SUN-185 - The Prevalence of Hyperparathyroidism in Pediatric Patients with Celiac Disease and Calcium Abnormalities

Background:
Patients with primary hyperparathyroidism (HPT), and those with tertiary HPT, often present with elevated calcium. Patients with secondary HPT, including those with Celiac Disease (CD), may present with low or normal calcium. The timeline of progression from secondary to tertiary HPT in patients with CD is unclear and further investigation is needed to determine whether pediatric patients with CD present with significant calcium abnormalities. This study seeks to characterize the prevalence of calcium disturbances and HPT in pediatric patients with CD.

Methods:
A retrospective review of patients aged ≤ 23 years diagnosed with CD between 1/1/09-7/26/24 at one institution was completed. Patients were identified by CD diagnosis (ICD-10 K90) and data was extracted from electronic health records. Patients were included if they had at least one comprehensive metabolic panel (CMP) available. Outcomes included prevalence of diagnoses related to hypercalcemia (ICD-10 e83.52), hypocalcemia (ICD-10 e83.51), related to HPT (ICD-10 e21) and other comorbidities.

Results:
There were 1,633 patients diagnosed with CD (median age 15, IQR [12, 18], 22% male) of which 615 (38%) had CMPs available, including 448 (27%) with CMPs within the past five years. The median age of CD diagnosis was 6.5 [3, 9.3] years. Among patients that had CMPs available, there were five patients (1%) diagnosed with hypercalcemia and four patients ( < 1%) diagnosed with hypocalcemia. In those with calcium abnormalities, 6/9 (66.7%) were evaluated for PTH abnormalities and two patients were found to have HPT. Of the five patients with hypercalcemia, three had PTH levels assessed, and none were diagnosed with HPT; however, two had vitamin D deficiency , and one had familial benign hypercalcemia. The median difference in years from diagnosis with CD to hypercalcemia was 3 [2, 7.5] years. Of the four patients with hypocalcemia, three had PTH levels assessed. Two patients had both HPT and vitamin D deficiency, and one of these patients had ESRD. The median difference in years from diagnosis with CD to hypocalcemia was 12 [11.5, 13.5] years.

Conclusion:
In this cohort of pediatric patients with CD, diagnoses of calcium disturbances were rare. In two patients with hypocalcemia, SHPT was revealed; however, no patients had concomitant hypercalcemia and HPT suggestive of tertiary HPT. Future studies will aim to further characterize time from diagnosis with CD to HPT to better inform screening protocols.

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