Z Gastroenterol 2005; 43 - 1
DOI: 10.1055/s-2005-869648

Secondary hyperparathyroidism and severe maldigestion induced by long-term breast-feeding (a case report)

B Aladics 1, O Szokolóczi 1, E Schafer 1, A Sáfrány 2, I Szántó 2, A Ujvári 3, Á Pap 1, R Schwab 1
  • 1Cooperative Research Center, Semmelweis University, Budapest, Hungary
  • 2Departments of Medicine & Gastroenterology, Kelen Hospital, Budapest, Hungary
  • 3St. Istvan Hospital, Budapest, Hungary

Background: Chronic diarrhoea in otherwise asymptomatic young adults can be a challenging clinical problem.

Our Patient: A 34-year-old female patient was referred to our unit because of chronic diarrhoea. Her symptoms had been worsening since 6 months. She had experienced massive pale, bulky stools (3–4/day) and lost approx. 7kg of her body weight. She had no history of smoking and drinking or previous medical or surgical care. She was not taking regular medications. No allergies were known. She gave birth to 2 healthy babies during the past 3 years. Detailed questioning revealed that she was breast-feeding the babies apart from the last 4 weeks of her 2nd pregnancy. In parallel to worsening of her diarrhoea she experienced recurrent attacks of severe epigastrial pain lasting from minutes to hours. Between attacks she was absolutely asymptomatic and well off. All routine laboratory tests and ultrasound examinations performed at that time were negative. She had good appetite and was loosing weight despite eating fair amounts of food regularly.

On examination she was severely malnourished with a BMI=16kg/m2. Routine laboratory tests showed decreased se. total protein, lymphocyte count and severely abnormal starch provocation test (ATT=1300%). However, MRCP did not show any morphological abnormality of the pancreas. Tests of bone metabolism showed decreased serum calcium, but elevated parathormone, ALP, beta-crosslaps, osteocalcin levels.

Discussion: Consequences of long term breast feeding may severely be underestimated. Malnourishment due to long term breast-feeding in this case has lead secondary pancreatic insufficiency. These have severely deteriorated digestive absorptive functions and in turn have worsened the overall nutritional status further on. The patient has also developed massive secondary osteoporosis.

Stopping breast feeding in addition to empirical high dose pancreatin substitution has stopped diarrhoea. Thorough follow up will show any possible long term medical consequences or other underlying diseases.