Indications for primary aldosteronism screening in people with hypertension and hyperparathyroidism: a multi-centre...

Parathyroid hormone (PTH) excess is associated with hypertension while elevated PTH has been observed in primary aldosteronism (PA). This study aimed to determine the proportion of patients with hyperparathyroidism who met Endocrine Society criteria for PA screening, and to assess current screening practices.

Multi-centre retrospective cohort study including patients attending outpatient endocrine clinics at three tertiary health services in Victoria, Australia between 2015-2019. Patients were included if they had an elevated PTH level and excluded if they had a secondary cause of hyperparathyroidism or a prior diagnosis of PA. Demographic, clinical and biochemical data were extracted from electronic medical records.

Of 275 patients with hyperparathyroidism, hypertension was present in 51.6%; including 62.4% of patients with hypercalcaemia and 35.5% of those with normocalcaemia. Overall,15.6% (43/275) had a guideline indication for PA screening, including 21.8% (36/165) of those with hypercalcaemia and 6.4% (7/110) of those with normocalcaemia. Of those with hypertension, 30% (43/142) had a guideline indication for PA screening. The most common indication for screening was hypertension and hypokalaemia (16/43). Despite this, only 9.3% (4/43) were screened, with one confirmed PA diagnosis.

Hypertension is common in patients with hyperparathyroidism. A third of patients with hyperparathyroidism and hypertension had a guideline indication for PA screening, however screening remains substantially under-utilised. A prospective study is needed to evaluate the prevalence and impact of PA in patients with hyperparathyroidism.