Acute pancreatitis associated with primary hyperparathyroidism

Abstract

Coexistence of primary hyperparathyroidism and acute pancreatitis has widely been reported in literature, but a causal relationship remains controversial. A case of acute pancreatitis as a first symptom of primary hyperparathyroidism with severe hypercalcemia is reported. In this patient a reduction of serum calcium level was obtained with medical therapy and resulted in the resolution of acute pancreatitis symptoms within 10 days. At the same time a parathyroid adenoma was clinically identified and elective parathyroidectomy was performed with complete normalization of intact parathyroid hormone and serum calcium level. At three-year follow-up, no recurrence or complications of pancreatitis were documented. The presented case suggests a cause and effect relationship between acute pancreatitis and severe hypercalcemia which should be kept in mind in the differential diagnosis of non-biliary, non-alcoholic acute pancreatitis. Reduction of hypercalcemia with medical treatment can represent a good chance for elective surgical neck exploration.

Acute pancreatitis as an initial manifestation of parathyroid carcinoma

“…Association between PHPT and acute pancreatitis was first reported by Erdheim in 1903. [ 6 ] The etiologic relationship between them was then indicated. [ 7 ] The prevalence of acute pancreatitis in patients with PHPT is reported to be 1.5%.…”

A case of severe acute necrotizing pancreatitis in a 38-year-old woman postpartum due to a parathyroid adenoma

“…If there are signs of pancreatitis an MRI is required for clarification. Additionally in case of elevated serum calcium a measurement of the parathormone level and an MRI of the neck and mediastinum are indispensable [ 1 ], [ 2 ], [ 11 ], [ 15 ], [ 17 ]. Increased calcium level in combination with pancreatitis is suspicious of hyperparathyroidism as in most cases calcium level decreases in case of pancreatitis [ 11 ], [ 14 ].…”

Sarcoidosis presenting as acute pancreatitis

“…Various disorders predisposing to hypercalcemia have been reported as a cause of acute pancreatitis including malignancy, parathyroid disorders, and Vitamin D supplementation, intravenous calcium administration and certain drugs like thiazides. [9][10][11][12] Of these parathyroid disorders are amongst the commonest implicated in both the genesis of acute and chronic pancreatitis. [12,13] The mechanism of hypercalcemia related pancreatitis is not clear but may involve a secretory block, protease activation and intracellular accumulation of zymogens resulting in pancreatic injury.…”