were normal (potassium, creatinine, glycemia, total cholesterol, triglycerides, type I urine, and electrocardiography) at that time. In 1999, the patient was using hydrochlorothiazide and methyldopa, but, as blood pressure control deteriorated, the prescription was changed to indapamide (2.5 mg/day), perindopril (4 mg/day), and nadolol (80 mg/day). However, no satisfactory blood pressure control was achieved, and the patient began to complain of intense weakness characterized by the incapacity to perform her normal activities, such as sweeping the floor, washing the clothes, and even answering the phone. The patient reported the following personal antecedents: arterial hypertension for 31 years, gastritis for 8 years, and hypertriglyceridemia for 4 years. The patient denied having diabetes mellitus, Chagas' disease, stroke, acute myocardial infarction, or any other disease. In regard to familial antecedents, the patient reported 4 hypertensive paternal uncles, 2 with deep venous thrombosis, 1 with myocardial infarction, and another with stroke. Her mother was hypertensive. On physical examination, the patient was in regular general condition, eupneic, afebrile, acyanotic, hydrated, and with healthy coloring. Her pulse was 76 bpm; her BP in the sitting position (right upper limb) was 170/110 mmHg; her BP in the supine position (right upper limb) was 190/120 mmHg; her BP in the supine position (left upper limb) was 180/120 mmHg; and her BP in the standing position (right upper limb) was 170/110 mmHg. On auscultation, her lungs were clear with no rales. Her heart auscultation showed regular cardiac rhythm with cardiac sounds of normal intensity and no murmurs. Her heart rate was 76 bpm. Her abdomen showed hydro-aerial noise, no visceromegaly, and no abdominal murmur. Her lower limbs showed symmetric palpable pulses and no edema. Differently from the normal results of the various measurements of serum potassium in 1999, potassium levels were extremely altered (K + = 1.5 mEq/L; normal = 3.5-5.3), and the patient was using indapamide, perindopril, and nadolol. All other routine laboratory tests were within the normal range (glycemia, creatinine, total cholesterol, and urinary sediment). Chest X-rays showed a normal cardiac area with no alterations in the pulmonary parenchyma. The electrocardiogram showed sinus rhythm and an alteration in ventricular repolarization of the anterolateral wall. The echocardiogram showed left ventricular hypertrophy (IVS = 13; LVPW = 13; LV mass = 292.8 g; LV mass index = 160.9 g/m 2). The laboratory finding of important hypokalemia drew attention to the following 2 situations: hypokalemia secondary to the use of

Introdução: A pancreatite aguda (PA) é uma condição inflamatória comum nos centros médicos com uma incidência anual mundial de 4,9 - 73,4 casos por 100.000 habitantes e tem como principais causas o cálculo biliar (40-70%) e o etilismo (25-35%) seguidas de outras condições incomuns, entre elas a hipertrigliceridemia e a hipercalcemia. A PA devido a hipercalcemia, embora rara, pode representar dificuldade diagnóstica e, em muitos casos, ser diagnosticada tardiamente. Objetivo: Relatar um caso raro de pancreatite aguda causada por hipercalcemia. Relato de Caso: Paciente internado quatro vezes em três anos com queixa de dor abdominal. No momento inicial foi feito o diagnóstico de pancreatite alcoólica reforçado pelo histórico pessoal de etilismo crônico. Na última internação do paciente foram investigados os níveis séricos de cálcio total e paratormônio (PTH), com valores respectivos de 12,2 mmol/L e 178,8 pg/mL, sugerindo possível hiperparatireoidismo primário (HPP). Confirmou-se a hipótese com a cintilografia de paratireoide e o paciente foi submetido à paratireoidectomia esquerda e tireoidectomia parcial homolateral, apresentando melhora dos níveis séricos de PTH no pós-operatório, assim como do seu quadro de PA. Conclusão: A dosagem de cálcio sérico em pacientes com quadro de PA pode ser benéfica para o diagnóstico, instituiçãoprecoce de tratamento e controle de recidivas em pacientes com HPP.