Association Between Primary Aldosteronism and Papillary Thyroid Cancer in Hypertensive Patients
Overview
This propensity score–matched case-control study found a significant association between primary aldosteronism (PA) and papillary thyroid cancer (PTC) in patients with hypertension (HT). After matching for hypertension severity, PA prevalence was significantly higher in the PTC group compared to hypertensive controls, and PTC was independently associated with PA diagnosis.
Background
Arterial hypertension is a major cardiovascular risk factor affecting a large adult population worldwide. Primary aldosteronism is the most common endocrine cause of hypertension, characterized by autonomous aldosterone production leading to hypertension and electrolyte imbalances. Early diagnosis of PA is critical for targeted treatment and prevention of cardiovascular complications. Previous studies suggested a higher prevalence of thyroid abnormalities, including papillary thyroid cancer, in patients with PA, but lacked matched control groups to confirm an association.
Data Highlights
Group
PA Prevalence (%)
95% CI
Severe HT Frequency (%)
PTC with HT (n=137)
29.20
21.91-37.68
23
HT Controls (matched by age, sex, BMI; n=137)
20.44
14.22-28.35
73
HT Controls (matched by HT stage)
9.56
5.39-16.1
Not specified
Key Findings
The prevalence of PA was 29.2% in patients with PTC and HT versus 20.4% in HT controls matched by age, sex, and BMI (P = .093).
Severe hypertension (stage III or resistant) was significantly less frequent in the PTC group (23%) compared to HT controls (73%; P < .001).
After matching controls by hypertension stage, PA prevalence was significantly higher in the PTC group compared to controls (P < .0001).
Multivariable analysis showed PTC was independently associated with PA diagnosis in both unmatched (OR 4.74; 95% CI, 2.26-10.55) and HT stage–matched cohorts (OR 5.88; 95% CI, 2.79-13.37), both P < .001.
The study proposes screening for PA in patients with PTC and hypertension regardless of hypertension severity.
Clinical Implications
Clinicians should consider screening for primary aldosteronism in hypertensive patients diagnosed with papillary thyroid cancer, even if hypertension is not severe. Early identification of PA in this population may allow for targeted treatment to improve blood pressure control and reduce cardiovascular risk. This approach may represent a new recommendation for PA screening in hypertensive patients with PTC.
Conclusion
Papillary thyroid cancer is independently associated with an increased prevalence of primary aldosteronism in hypertensive individuals. Screening for PA should be considered in this patient population regardless of hypertension severity to optimize management.
References
Nakamura et al. 2023 -- Investigation of Primary Aldosteronism in Papillary Thyroid Cancer Patients
ClinicalTrials.gov NCT06068101 -- Study on PA and PTC Association
by Ana Alice W Maciel, Debora L S Danilovic, Ibere C Soares, Thais C Freitas, Jessica Okubo, Gustavo F C Fagundes, Felipe Freitas-Castro, Lucas S Santana, Augusto G Guimaraes, Vinicius F Calsavara, Felipe L Ledesma, Luciana A Castroneves, Fernando M A Coelho, Victor Srougi, Fabio Y Tanno, Jose L Chambo, Francisco C Carnevale, João V Silveira, Fernanda M Consolim-Colombo, Luiz A Bortolotto, Luciana P Brito, Maria Candida B V Fragoso, Luciano F Drager, Celso E Gomez-Sanchez, Ana Claudia Latronico, Berenice B Mendonca, Ana O Hoff, Madson Q Almeida
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