Unmasking of normocalcemic primary hyperparathyroidism after sodium-glucose cotransporter-2 inhibitor initiation

Christodoulos Dolapsakis

4th Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
https://orcid.org/0000-0001-9251-7872

Emmanouil Karofylakis

4th Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece

Stamatios Chalvatzis

4th Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece

Keywords

SGLT2 inhibitors, hypercalcemia, hyperparathyroidism

Abstract

Sodium-glucose cotransporter-2 (SGLT2) inhibitors have complex interactions with bone metabolism, including an increase in parathyroid hormone (PTH) levels. Here we report a case of a SGLT2 inhibitor-induced hypercalcemia due to primary hyperparathyroidism. In the subset of patients with normocalcemic primary hyperparathyroidism, SGLT2 inhibitor initiation can unmask the disorder causing overt hypercalcaemic hyperparathyroidism. Although normocalcemic primary hyperparathyroidism is a rare entity, we propose obtaining a baseline PTH level before starting a SGLT2 inhibitor in patients with calcium levels in the upper limit of normal and normal total 25-hydroxyvitamin D levels, especially if they are under vitamin D supplementation. PTH should be rechecked in order to exclude overt primary hyperparathyroidism.

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Published: 2025-01-29
Issue: 2025: Vol 12 No 2 (view)

How to cite:
1.
Dolapsakis C, Karofylakis E, Chalvatzis S. Unmasking of normocalcemic primary hyperparathyroidism after sodium-glucose cotransporter-2 inhibitor initiation. EJCRIM [Internet]. 2025 Jan. 29 [cited 2025 May 7];12(2). Available from: https://www.ejcrim.com/index.php/EJCRIM/article/view/5169

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