Frequency of evaluation of celiac disease in patients with presumed primary hyperparathyroidism and impact on clinical outcomes

IF 3.2 2区医学 Q1 SURGERY

Surgery Pub Date : 2025-06-11 DOI:10.1016/j.surg.2025.109488

Alexa B. Lisevick MD , Sophie Dream MD, MPH , Tina W.F. Yen MD, MS , Kara Doffek BS , Tahseen Shaik BS , Joseph Shaker MD , Douglas B. Evans MD , Tracy S. Wang MD, MPH

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Abstract

Background

Patients with primary hyperparathyroidism and secondary hyperparathyroidism due to celiac disease may both present with high parathyroid hormone and normal calcium levels, but their management differs. This study aimed to assess the frequency of celiac disease evaluation among patients with presumed primary hyperparathyroidism and characterize the impact of preoperative evaluation among patients undergoing parathyroidectomy.

Methods

A single-institution cross-sectional study of adult patients evaluated for initial parathyroidectomy for presumed sporadic primary hyperparathyroidism from January 1, 2010, to July 1, 2024, was completed. All patients were assessed for preoperative celiac disease antibody testing. Among those who underwent parathyroidectomy, preoperative biochemical profiles, prevalence of multigland disease, and persistent disease were compared by celiac disease evaluation status.

Results

Of 2,415 patients (80% female, median age 64 years [55, 70]), 266 (11%) were evaluated for celiac disease, of whom 15 (6%) had positive celiac disease antibodies. Two of 15 patients were confirmed to have celiac disease, in whom primary hyperparathyroidism was recognized after celiac disease treatment. Patients evaluated for celiac disease were more likely female (88% vs 78%, P < .005) and older (median age 65 years [55, 73] vs 63 years [55, 70], P = .04), less frequently presented with high serum calcium (97% vs 99%, P < .005), had higher prevalence of multigland disease (38% vs 30%, P = .01), and similar prevalence of postoperative persistent disease (3% vs 2%, P = .38) compared with those not evaluated. Overall, 2,137 (89%) underwent parathyroidectomy. Patients managed nonoperatively were more frequently evaluated for celiac disease (10% vs 18%, P < .005).

Conclusions

Celiac disease is infrequently diagnosed in patients with presumed primary hyperparathyroidism. Celiac disease diagnosis and treatment may facilitate recognition of primary hyperparathyroidism and should be considered in patients presenting with normocalcemia and high parathyroid hormone.

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原发性甲状旁腺功能亢进患者乳糜泻的评估频率及其对临床结果的影响

背景：乳糜泻引起的原发性甲状旁腺功能亢进和继发性甲状旁腺功能亢进患者可能都表现为甲状旁腺激素升高和钙水平正常，但处理方法不同。本研究旨在评估原发性甲状旁腺功能亢进患者乳糜泻评估的频率，并描述术前评估对甲状旁腺切除术患者的影响。方法对2010年1月1日至2024年7月1日期间因推测为散发性原发性甲状旁腺功能亢进而接受初始甲状旁腺切除术的成年患者进行单机构横断面研究。所有患者术前均进行乳糜泻抗体检测。在接受甲状旁腺切除术的患者中，通过乳糜泻评估状态比较术前生化特征、多腺体疾病患病率和持续性疾病。结果在2415例患者中（80%为女性，中位年龄64岁[55,70]），266例（11%）被评估为乳糜泻，其中15例（6%）乳糜泻抗体阳性。15例患者中有2例确诊为乳糜泻，其中2例患者在接受乳糜泻治疗后被确认为原发性甲状旁腺功能亢进。被评估为乳糜泻的患者更有可能是女性(88% vs 78%, P <；.005)和老年人（中位年龄65岁[55,73]对63岁[55,70],P = .04），出现高血钙的频率较低(97%对99%，P <；.005)，多腺体疾病的患病率较高（38%对30%，P = 0.01），术后持续性疾病的患病率相似（3%对2%，P = .38）。总的来说，2137例（89%）接受了甲状旁腺切除术。非手术治疗的患者更常被评估为乳糜泻(10% vs 18%, P <；.005)。结论原发性甲状旁腺功能亢进患者中腹腔疾病的诊断率较低。乳糜泻的诊断和治疗可能有助于识别原发性甲状旁腺功能亢进，在出现正常钙血症和甲状旁腺激素高的患者中应予以考虑。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Surgery 医学-外科

CiteScore

5.40

自引率

5.30%

发文量

687

审稿时长

64 days

期刊介绍： For 66 years, Surgery has published practical, authoritative information about procedures, clinical advances, and major trends shaping general surgery. Each issue features original scientific contributions and clinical reports. Peer-reviewed articles cover topics in oncology, trauma, gastrointestinal, vascular, and transplantation surgery. The journal also publishes papers from the meetings of its sponsoring societies, the Society of University Surgeons, the Central Surgical Association, and the American Association of Endocrine Surgeons.