Subtype- and treatment-based analysis of calcium dynamics in primary aldosteronism
Authors' conclusion
Adrenalectomy was associated with greater improvements in calcium abnormalities than MRAs in patients with UPA, consistent with its cardiovascular benefits. These findings underscore the importance of subtype-specific strategies and suggest that adrenalectomy may offer additional benefits beyond cardiovascular outcomes.
Study context
- Population
- Patients with primary aldosteronism (PA); before/after treatment comparisons in 43 with unilateral PA (UPA) and 131 with bilateral PA (BPA)
- Participants
- 352 vs 57
- Exposure
- PA vs controls; adrenalectomy vs mineralocorticoid receptor antagonists (MRAs) in UPA
- PAn = 352
- Controlsn = 57reference
- Outcome
- Urinary FECa and iPTH, PA vs controls
Main finding
As reported in the abstract
| Group | Value | Intact PTH (iPTH) |
|---|---|---|
| PA | 1.28% | 60.0 pg/mL |
| Controls | 1.04% | 57.0 pg/mL |
Value
PA1.28%
Controls1.04%
Intact PTH (iPTH)
PA60.0 pg/mL
Controls57.0 pg/mL
- PA vs Controls: P < 0.001 — fractional excretion of calcium (FECa) higher in PA
- PA vs Controls: P = 0.047 — iPTH higher in PA
Observational data: associations, not effects.
Further findings
FECa and iPTH in UPA
- FECa in UPA
- 1.50%
- iPTH in UPA
- 73.1 pg/mL
Post-treatment FECa in UPA, adrenalectomy vs MRA
- FECa post-MRA
- 0.68%
- FECa post-adrenalectomy
- 0.36%
- Both treatments reduced FECa and iPTH; adrenalectomy gave greater improvement than MRAs
FECa in BPA after MRAs · after treatment
- MRAs decreased FECa irrespective of disease severity
Original publication
Subtype- and treatment-based analysis of calcium dynamics in primary aldosteronism. Eur J Endocrinol. Published 20 February 2026. doi:10.
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