{
  "abstract": "OBJECTIVES: Acromegaly is frequently associated with disturbances in calcium-phosphate metabolism, including mild hypercalcemia. Hypercalcemia may also reflect primary hyperparathyroidism (PHPT), which can occur with or without variants in MEN1 or the related genes. Distinguishing PHPT from insulin-like growth factor I (IGF-I)-related alterations in mineral metabolism remains challenging. We aimed to assess the prevalence and characteristics of PHPT in patients with acromegaly and explore biochemical approaches for identifying parathyroid autonomy. DESIGN: We conducted a retrospective study at 2 French university hospitals, including adults with acromegaly who had at least 1 serum calcium measurement obtained during uncontrolled disease. Three diagnostic approaches based on serum calcium and phosphate levels were evaluated: a threshold-based decision rule, logistic regression, and a support vector machine model. RESULTS: Among 393 patients (54% women; median age 43 years [interquatile range 33-55]), 23 (5.9%) had concomitant PHPT. In isolated acromegaly, hyperphosphatemia occurred in 37.3% and mild hypercalcemia in 3.2% of patients; both resolved after acromegaly treatment. Patients with PHPT had persistent mild hypercalcemia (median calcium 2.72 mmol/L [interquatile range 2.66-2.86]), elevated PTH, and low-to-normal phosphate levels, these abnormalities resolved after parathyroid surgery in the 10 operated patients. No pathogenic variants were identified in the tested genes. A threshold-based rule combining calcium >2.60 mmol/L and phosphate <1.46 mmol/L showed excellent diagnostic performance for identifying parathyroid autonomy, with bootstrap 0.632+ corrected sensitivity and specificity of 0.940 and 0.993, respectively, and was preferred because of its simplicity. CONCLUSIONS: 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.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": null,
  "arxiv": null,
  "author_total": 16,
  "authors": [
    {
      "name": "Cécilia Laure"
    },
    {
      "name": "Adrien Lecoeuvre"
    },
    {
      "name": "Benoit Cochet"
    },
    {
      "name": "Marie Verdoux"
    },
    {
      "name": "Maureen Lopez"
    },
    {
      "name": "Margot Dupeux"
    },
    {
      "name": "Anne-Lise Lecoq"
    },
    {
      "name": "Sylvie Salenave"
    },
    {
      "name": "Luigi Maione"
    },
    {
      "name": "Fanny Chasseloup"
    },
    {
      "name": "Pauline Romanet"
    },
    {
      "name": "Séverine Trabado"
    },
    {
      "name": "Jacques Young"
    },
    {
      "name": "Isabelle Raingeard"
    },
    {
      "name": "Philippe Chanson"
    },
    {
      "name": "Peter Kamenický"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/4hzfvjhtcq6ew.bib",
  "cited_by": 0,
  "doi": "10.1093/ejendo/lvag169",
  "fulltext_url": null,
  "id": "4hzfvjhtcq6ew",
  "issns": [
    "0804-4643",
    "1479-683X"
  ],
  "landing_url": "https://hal.science/hal-05768444v1",
  "language": "en",
  "licence": "CC-BY-NC",
  "licence_label": "CC BY-NC",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "hal",
      "0.sdv"
    ],
    [
      "hal",
      "1.sdv.mhep"
    ],
    [
      "hal",
      "2.sdv.mhep.em"
    ],
    [
      "openalex",
      "2712|Pituitary Gland Disorders and Treatments"
    ]
  ],
  "openalex": "W7214061954",
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-28",
  "publisher": "Oxford Univ. Press",
  "ris": "https://research.draconitic.com/paper/4hzfvjhtcq6ew.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:42Z",
      "native_id": "hal-05768444",
      "source": "hal",
      "url": "https://hal.science/hal-05768444v1"
    }
  ],
  "subjects": [
    {
      "field": "biology",
      "origin": "hal:0.sdv",
      "subfield": "general"
    },
    {
      "field": "medicine",
      "origin": "hal:2.sdv.mhep.em",
      "subfield": "endocrinology-metabolism"
    }
  ],
  "title": "Distinguishing hyperparathyroidism from insulin-like growth factor I–driven calcium–phosphate metabolism changes in acromegaly",
  "title_text": "Distinguishing hyperparathyroidism from insulin-like growth factor I–driven calcium–phosphate metabolism changes in acromegaly",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:17:42Z",
  "url": "https://research.draconitic.com/paper/4hzfvjhtcq6ew",
  "venue": "European Journal of Endocrinology",
  "versions": []
}