Acute Pancreatitis as the Index Manifestation of Parathyroid Adenoma

Abstract

Acute pancreatitis is one of the most common clinical emergencies encountered in our day-to-day practice. Although gallstones are the most common cause worldwide, alcohol consumption remains the leading cause of acute pancreatitis in the Indian population. We report a rare case of parathyroid adenoma, which presented with acute pancreatitis as its initial manifestation in an elderly patient. A 65-year-old gentleman with acute abdominal pain, distension, and obstipation, underwent emergency laparotomy in view of acute intestinal obstruction and was found to have acute pancreatitis intra-operatively. On post-operative evaluation, his serum calcium was >14 mg/dl and serum parathormone (PTH) was >2,000 pg/ml. Single-photon emission computed tomography (SPECT) and technetium (Tc-99m) sestamibi scintigraphy revealed a right inferior parathyroid adenoma, which was surgically excised, following which the patient made an uneventful recovery. Hypercalcemia induced by hyperparathyroidism causes auto-activation of pancreatic enzymes within the pancreatic parenchyma and is also believed to cause pancreatic duct obstruction by calcium deposition, thus causing pancreatitis. Radionucleotide scan, in addition to contrast-enhanced computed tomography, can help in localizing the lesion causing hyperparathyroidism. Appropriate resuscitation and stabilization with anti-hypercalcemic measures, including hydration and forced calciuresis, followed by surgery form the mainstay of treatment in patients with primary hyperparathyroidism. Patients with acute pancreatitis without a history of gallstone disease or alcohol intake should be evaluated for other rare causes. Early diagnosis and prompt treatment of the underlying condition can prevent the recurrence of pancreatitis.

Giant parathyroid adenoma causing severe hypercalcemia; a case report from Duhok

“…Cases classically present with features of (PHPT); recurrent renal stones, and psychiatric, skeletal, and gastrointestinal features, yet can be diagnosed early in the absence of symptoms 8 . Additionally, cases could present with life-threatening emergency forms, such as acute pancreatitis and hypercalcemic crisis 4 – 13 . A giant parathyroid adenoma indicates an adenoma with weight greater than 3.5 g, and a diameter greater than 2 cm 9 .…”

“…Once patients are diagnosed with renal stones, serum calcium is one of the necessary assessments that should be investigated 3 . Hypercalcemia, an elevation of greater than 2 standard deviations in the serum calcium concentration 4 , is one of the causes and risk factors for nephrolithiasis, and levels greater than 13.9 mg/dl are regarded as hypercalcemic crises 3 , 4 . Additionally, calcium levels are regulated via parathyroid hormone (PTH) and calcitonin 4 , 5 .…”

Turning Points in Cross-Disciplinary Perspective of Primary Hyperparathyroidism and Pancreas Involvements: Hypercalcemia-Induced Pancreatitis, MEN1 Gene-Related Tumors, and Insulin Resistance

“…Summarizing, in addition to the five previously mentioned cases of pregnancy primary hyperparathyroidism [37][38][39]41,42] and three reports of a parathyroid carcinoma [47][48][49], another seventeen articles introduced one patient per case study, except for two papers with two subjects (a total of nineteen individuals). Four children (aged between 9 and 14 years; an average age of 12; female-to-male ratio of three to one) and fifteen adults (aged between 31 and 81 years; mean age of 51.6 years; female-to-male ratio of two to one) were reported within the last five years in the field of hypercalcemia-derivate pancreatitis in patients with parathyroid NETs (N = 27 individuals) [18,21,22,25,34,35,[53][54][55][56][57][58][59][60][61][62][63] (Table 4). From a cross-disciplinary perspective, the synchronous identification of pancreatitis and primary hyperparathyroidism requires the dual management of pancreatic involvement and hypercalcemia in the sense of rapid calcium lowering, and, when clinically stable, a definite cure of primary hyperparathyroidism should be provided by parathyroidectomy.…”

“…Summarizing, in addition to the five previously mentioned cases of pregnancy primary hyperparathyroidism [ 37 , 38 , 39 , 41 , 42 ] and three reports of a parathyroid carcinoma [ 47 , 48 , 49 ], another seventeen articles introduced one patient per case study, except for two papers with two subjects (a total of nineteen individuals). Four children (aged between 9 and 14 years; an average age of 12; female-to-male ratio of three to one) and fifteen adults (aged between 31 and 81 years; mean age of 51.6 years; female-to-male ratio of two to one) were reported within the last five years in the field of hypercalcemia-derivate pancreatitis in patients with parathyroid NETs (N = 27 individuals) [ 18 , 21 , 22 , 25 , 34 , 35 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 ] ( Table 4 ).…”

“…Reported data (case studies) on pancreatitis in patients with PTH-related hypercalcemia during the diagnosis of primary hyperparathyroidism according to our research (the table starts with the most recent publication date)[18,21,22,25,34,35,[53][54][55][56][57][58][59][60][61][62][63].…”