Primary AldosteronismNCT02216721
The Effect of Disease-specific Treatment on Bone Turnover Markers in Patients With Primary Aldosteronism
An observational study of Primary Aldosteronism, run by University Malaysia Sarawak at 1 site in Malaysia.
Trial 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. Read more about this study
- Who is it for?
- Ages 18 to 100 yearsHealthy volunteers can take part
- Conditions the study is for
- Primary Aldosteronism
- How many people
- 35 participants
- Where
- 1 siteMalaysia
- Study dates
- Aug 2014to May 2015
- Phase
- Observational
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 100 years
- All sexes
- Healthy volunteers accepted
- Adult, Older adult
Study population: This is a prospective study conducted in out-patient clinics of a tertiary care center. The study population consists of patients referred to our centres for endocrine hypertension.
Who may be able to join
- Age >18 years old
- Confirmed primary aldosteronism with following criteria i) Aldosterone-renin ratio > 555 SI or 30 (if aldosterone is taken in pmol/L, renin in ng/dL) and ii) Aldosterone post fludrocortisone suppression test > 166pmol/L or >6ng/dL, or iii) Aldosterone post saline suppression test >277pmol/L or >10ng/dL
Who cannot join
- Patients on medication affecting bone metabolism, eg bisphosphonates, hormonal replacement therapy, SERM, testosterone, antiandrogen, anticonvulsants, calcium and Vitamin D
- Primary aldosteronism post treatment (surgically or medically on spironolactone or eplerenone)
- Estimated GFR <30ml/min
- Severe hepatic failure
- Severe heart failure
Trial locations and contacts
1 site in 1 country.
Malaysia1 site
Hospital Universiti Kebangsaan Malaysia
Kuala Lumpur, WP Kuala Lumpur, 56000
About this study
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.
Read the detailed description
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 significant in PA patients who underwent adrenalectomy compared to patients treated medically with mineralocorticoid receptor antagonists.
A recent large-scale study on more than 3000 German general adult population showed a significant but non linear association between aldosterone-renin ratio with plasma PTH concentrations, especially in subjects with ARR>90th percentile, despite normal Vitamin D levels. This was believed to be due to the presence of parathyroid receptors type 1 in the adrenals as well as the parathyroid glands expressing mineralocorticoid receptors. However, calcium intake status as well as calcium levels were not assessed in this study.
This findings were all echoed in a few other studies which showed a positive association between PTH levels with PA which was not affected by Vitamin D status.
It is well known that high PTH level is associated with low bone mass and higher osteoporotic fracture risk due to the stimulation effect of PTH on the osteoclastic and osteoblastic activity of the bones resulting in the release of calcium and phosphate from the bone.
Up to date, to our knowledge, there has been no study on the association between PA with bone turnover markers. The use of this sensitive marker as a surrogate indicator of improvement in bone mass pre and post treatment in patients with PA either medically or surgically is novel. The relationship between calcium intake in the patients with the bone metabolism and blood parameters were not looked into previously. In addition, the involvement of peripheral cortical bone mass (distal radius), which is usually associated with elevated PTH, in this group of patients has not been studied.
In this study, we aim to:
- Assess the BMD of vertebrae, total and femoral neck, and distal third radius in PA patients compared to non-PA.
- Evaluate the effect of specific treatments on bone turnover markers and BMD in patients with PA
- Assess the relationship between BMD and bone turnover markers with serum iPTH, calcium, magnesium and vitamin D levels.
- Conditions
- Primary Aldosteronism
- Keywords
- bone mineral density, bone turnover markers, primary aldosteronism treatment
- Medical subject headings
- Hyperaldosteronism
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
| Study group | Role | What they receive |
|---|---|---|
| Non primary aldosteronism | Non primary aldosteronism patients undergoing usual anti hypertensive treatment | |
| Primary Aldosteronism | Patients with confirmed primary aldosteronism undergoing treatment |
What is being measured
The primary outcome is the main question the study is designed to answer.
Bone mineral density
Change of bone mineral density 3 months post treatment for primary aldosteronism
Measured: 3 months
Secondary outcomes (1)
Bone turnover markers
Change of bone turnover markers 3 months post treatment for primary aldosteronism
Measured: 3 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted15 Aug 2014 (estimated)
- Study startAug 2014
- Primary completionMay 2015
- Study completionMay 2015
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Primary AldosteronismStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Case-control
- Time perspective
- Prospective
- Enrolment
- 35 participants (actual)
Sponsor and investigators
- Lead sponsor
- University Malaysia Sarawak
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Dr Huai Heng, Loh, University Malaysia Sarawak
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT02216721
- Sponsor's protocol ID
- FF-2014-267
- Status last verified
- Nov 2015
- First submitted
- 12 Aug 2014
- Last updated
- 2 Dec 2015
- Results posted
- No
- Data monitoring committee
- Yes
Study at a glance
From the registry record, last updated by the sponsor on 2 Dec 2015. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- The Effect of Disease-specific Treatment on Bone Turnover Markers in Patients With Primary Aldosteronism
- ClinicalTrials.gov ID
- NCT02216721
- Acronym / sponsor ID
- FF-2014-267
- Conditions
- Primary Aldosteronism
- Keywords
- bone mineral density, bone turnover markers, primary aldosteronism treatment
- Study type
- Observational
- Recruitment status
- Completed
- Enrolment
- 35 participants (actual)
- Lead sponsor
- University Malaysia SarawakUniversity, hospital or other
- Study start
- Aug 2014
- Primary completion
- May 2015 (actual)
- Study completion
- May 2015 (actual)
- First posted
- 15 Aug 2014 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
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 description
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 significant in PA patients who underwent adrenalectomy compared to patients treated medically with mineralocorticoid receptor antagonists.
A recent large-scale study on more than 3000 German general adult population showed a significant but non linear association between aldosterone-renin ratio with plasma PTH concentrations, especially in subjects with ARR>90th percentile, despite normal Vitamin D levels. This was believed to be due to the presence of parathyroid receptors type 1 in the adrenals as well as the parathyroid glands expressing mineralocorticoid receptors. However, calcium intake status as well as calcium levels were not assessed in this study.
This findings were all echoed in a few other studies which showed a positive association between PTH levels with PA which was not affected by Vitamin D status.
It is well known that high PTH level is associated with low bone mass and higher osteoporotic fracture risk due to the stimulation effect of PTH on the osteoclastic and osteoblastic activity of the bones resulting in the release of calcium and phosphate from the bone.
Up to date, to our knowledge, there has been no study on the association between PA with bone turnover markers. The use of this sensitive marker as a surrogate indicator of improvement in bone mass pre and post treatment in patients with PA either medically or surgically is novel. The relationship between calcium intake in the patients with the bone metabolism and blood parameters were not looked into previously. In addition, the involvement of peripheral cortical bone mass (distal radius), which is usually associated with elevated PTH, in this group of patients has not been studied.
In this study, we aim to:
- Assess the BMD of vertebrae, total and femoral neck, and distal third radius in PA patients compared to non-PA.
- Evaluate the effect of specific treatments on bone turnover markers and BMD in patients with PA
- Assess the relationship between BMD and bone turnover markers with serum iPTH, calcium, magnesium and vitamin D levels.
Study design
- Observational model
- Case-control
- Time perspective
- Prospective
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Non primary aldosteronism | – | –Non primary aldosteronism patients undergoing usual anti hypertensive treatment |
| Primary Aldosteronism | – | –Patients with confirmed primary aldosteronism undergoing treatment |
Who may qualify
- Ages
- 18 to 100 years
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
- Study population
- This is a prospective study conducted in out-patient clinics of a tertiary care center. The study population consists of patients referred to our centres for endocrine hypertension.
Key inclusion criteria (2 listed)
- Age >18 years old
- Confirmed primary aldosteronism with following criteria i) Aldosterone-renin ratio > 555 SI or 30 (if aldosterone is taken in pmol/L, renin in ng/dL) and ii) Aldosterone post fludrocortisone suppression test > 166pmol/L or >6ng/dL, or iii) Aldosterone post saline suppression test >277pmol/L or >10ng/dL
Key exclusion criteria (5 listed)
- Patients on medication affecting bone metabolism, eg bisphosphonates, hormonal replacement therapy, SERM, testosterone, antiandrogen, anticonvulsants, calcium and Vitamin D
- Primary aldosteronism post treatment (surgically or medically on spironolactone or eplerenone)
- Estimated GFR <30ml/min
- Severe hepatic failure
- Severe heart failure
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Primary outcome
Bone mineral density
Time frame: 3 months
Change of bone mineral density 3 months post treatment for primary aldosteronism
1 secondary outcome
Bone turnover markers
Time frame: 3 months
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 2 Dec 2015.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Primary Aldosteronism, run by University Malaysia Sarawak at 1 site in Malaysia.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 2 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 2 Dec 2015. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Malaysia. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Bone mineral density (time frame: 3 months). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 2 Dec 2015.