Endocrine Abstracts

A female born in 1950, with history of Coeliac Disease since 1985, hypolactasia, pernicious anaemia, osteoporosis, asthma, lymphocytic colitis and non-alcoholic fatty liver disease with portal hypertension was referred to the Endocrinology team in June 2021 as the calcium was noted to be high. She had strongly positive anti endomyseal antibody, high Tissue Transglutaminase tire and duodenal biopsy proved villous atrophy with no evidence of Enteropathy associated T cell Lymphoma. She was on a strict gluten free diet but despite that she had weight loss, multiple nutritional deficiencies which includes iron, B12, folate, vitamin D deficiency. She was on replacement for all the above. She was noted to have hypocalcaemia in 1999 and 2000 but hypercalcemia since 2006. There was no family history of increased calcium. She had hypercalcemia of 2.65 mmol/l (2.20-2.60), raised PTH of > 46.5 pmol/l (1.6-6.9), low Vitamin D <9 nmol/l (50-120) and low phosphate 0.36 mmol/l (0.8 -1.50) The patient was thought to have either primary hyperparathyroidism (in which case familial hypocalciuric hypercalcemia (FHH) had to be ruled out) or secondary hyperparathyroidism due to Vitamin D deficiency. She was started on Vitamin D supplements and her calcium supplements were discontinued. She has persistently raised Calcium of 2.79 mmol/l (2.20-2.60) and PTH of 14.5 from 46.5 pmol/l(1.6-6.9) in spite of improving Vitamin D levels. Her urinary Calcium and creatinine clearance ratio was 0.007 which is more in keeping with hypocalciuric hypercalcemia. She is awaiting genetic testing to confirm Familial Hypocalciuric hypercalcemia. Coeliac disease is usually associated with hypocalcemia and the elevated parathyroid levels if any would be considered as secondary hyperparathyroidism. There are only few case reports of hypercalcemia due to primary hyperparathyroidism in patients with coeliac disease.