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208 CELIAC DISEASE CAUSING HYPOCALCEMIA WITHOUT IRON DEFICIENCY: CASE REPORT & RETROSPECTIVE CHART REVIEW N Chandok, J Radhi, L Liu BACKGROUND AND CASE: Our case describes a 67 year old female with osteoporosis. During her workup for osteoporosis, it was determined that she had hypocalcemia, low vitamin D and secondary hyperparathyroidism. After several months of calcium and vitamin D supplementation, she continued to have hypocalcemia. She was subsequently screened for celiac disease and found to have positive serology and her duodenal biopsy showed severe disease. After adopting a gluten free diet, her calcium, vitamin D, parathyroid hormone and duodenal biopsy normalized. This case illustrates an atypical presentation of celiac disease.
McMaster University, Hamilton, Ontario
OBJECTIVE: We sought to estimate the prevalence of celiac disease presenting as hypocalcemia without iron deficiency among adult patients at a Canadian teaching hospital and to determine how often serum calcium is measured in adults with newly diagnosed celiac disease.
METHODS: All patients over the age of 18 who received a biopsy-proven diagnosis of celiac disease from January 2000 to September 2006 at McMaster Medical Centre were reviewed. Using computerized health records, information on patient age, sex, duodenal biopsy, celiac antibody serology, symptoms at diagnosis, calcium, ferritin, hemoglobin and albumin were recorded.
RESULTS: 43 men and 103 women were diagnosed with celiac disease. The mean age at diagnosis was 49.1 years (range 18 to 80). Ninety-one patients had ferritin measured, and 73 patients had their serum calcium checked, around the time of diagnosis. Of the 73 patients, 30 had low ferritin, 31 had normal ferritin and ferritin was not measured in 12. 4 of the 73 patients (4.1%) had hypocalcemia based on corrected calcium levels; 3 of these 4 patients (75%) had normal ferritin. In other words, 3 of the 31 patients (9.7%) were found to have a normal ferritin and hypocalcemia.
CONCLUSION: Among patients with newly diagnosed celiac disease, only half had their serum calcium measured. This may underscore a widespread under-recognition of hypocalcemia as a manifestation of celiac disease. Our data illustrated that 10% of these patients can present with hypocalcemia even with normal ferritin. Serum calcium should be routinely checked in adults with newly diagnosed celiac disease, and in patients with hypocalcemia even with normal ferritin, screening for celiac disease should be considered to potentially prevent disorders like osteoporosis.