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Objective There is limited knowledge about the natural history of normocalcaemic, vitamin D-sufficient hyperparathyroidism ( nHPT). The aim was to study the prevalence of nHPT and its relation to morbidity. Design Cross-sectional and retrospective study at the Sahlgrenska University Hospital, Gothenburg, Sweden. Subjects A random population of 608 men and women, age 25-64 years, was studied in 1995 as part of the WHO MONICA study and reinvestigated in 2008 ( n = 410, of whom 277 were vitamin D sufficient). Measurements A serum intact parathyroid hormone (S- PTH) ≥60 ng/l was considered as HPT, S-calcium 2·15-2·49 mmol/l as normocalcaemia and S-25( OH)D ≥ 50 nmol/l as vitamin D sufficiency. Data on fractures, stroke and myocardial infarction were retrieved until 2013, that is a 17-year follow-up. Results The prevalence of nHPT was 2·0% in 1995 (age 25-64) and 11·0% in 2008 (age 38-79). S- PTH was positively correlated with age and BMI. After adjustment for these variables, a high S- PTH level (≥60 ng/l) at follow-up was associated with previously low S-25( OH)D, high osteocalcin, S- PTH and both past and presently treated hypertension. No relation was seen with creatinine, cystatin C, malabsorption markers, thyroid function, glucose, insulin, lipids, calcaneal quantitative ultrasound, fractures, myocardial infarction, stroke or death at follow-up. Conclusions This small random population study showed that nHPT was common, 11% at follow-up. Only one individual developed mild hypercalcaemia in 13 years. Previous S- PTH was predictive of nHPT and hypertension was prevalent, but no increase in hard end-points was seen over a 17-year period. [ABSTRACT FROM AUTHOR]

Eur J Clin Invest 2011; 41 (11): 1227-1236 Abstract Background Previous studies based on standard endocrine testing have generally shown a low prevalence of primary aldosteronism, a form of autonomous aldosterone secretion (AAS), in hypertensive individuals. The purpose of this case-control study was to evaluate whether use of appropriately defined controls and combined testing reveal previously undetected AAS in hypertensives. Materials and methods We investigated aldosterone secretion in 180 hypertensives with ( n = 44) and without ( n = 136) adrenal adenomas on computerized tomography (CT) and 72 matched nonhypertensive individuals with normal adrenal CT. Serum aldosterone and active renin were measured, and the aldosterone/active renin ratio was calculated before and after a modified fludrocortisone-suppression test (FST).In the latter, to eliminate any stimulatory effect of endogenous stress-induced adrenocorticotrophin hormone on aldosterone secretion, we administered 1 mg of dexamethasone on the last day of the classical FST fludrocortisone/dexamethasone suppression test (FDST). Results Using the 97·5 percentiles of serum aldosterone (74 pM L−1) and the aldosterone/renin ratio (32 pM L−1 mU−1 L−1) values obtained from the controls following the FDST, normal cut-off values indicative of adequate aldosterone suppression were established. Using the combination of these cut-offs, the estimated prevalence of AAS in patients with hypertension was 31%. Multiple linear regression analysis revealed a significant correlation between systolic and/or diastolic arterial blood pressure and the aldosterone value ( P < 0·0001 and P < 0·01, respectively) and/or the aldosterone/renin ratio ( P < 0·0001 and P < 0·01, respectively), which were obtained following the FDST. Conclusions By applying new cut-offs obtained following modification of standard testing, AAS is quite prevalent in hypertensive individuals and correlates highly with arterial blood pressure. This may have relevance for both the aetiology of the hypertension and its optimal therapy. [ABSTRACT FROM AUTHOR]