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

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.