Endocrine Abstracts

Theassociation of primary hyperparathyroidism with autoimmune diseases is described very rarely in the literature so far. There are only few cases of immune-mediated hyperparathyroidism, associated with anti-calcium- sensing receptor autoantibodies, Recent epidemiological studies have shown that coeliac disease is more common than previously thought, with prevalence approaching 1%.

Observation : A 47-year-old woman was diagnosed as having coeliac disease revealed by weight loss and asthenia Laboratory showed a hypovitaminosis D with elevated PTH level, suggestive at first of secondary hyperparathyroidism. transglutaminase antibodies, Antinuclear antibodies were positive with elevated liver enzymes in favor of autoimmune hepatitis In addition, the patient presented with intermittent low-back pain; a phosphocalcic test was again ordered, showing hypercalcemia at 122 mg/ and osteoporosis on bone densitometry. Cervical ultrasound and mibi scintigraphy revealed a left retro-thyroidal formation in favour of a parathyroid adenoma; the patient was referred for surgery.

Discussion : In patients with primary hyperparathyroidism, there is a higher prevalence of autoimmune disease than in the general population. Primary hyperparathyroidism may present with nonspecific features, many of which are shared with coeliac disease, including fatigue, poor appetite and depression. that may compound the clinical diagnosis. There is a time lag of 1–5 years between diagnoses, because the low-normal vitamin D level was taken to be compensatory secondary hyperparathyroidism. The authors emphasised the need to look for intestinal malabsorption in the case of normocalcaemic hyperparathyroidism. The association of primary hyperparathyroidism with coeliac disease has both diagnostic and therapeutic implications. Hyperplasia of the parathyroid glands is the predominant morphological feature in tertiary hyperparathyroidism which implies that the adenoma in our case arose sporadically rather than as a result of chronic stimulation However, detecting a reduced expression of calcium-sensing receptor protein could also help to confirm the sporadic occurrence of adenoma in association with coeliac disease

Conclusion : Carrying out a screen for coeliac disease in patients with confirmed primary hyperparathyroidism and a control group may strengthen the evidence for an association. Further studies will be required to establish the link.