Vol 63, No 1 (2012)
Case report
Submitted: 2013-02-15
Published online: 2012-02-29
Parathyroid adenoma with coeliac disease: primary or quaternary hyperparathyroidism?
Inan Anaforoglu, Kerem Ersoy, Ekrem Algun
Endokrynol Pol 2012;63(1):56-58.
Vol 63, No 1 (2012)
Case report
Submitted: 2013-02-15
Published online: 2012-02-29
Abstract
Coeliac disease is a gluten-sensitive enteropathy of varying severity. Osteomalacia and hypocalcaemia can result from malabsorption of
vitamin D and calcium, which, in turn, can lead to secondary hyperparathyroidism. If coeliac disease remains untreated for long, tertiary
hyperparathyroidism can also develop through autonomy of the parathyroid glands via chronic stimulation. Primary hyperparathyroidism also has been reported in some cases of coeliac disease. We report the case of an adolescent with coeliac disease presenting with severe hypercalcaemia from a parathyroid adenoma. A 14 year-old girl was admitted to our department for delayed puberty and growth retardation. Laboratory examination revealed iron deficiency anaemia, low 25OH vitamin D level (7 ng/ml), high parathyroid hormone level (PTH) (955 pg/ml), and hypercalcaemia (13.4 mg/dl). Endoscopic biopsy was compatible with gluten enteropathy. Endomysium antibody was positive. A gluten-free diet was started. Her calcium returned to normal after excision of the parathyroid adenoma. After four months of the gluten-free diet, she began to mature, and puberty began with development of breasts and axillary-pubic hair growth. It has been
suggested that autonomous four-gland hyperplasia or tertiary hyperparathyroidism may progress to adenoma formation, and that this
should be termed “quaternary hyperparathyroidism”. More studies are required to explain the relationship between coeliac disease and hyperparathyroidism.
Abstract
Coeliac disease is a gluten-sensitive enteropathy of varying severity. Osteomalacia and hypocalcaemia can result from malabsorption of
vitamin D and calcium, which, in turn, can lead to secondary hyperparathyroidism. If coeliac disease remains untreated for long, tertiary
hyperparathyroidism can also develop through autonomy of the parathyroid glands via chronic stimulation. Primary hyperparathyroidism also has been reported in some cases of coeliac disease. We report the case of an adolescent with coeliac disease presenting with severe hypercalcaemia from a parathyroid adenoma. A 14 year-old girl was admitted to our department for delayed puberty and growth retardation. Laboratory examination revealed iron deficiency anaemia, low 25OH vitamin D level (7 ng/ml), high parathyroid hormone level (PTH) (955 pg/ml), and hypercalcaemia (13.4 mg/dl). Endoscopic biopsy was compatible with gluten enteropathy. Endomysium antibody was positive. A gluten-free diet was started. Her calcium returned to normal after excision of the parathyroid adenoma. After four months of the gluten-free diet, she began to mature, and puberty began with development of breasts and axillary-pubic hair growth. It has been
suggested that autonomous four-gland hyperplasia or tertiary hyperparathyroidism may progress to adenoma formation, and that this
should be termed “quaternary hyperparathyroidism”. More studies are required to explain the relationship between coeliac disease and hyperparathyroidism.
Keywords
coeliac disease; parathyroid adenoma; gluten intolerance
Title
Parathyroid adenoma with coeliac disease: primary or quaternary hyperparathyroidism?
Journal
Endokrynologia Polska
Issue
Vol 63, No 1 (2012)
Article type
Case report
Pages
56-58
Published online
2012-02-29
Page views
660
Article views/downloads
2026
Bibliographic record
Endokrynol Pol 2012;63(1):56-58.
Keywords
coeliac disease
parathyroid adenoma
gluten intolerance
Authors
Inan Anaforoglu
Kerem Ersoy
Ekrem Algun
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