{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T09:02:14Z","timestamp":1790758934796,"version":"4.1.0"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":33,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Acromegaly is frequently associated with disturbances in calcium\u2013phosphate 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)\u2013related 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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 &amp;gt;2.60 mmol\/L and phosphate &amp;lt;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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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\u2013related mineral disturbances.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ejendo\/lvag169","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T18:26:15Z","timestamp":1789755975000},"page":"508-517","source":"Crossref","is-referenced-by-count":0,"title":["Distinguishing hyperparathyroidism from insulin-like growth factor I\u2013driven calcium\u2013phosphate metabolism changes in acromegaly"],"prefix":"10.1093","volume":"195","author":[{"given":"C\u00e9cilia","family":"Laure","sequence":"first","affiliation":[{"name":"Assistance Publique-H\u00f4pitaux de Paris, H\u00f4pital Bic\u00eatre, Service d\u2019Endocrinologie et des Maladies de la Reproduction, Centre de R\u00e9f\u00e9rence des Maladies Rares du M\u00e9tabolisme du Calcium et du Phosphate, Centre de R\u00e9f\u00e9rence des Maladies Rares de l\u2019Hypophyse , Le Kremlin-Bic\u00eatre 94275 ,","place":["France"]},{"name":"Service Endocrinologie-Diab\u00e9tologie, Centre Hospitalier Universitaire , Montpellier 34295 ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrien","family":"Lecoeuvre","sequence":"additional","affiliation":[{"name":"Assistance Publique-H\u00f4pitaux de Paris, H\u00f4pital Bic\u00eatre, Unit\u00e9 de Recherche Clinique Paris Saclay , Le Kremlin-Bic\u00eatre 94275 ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benoit","family":"Cochet","sequence":"additional","affiliation":[{"name":"Assistance Publique-H\u00f4pitaux de Paris, H\u00f4pital Bic\u00eatre, Unit\u00e9 de Recherche Clinique Paris Saclay , Le Kremlin-Bic\u00eatre 94275 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