Acute pancreatitis with hypercalcemia caused by primary hyperparathyroidism associated with paraneoplastic syndrome: A case report and review of literature

Abstract

BACKGROUND Although acute pancreatitis associated with hyperparathyroidism has occasionally been reported, acute pancreatitis with metabolic encephalopathy caused by hyperparathyroidism combined with paraneoplastic syndrome is an extremely rare entity and poorly described in the literature. CASE SUMMARY We present a case of a 56-year-old female with upper abdominal discomfort and intermittent nausea and vomiting for 1 wk, without apparent abdominal pain or bloating, no jaundice and decreased blood pressure at the outset. The patient was ultimately diagnosed with moderately severe acute pancreatitis (according to the revised Atlanta classification of acute pancreatitis) combined with metabolic encephalopathy secondary to hypercalcemia caused by primary hyperparathyroidism associated with paraneoplastic syndrome. After active treatment of acute pancreatitis, massive fluid resuscitation, resection of parathyroid and uterine malignant tumors, neoadjuvant chemotherapy and other treatments, her serum calcium eventually returned to the normal level. The patient was successfully discharged from hospital. CONCLUSION This is the first case of acute pancreatitis caused by primary hyperparathyroidism associated with paraneoplastic syndrome.

Hypercalcemia in Cancer: Causes, Effects, and Treatment Strategies

“…Elevated levels of calcium inhibit neuromuscular depolarization, contributing to decreased smooth muscle tone and consequent autonomic dysfunction. Pancreatitis ensues through the abnormal accumulation of intracellular calcium ions, leading to the excessive activation of trypsinogen and resulting in pancreatic autodigestive injury [ 29 , 30 ].…”

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

“…Neither of these two entities stand for a frequent cause of pancreatitis in the general population, hypercalcemia accounting for less than 1% of all cases (some reports showed a rate between 1.5% and 8%) [20]. O note, in 2021, an exceptional case of pancreatitis synchronously presenting both mecha nisms of hypercalcemia (PTH-dependent and -independent) was reported [21]. The topics of stratified research with respect to pancreas involvement (red) in subjects confirmed with primary hyperparathyroidism (red) according to our methods.…”

“…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 ).…”

Hypercalcemic Pancreatitis: A Rare Type of Acute Pancreatitis Caused by a Parathyroid Adenoma

“…. PHPT is most commonly caused by a solitary parathyroid adenoma (85%-90%) [7,8] . Other less common causes include: Hyperplasia of the four parathyroids, parathyroid carcinoma, and multiple endocrine neoplasia type 1 and 2A [9,10] .…”