Distinguishing hyperparathyroidism from insulin-like growth factor I–driven calcium–phosphate metabolism changes in acromegaly
Authors' conclusion
PHPT may be more frequent in acromegaly than in the general population. In patients with acromegaly and hypercalcemia, a nonelevated phosphate level strongly suggests concomitant PHPT, whereas an elevated phosphate level favors IGF-I-related mineral disturbances.
Study context
- Population
- Adults with acromegaly with ≥1 serum calcium measurement during uncontrolled disease; 54% women, median age 43 years (IQR 33–55)
- Participants
- 393 adults
- Exposure
- Acromegaly with concomitant primary hyperparathyroidism (PHPT) vs isolated acromegaly; threshold rule, logistic regression and support vector machine for identifying parathyroid autonomy
- PHPTn = 23
- Outcome
- Prevalence and characteristics of PHPT in acromegaly
Methodological details2 French university hospitals
- 2 French university hospitals
Main finding
As reported in the abstract
Prevalence of concomitant PHPT
PHPT
5.9%
23
Observational data: associations, not effects.
Further findings
- Serum calcium in PHPT
- 2.72 · median · IQR 2.66–2.86 · mmol/L
- Serum calcium in PHPT — Persistent mild hypercalcemia, elevated PTH and low-to-normal phosphate, resolved after parathyroid surgery
- 10 operated patients
- Diagnostic performance of threshold rule (calcium >2.60 mmol/L and phosphate <1.46 mmol/L) for parathyroid autonomy: Threshold-based rule sensitivity 0.940 · specificity 0.993
- Diagnostic performance of threshold rule (calcium >2.60 mmol/L and phosphate <1.46 mmol/L) for parathyroid autonomy: bootstrap 0.632+ corrected
Calcium-phosphate disturbances in isolated acromegaly
- Hyperphosphatemia
- 37.3%
- Mild hypercalcemia
- 3.2%
- Both resolved after acromegaly treatment
Serum calcium in PHPT
- No pathogenic variants identified in the tested genes
Diagnostic performance of threshold rule (calcium >2.60 mmol/L and phosphate <1.46 mmol/L) for parathyroid autonomy
- Preferred because of its simplicity
Original publication
Distinguishing hyperparathyroidism from insulin-like growth factor I–driven calcium–phosphate metabolism changes in acromegaly. Eur J Endocrinol. Published 22 September 2026. doi:10.
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