SAT-753 An Unusual Case of Seizures in a Patient with Concomitant Autoimmune Hypoparathyroidism and Coeliac Disease

Abstract Disclosure: T. Mareedu: None. A. Khan: None. C. Keshwani: None. N.P. Doddareddy: None. P. Shettywarangale: None. R. Singhal: None. V.A. Mendpara: None. S. Younas: None. T. Jain: None. Introduction: Hypoparathyroidism and coeliac disease, though distinct both impact calcium balance and worsens seizure episodes. Coeliac disease is an autoimmune disorder often underdiagnosed and is linked with other conditions like thyroid disease and type 1 diabetes. It involves anti-gliadin and endomysial antibodies and in rare cases, parathyroid tissue antibodies, leading to hypoparathyroidism. This case highlights the complex interaction between these conditions, emphasizing the need for a multidisciplinary approach to diagnosis and treatment.Clinical case: A 30-year-old male presented with a 2-year history of generalized tonic-clonic seizures, intermittent limb spasms, tingling and recent shoulder pain with restricted movement. No history of head injury, alcohol use or fever was noted. He had recurrent diarrhea which later reduced and he was on phenytoin. Examination showed positive Chvostek & Trousseau signs, pallor, BMI of 17.3 kg/m² and stable vitals. CNS exam showed light-insensitive pupils, normal extraocular movements, no focal deficits. Lab findings showed hemoglobin of 11 g/dL (13.8-17.2), MCV of 70 fl (80-100), serum ferritin 25 ng/mL (30-400), TSAT of 14% (20-50%), serum albumin 2.8 g/dL (3.5-5.0), serum creatinine 1.8 mg/dL (0.7-1.3), BUN 68 mg/dL (7-20), serum magnesium 1.3 mg/dL (1.7-2.2), intact PTH 0 pg/mL (15-65), anti-tissue transglutaminase positive. Gastrointestinal biopsy confirmed coeliac disease. Imaging showed posterior dislocation of the right humeral head. His EKG showed ST depression, T wave flattening. He was treated with intravenous calcium gluconate, oral calcium citrate, magnesium, gluten-free diet. His symptoms improved, seizures ceased and biochemical markers normalized over 2 months, though intact PTH remained low.Discussion: The coexistence of hypoparathyroidism and coeliac disease complicates calcium regulation due to malabsorption and autoimmune interactions. Hypoparathyroidism lowers parathyroid hormone, reducing calcium absorption and increasing excretion, while coeliac disease exacerbates hypocalcemia by impairing intestinal absorption. Autoantibodies in coeliac disease may cross-react with parathyroid tissue, further complicating management. Studies reveal a link between epilepsy and coeliac disease, emphasizing the need for screening of coeliac disease in seizure patients. Treatment involves calcium, vitamin D, and a gluten-free diet, highlighting the importance of monitoring adherence and biochemical markers. A Swedish cohort study found a higher epilepsy risk in coeliac patients, reinforcing the necessity of early diagnosis. Theres are positive outcomes with using recombinant human parathyroid hormone to aid chronic cases. This case highlights the importance of considering malabsorptive disorders in hypocalcemia and seizure disorders. Presentation: Saturday, July 12, 2025