose PA was explored using the ROC curve.Besides,the correlation analysis of the factors affecting PTH levels was performed.Results:1.PA patients with longer duration of diagnosed hypertension had lower blood potassium,blood calcium,albumin,uric acid,and HDL,while urinary potassium,urinary calcium,and PTH levels were relatively higher,and the difference was significant(P < 0.05).The differences in blood phosphorus,blood magnesium,urinary sodium levels,LDL,triglycerides,cholesterol,glycosylated hemoglobin and 25 hydroxyvitamin D were not statistically significant in two groups.2.PAC and DRC decreased with age and ARR showed an increasing trend with age in EH patients,while in PA patients,DRC,PAC and ARR did not show any change with age and were no significant correlation with age.3.In patients with EH,age was significantly negatively correlated with upright PAC and upright DRC,positively correlated with upright ARR.In PA patients,age was not significantly correlated with upright PAC,upright DRC and upright ARR(P > 0.05).4.The optimal cut point for ARR to diagnose PA was 22.52,corresponding to an area under the ROC curve(AUC)of 0.907(95% CI: 0.878-0.936),sensitivity of 87.0%,specificity of 82.9%,Youden index of 0.698,and positive likelihood ratio of 2.880.5.PTH levels were 82.07 ± 34.39pg/m L,62.34 ± 36.20pg/m L and 50.22 ±21.54pg/m L in APA,IHA and EH patients,respectively,and there were significant differences among them,but the differences in the distribution of PTH levels in IHA and EH patients were relatively small.PTH levels are higher in patients with APA,which can assist in identifying APA and IHA,with a cut point value of 54.01,an area under the ROC curve of 0.686,and a maximum Youden index of 0.340,corresponding to a sensitivity of 80.0%,a specificity of 54.0%,and a positive likelihood ratio of 1.740.6.PTH level was negatively correlated with blood potassium level,blood calcium level and 25 hydroxyvitamin D level,positively correlated with urinary potassium level and upright PAC level,and not correlated with blood phosphorus level,urinary calcium level and upright DRC level.Conclusion:1.The levels of renin and aldosterone in patients with essential hypertension decreased gradually with age.The decrease in renin was more obvious,and ARR increased with age.In contrast,in PA patients there was no significant correlation between age and renin,aldosterone and ARR.2.The best ARR cut point value for the diagnosis of PA in this group was22.52,with a sensitivity of 87.0% and a specificity of 82.9%.3.PTH levels were elevated in patients with PA,especially in aldosteronism,which has some clinical reference value for the subtyping diagnosis of patients with APA and IHA. |
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