title: Coeliac disease in subjects with secondary hyperparathyroidism.
abstract: OBJECTIVE
  Coeliac disease (CD) may present in its classical form with diarrhoea and weight loss, but also with atypical symptoms that are both related and unrelated to malabsorption. Osteomalacia or osteopenia following malabsorption of calcium and vitamin D is known to occur in patients with CD, and in such cases secondary hyperparathyroidism (SHP) caused by low serum calcium levels is frequently found. However, the prevalence of CD in subjects with SHP has not been reported.
  
  
  METHODS
  In the Tromsø study 2001, serum parathyroid hormone (PTH) and calcium were measured in 7954 subjects of whom 6061 were eligible for follow-up. From this group, 97 subjects with SHP (serum PTH> or =6.5 pmol/l and serum calcium <2.40 mmol/l) and 104 matched control subjects were re-examined with serological tests for CD (anti-tissue transglutaminase, anti-gluten IgA and IgG).
  
  
  RESULTS
  CD was diagnosed in 4 subjects, all from the original SHP group. At the re-examination, only 29 of the 97 subjects with SHP still had elevated serum PTH levels. Among these were 3 of the subjects with CD. When grouping the serological test results as negative, borderline or positive, there was a significant difference between the SHP group and the controls for anti-tissue transglutaminase and anti-gluten IgA (p<0.05).
  
  
  CONCLUSIONS
  Subjects with SHP, at least when SHP is persistent, should be tested for CD.
authors.affiliation: Medical Department B, University of Tromsø, Tromsø, Norway. rolf.jorde@unn.no
authors.forename: R
authors.initials: R
authors.lastname: Jorde
authors.forename: F
authors.initials: F
authors.lastname: Saleh
authors.forename: J
authors.initials: J
authors.lastname: Sundsfjord
authors.forename: E
authors.initials: E
authors.lastname: Haug
authors.forename: B
authors.initials: B
authors.lastname: Skogen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002118:Calcium / Q000097:blood; D002446:Celiac Disease / Q000150:complications / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D010281:Parathyroid Hormone / Q000097:blood; D015995:Prevalence
chemical_list: D010281:Parathyroid Hormone; D002118:Calcium